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Everything you need to know about bariatric surgery
Excessive weight gain is considered a disease by medical professionals, and it was officially recognized as such by the Medical Association in 2018. Today, we know that obesity is not just about gaining weight; it is defined as a chronic inflammatory disease, with all the implications that come with it.
Almost a quarter of Israel's population suffers from obesity, and over 4,000 people die from its complications each year. The known complications of obesity are related to heart problems, blood supply issues, and brain function. Additionally, individuals with excessive weight are at risk of various metabolic disorders, including diabetes, fertility problems, cancer, fatty liver disease, and more, as well as symptoms directly resulting from obesity itself (such as sleep apnea). Various studies also highlight the significant mental impact of obesity: individuals with excess weight are at a heightened risk of experiencing depression and anxiety, stemming both from the disease itself and the associated stigma.
One of the major challenges in weight management is that our body weight is influenced by numerous factors, and a patient's willpower to maintain a healthy weight is only a small part of the larger picture. Various studies have shown that patients with high body weight who successfully lose weight through a well-adjusted diet are highly likely to regain their previous weight. One reason for this is that the body essentially 'remembers' its 'normal' weight and any deviation from it encourages the body to try and return to it (by increasing the appetite and utilizing other mechanisms). One of the major misconceptions in the battle against obesity is labeling people who cannot lose weight as "lazy." In reality, it’s quite the opposite. Obesity might be a physiological response of the body that we do not fully understand, and attempting to combat it solely through willpower often leads to failure.
To assist those patients who have tried to lose weight but cannot overcome the body's natural weight-regulating mechanisms, various treatment options can be offered, with the main ones being medical therapy and bariatric surgeries.
Bariatric surgery is a medical procedure that has existed for over fifty years, with the primary goal of treating severe obesity. These surgeries are typically considered after a period in which patients have attempted other forms of weight loss without success (such as lifestyle changes, different diets, and drug therapies). There are various types of bariatric surgeries, and the choice of surgery should be tailored to each patient. Bariatric surgeries were initially invasive procedures, but most of them are now performed laparoscopically, which means without opening the abdomen, allowing for faster recovery and fewer complications and pain.
The primary goal of all bariatric surgeries is to create a change in the digestive system that leads to reduced food intake reaching the patient's body regularly, resulting in weight loss. To achieve this, these surgeries either reduce the capacity of the stomach, hinder food absorption in the intestines, or a combination of both. Reducing stomach capacity leads to an earlier sense of fullness and discourages overeating while preventing the absorption of food products allowing the body to expel excess food rather than digest it.
Another goal that has been discovered through years of performing bariatric surgeries is metabolic adaptation. As mentioned, our weight regulation is influenced by a variety of factors, both genetic and non-genetic. It has been found that bariatric surgeries contribute to a "re-education" of the system, getting the body accustomed to a lower weight, which helps in maintaining the weight over time after the surgery.
Extensive meta-analyses conducted over the past two decades have shown that bariatric surgeries can result in a significantly higher weight loss percentage among patients. Moreover, in the long term, these surgeries often lead to improvements in blood sugar levels, reduced blood pressure, and better sleep quality for the patients.
It's important to remember that bariatric surgery is an invasive procedure that comes with certain risks, like any other surgery. Therefore, health organizations have established clear criteria for approving bariatric surgery. The primary criterion for bariatric surgery approval is body mass index (BMI). Since determining a healthy weight takes into account a person's height, a simple formula called BMI (Body Mass Index) is used to measure a patient's body composition. You can easily find online calculators to compute BMI.
Patients with a BMI higher than 40 are considered potential candidates for bariatric surgery. Additionally, candidates for bariatric surgery include patients with a BMI higher than 35 who simultaneously suffer from other obesity-related risk factors such as type 2 diabetes, high blood pressure, and more. It should be noted that these guidelines are periodically updated, and some organizations have expanded the recommendation for surgery to patients with a BMI above 30. In some places, bariatric surgery may be considered for individuals whose BMI has dropped slightly but is still above 30.
For adolescents and children, the criteria are different and stricter, primarily due to the significant psychological implications of the surgery on this age group. In addition, experience shows that their ability to adhere to the required lifestyle changes after surgery is relatively limited. However, adolescents who have reached the age of 13 with a BMI of over 50 may be considered for surgery, particularly if they have concomitant medical conditions. In such cases, a psychiatric assessment is also required to demonstrate the patient's ability to follow the treatment plan, along with parental consent and a supportive social environment. Furthermore, children and adolescents under 18 will need to undergo a committee evaluation composed of various professionals to assess the benefits versus the risks.
Individuals who meet the criteria for surgery and wish to proceed should first consult with their family physician and undergo relevant medical tests, including blood tests, EKG, gastrointestinal system imaging, and more. Simultaneously, they should schedule an appointment with a dietitian specializing in preparing for bariatric surgery. During the period leading up to the surgery, lifestyle changes and dietary habits need to be adjusted, including transitioning to a low-carb diet.
In the next stage, if they are found suitable for surgery, patients will be referred to a bariatric committee at the hospital where the surgery is expected to take place. There, additional data will be evaluated, and an adapted surgical plan will be decided upon. Before the surgery itself, patients will receive instructions regarding fasting before anesthesia and other preoperative guidelines.
As mentioned, there are various types of bariatric surgeries. It is essential to emphasize that the decision to undergo a particular surgery is made based on the patient's circumstances, with the treating physician having the authority to determine the optimal treatment while considering the patient's preferences.
In general, as part of the therapeutic approach for individuals suffering from excess weight, bariatric surgeries can bring about significant changes. Dealing with excess weight does not end after the surgery, and it is essential to continue working on proper nutrition, physical activity, and more to maintain the weight loss. However, research data demonstrate the substantial effectiveness of bariatric surgery in reducing both weight and BMI. Some studies have shown a reduction of over 70% in excess weight. Therefore, considering appropriate data and following the recommendations of a family physician, considering lifelong bariatric surgery should be taken into account.
Bariatric surgeries are included in Israel's healthcare system, and those eligible can receive them as part of the treatment provided by their healthcare provider.
Following bariatric surgery, adopting a lifestyle suitable for the physiological changes resulting from the surgery is crucial. Changes should focus on the patient's food intake, but should also include recommendations for tailored physical activity. Typically, patients are advised to consume soft-textured, fiber-rich foods during the first few months after surgery. Subsequently, an emphasis should be placed on consuming adapted and nutritious foods to prevent nutritional deficiencies through dietary enrichment and the use of nutritional supplements.
Consistent and long-term follow-up by a dietitian specializing in bariatric surgeries is of utmost importance, especially during the first year after surgery (and subsequently, at reduced intervals).
Maintaining a healthy and balanced lifestyle with appropriate professional guidance is essential for the long-term success of bariatric procedures and for achieving lasting weight loss results.
