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WEIGHT LOSS SURGERY

1WHAT IS OBESITY?
Obesity can be defined as a chronic condition by an excess amount of body fat. Obesity is best defined by body mass index. BMI is simply determined by individual’s weight and height. BMI can be easily calculated by using the following formula:

⦁ Body Mass Index (BMI) Calculation

BMI= Weight (kg) / Height (m)2 Calculating Body Mass Index (BMI) Using American / British System BMI= Weight (lb.) / Height (in)2 x 703 For instance, you weigh 100kg’s and your height is 1,75cm. The calculation and classification of BMI will be as follows:BMI= 100 / (1,75X1,75) BMI= 32,65Underweight 18,50 < Healthy weight range 18,50 – 24,99 Overweight 25.00 – 29.99 Obese 30 or more Severe Obese 35 or more Morbidly Obese (Extreme obese) 40 or moreAccording to BMI, unfortunately you will be classified as an obese with 32,65 rating. In general, both overweight and obesity indicate a weight greater than what is healthy.
2WHAT ARE THE CAUSES OF OBESITY?
Cause of obesity in general can be considered as eating too much and moving too little. There are some strong scientific data indicates that 80% obesity is related to genetics that causing some individuals losing weight more difficult than others. However, certainly it does not make it impossible. Some of main other causes of obesity rather than genetics are as follows:

⦁ Overeating

⦁ Poor diet

⦁ Lack of physical activity

⦁ Choices of lifestyle

⦁ Medical reasons

⦁ Psychological reasons

⦁ Certain disorders

3WHO IS A GOOD CANDIDATE FOR A BARIATRIC SURGERY?
Bariatric surgery is a great tool that can be utilized to assist on changing the individual’s lifestyle in order to facilitate weight loss. However, it can not be considered solely as a cure for obesity. Patients indeed must be willing to make definitive changes in their lifestyle including improving their diet combined with daily exercise. Bariatric surgery could be considered as an option if have one of the following conditions:

⦁ BMI is 40 or more or you have 45kgs of overweight

⦁ unable to achieve a weight loss for a period of time despite diet and exercise efforts

⦁ BMI is 35 or higher and have a major weight related health problem

4WHAT ARE THE EVALUATION STEPS PRIOR TO BARIATRIC SURGERY?
Having complying with one of the criteria to be a candidacy for a bariatric surgery do not necessarily make the individuals qualify for it. MediExpert has some certain medical criteria to be met in order to be able to qualify for a weight loss surgery which are listed as follows:

⦁ Medical condition including blood tests, physical tests, medication taken, consumption of alcohol, whether you are a smoker or not

⦁ Weight history including previous diet attempts, weight trends, eating habits, exercise regimen and stress level

⦁ Motivation level to assess the willingness and evaluate the ability to adopt to diet and exercise after the surgery

⦁ Psychological status to ensure that there is not any disorder to prevent undergoing to a surgery

The evaluation will eventually determine whether the health benefits of the surgery outweigh the potential risks and also will evaluate whether you are medically and psychologically ready to undergo to a procedure accordingly.
5WHAT ARE THE REQUIREMENTS PRIOR TO THE SURGERY?
If you are approved as an eligible candidate after the evaluation, MediExpert health care team will provide you instructions on how to prepare the surgery some weeks before customized with the patient taking into account weight, age and the existence of comorbidity. Some are outlined as follows:

⦁ If you are a smoker, you will be asked to quit smoking at least six weeks prior to the surgery

⦁ You may be limited on eating and drinking following a diet

⦁ You may be asked to start an exercise programme

⦁ Adopt a healthier life style in general

There are strong evidence supporting that the results of the bariatric surgery are improved when adopting to new habits prior to the procedure.
6WHAT TYPES OF BARIATRIC SURGERY ARE AVAILABLE?

⦁ The Gastric Bypass 

Gastric bypass is also known as ‘Roux-en-Y Gastric bypass’ is one of the most common type of weight loss surgery with minimum side effects which has been performed more than 50 years. It is reversible and provides significant amount of weight loss for one to two years. In this surgery, surgeon cuts the top part of the stomach creating a small pouch about the size of a walnut in the upper section. This lead patients not to eat as much as they did before the surgery as the stomach can hold for only a few amounts of food, so patients simply eat less and feel full sooner. Surgeon then cuts the small intestine which the lower part attached directly to the small stomach pouch. The reconnected intestine causes the food to bypass most of the stomach as well as the first section of small intestine and enters directly into middle part of intestine. As soon as the food enters intestine, intestine then sends hormone signals of fullness resulting in body absorbing fewer calories. Patients required to reduce eating fats and sweets after the surgery. When consuming too much sweets and fats may result in physical symptoms including sweating, general weakness and abdominal cramping. Since stomach can not fully absorb vitamins and minerals after the surgery, patients must take vitamin and mineral supplements for a lifetime. Studies indicate that more than 95% of the patients undergoing gastric bypass procedure lose more than half of their excess weight.

⦁ The Sleeve Gastrectomy 

Sleeve gastrectomy is also known as also ‘Vertical sleeve gastrectomy’ involves removing approximately 75% of the stomach, leaving only a banana-shaped section or a sleeve-like stomach that is closed with staples.This allowing to reduce the level of ‘ghrelin’ hormone which is typically referred to as the ‘hunger hormone’ Therefore, individuals feel less hungry as the hunger is significantly reduced after undergoing this surgery.This type of procedure can not be reversed because most of the stomach is permanently removed and successfully used for individuals with BMI greater than 40.It includes a rapid weight loss in comparison to gastric bypass surgery as patients can statistically expect 60% loss of their excess weight which even better results can be achieved by a dietary support. The procedure does not involve neither re-routing the digestive process nor implantation of a band, simply hormonal changes in the body make patients eat less as well as it assists on resolving the diabetes.Recovery period is relatively reasonable enabling patients to be able to eat wide range of foods comfortably. Due to its simplicity, sleeve gastrectomy has become one of the most popular type of weight loss procedure.

⦁ Laparoscopic Gastric Banding

Laparospic gastric banding is also known as ‘Adjustable gastric banding’ or ‘Lap band’ or ‘Realize band’. Which is considered to be least invasive type of surgery for weight loss. The procedure requires placing an implant as the surgeon places a soft silicone band with an expandable balloon in the center around the uppermost part of the stomach. The balloon is filled with salt solution and basically acts like a belt that tightens. When the balloon is inflated, it compresses the stomach.Consequently, the stomach is separated into two compartments with a smaller upper part being above the band and communication with the rest of the stomach is made through a channel created by the band. Small upper part of the stomach limits the amount of food that can be eaten. Band is adjustable in order to be able to allow more or less food. Therefore, sufficient food is required only to fill the top part of the stomach.This type of procedure can be applied to individuals with BMI greater than 35. Most of the cases, procedure can be performed as an outpatient, where a patient can return home within the same day after the procedure.Due to its simplicity, it is a common type of weight loss surgery performed. Nonetheless, weight loss may be little less compared with other type of procedures. As a study indicates that for the patients with a BMI between 30-40, 80% of the patients lost minimum of 30% of their excess weight and was able to keep it for a year period.After surgery, follow-up visits are required in order to adjust the size of the band opening. If the band causes problems or not assisting on losing weight, removal of the band is possible.

⦁ Duodenal Switch (BPD-DS)

Duodenal switch is also known as ‘Bilio-pancreatic’ or ‘BPD-DS’ which is a more complex surgical procedure compared to the other types of bariatric surgery. Procedure involves a combination of sleeve gastrectomy and intestinal bypass. Approximately 75% of the stomach is removed resulting in stomach to take the shape of a tube as in the sleeve gastrectomy.Then, the lower intestine is divided much further down than gastric bypass as approximately 70% of the intestine bypassed by connecting the end part of intestine to the duodenum near the stomach which is the first part of the intestine. As a result only a small part of intestine is left where digestive enzymes and food meet.The name duodenal switch derives from the fact that in this procedure the intestinal bypass begins at the duodenum.On one hand, procedure limits the amount of food can be eaten, on the other hand reduces the absorption of nutrients. It is usually used for individuals with a BMI greater than 50.Duodenal switch has the best success rate compared with the other types of bariatric surgery in terms of longest lasting weight loss and an average weight loss of 80% of excess weight within two years period and studies indicate that 70% of excess body weight achieved beyond ten years period. Moreover, patients are more likely to achieve getting to their ideal weights.Nonetheless, this procedure can cause shortage of vitamin, minerals and proteins in the body that requires a lifetime supplement of calcium, iron as well as vitamins.

⦁ Gastric Balloons

Gastric balloons also known as ‘Stomach balloons’ or ‘ Intragastric’ are temporary removable devices that are placed in the stomach by endoscopy and can stay up to six months. Individuals with a BMI above 30 are eligible for gastric balloons. Gastric balloons assist to achieve weight loss by taking up space in the stomach, so that food intake is restricted. Patients can feel full faster and stay full for a longer period. It is a non-surgical and outpatient procedure that takes about half an hour and not require a general anesthesia. Individuals lose around 15% of their starting weight within a period of six months and keeping it for at least one year with a success rate of the procedure as high as 98%. During the same period, BMI rate of the individuals decreased by 5 accordingly. The main advantages for the gastric balloons are that the procedure is reversible, available for individuals who are not eligible for a weight loss surgery and less costly than alternative procedures. Moreover, there is no need to take any medication at all. Studies also indicate that there are significant improvements in the cardiovascular health, lipid levels, blood sugar levels and diabetes. Gastric balloon can be considered as a long-term weight loss management as the balloon must be removed after six months as increasing the duration of the balloon may lead to intestinal obstruction. Removal of the balloon is made using a similar endoscopic procedure. Studies demonstrate that the side effects are minimal in the gastric balloons as less than 5% of the patients had the balloons removed due to early intolerance and only less than 1% reported bowel obstruction and migraine respectively.
7HOW LONG DOES THE SURGERY TAKE?
It takes typically 1-3 hours depending on the type of weight loss surgery procedure to be performed except gastric balloon procedure which takes around half an hour only.
8HOW DOES THE SURGEON DECIDE WHICH SURGICAL APPROACH TO TAKE?
MediExpert surgeons will decide on the type of surgical procedure customized with the specific needs of the individual taking into consideration the evaluation outcome some of including history of weight loss, medical history, weight loss goals, risk tolerance, psychological and motivational status of the patient.
9IS WEIGHT LOSS SURGERY PAINFUL?
The level of pain depends on the type of surgery performed and some level of pain is considered normal as in most of major surgery. Pain medication is given to reduce discomfort. Any pain related to the surgery should go away within 7-10 days or so.
10HOW LONG IS THE RECOVERY TIME?
There are number of different factors to determine the duration of time that taking you back to resume normal life such as the type of procedure, age, starting weight, overall health, malnutrition, following up post operative instructions. It is typically 3-4 weeks to resume regular activities and 4-6 weeks are required for a full recovery period. MediExpert will provide you a detailed recovery guidelines to ensure the fastest recovery period possible.
11HOW LONG WILL I NEED TO BE OFF WORK AFTER THE SURGERY?
The type of weight loss surgery performed is the deciding factor in order to determine the time off the work. It is generally as early as 1-2 weeks off work required for non-strenuous jobs, whereas it can take up to 6 weeks for a physically demanding job. Only few days off work would be sufficient after gastric balloon procedure.
12SHOULD I NEED TO STAY IN THE HOSPITAL AFTER WEIGHT LOSS SURGERY?
Hospital stay depends on the type of procedure performed as gastric balloon is an outpatient, whereas1-3 nights are generally required for other surgical procedures.
13WILL I NEED ANY ASSISTANCE WHEN I GET BACK HOME?
After discharging from the hospital , you should be able to easily function on your own at home.
14WHEN CANI I DRIVE AFTER THE SURGERY?
It is recommended to start driving only 1 week after the surgery.
15SHOULD I EXERCISE AFTER THE SURGERY?
Practicing regular exercises play an important role in order to maintain weight loss. Walking would be a great help for a weight loss. We suggest to start with 30 minutes walking everyday and increase the amount of time to an hour step by step. MediExpert surgeons will give you clear instructions on the type of useful exercises along with how soon to start following the surgery.
16WHEN WILL THE STITCHES REMOVED?
Stitches used are dissolvable.
17WHEN CAN I EAT AFTER BARIATRIC SURGERY?
Although eating recommendations after a bariatric surgery may vary depending on the individual’s situation. Following can be considered as the main recommendations:

⦁ keep meals small

⦁ eat and drink slowly

⦁ focus on high protein foods

⦁ drink water between meals

⦁ chew food well

⦁ avoid fatty food and sugar

⦁ avoid snacks between meals

⦁ take mineral supplements and vitamin

18WHAT ARE THE HEALTH RISKS OF OBESITY?
There are various health risks linked to overweight and obesity. Some of the risks are as follows:

⦁ Arthritis

⦁ Cancer

⦁ Cardiovascular disease

⦁ Diabetes

⦁ Gastroesophageal reflux disease

⦁ Fatty liver disease

⦁ Heart diseases

⦁ High blood pressure

⦁ Hypertension

⦁ Infertility

⦁ Kidney disease

⦁ Sleep apnea

19WHAT ARE THE RISKS AND COMPLICATIONS ASSOCIATED WITH BARIATRIC SURGERY?
All surgical procedures carry risks in to a particular extent. Some of the possible risks and complications associated with the bariatric surgery as follows:

⦁ Acid reflux

⦁ Allergic reactions

⦁ Anesthesia-related risks

⦁ Bleeding

⦁ Blood clots

⦁ Bowel obstruction

⦁ Chronic nausea and vomiting

⦁ Depression

⦁ Difficulty swallowing

⦁ Dilation of esophagus

⦁ Dumping syndrome

⦁ Erosion

⦁ Hair loss

⦁ Hernia

⦁ Inability to eat certain foods

⦁ Infection

⦁ Loss of body function

⦁ Perforation

⦁ Pregnancy

⦁ Prolapse

⦁ Obstruction of stomach

⦁ Risks of transfusion

⦁ Ulcers

⦁ Vitamin and mineral deficiencies

⦁ Weight gain or failure to lose weight

20WHAT ARE THE BENEFITS OF WEIGHT LOSS SURGERIES?
Obesity is considered to be a triggering factor to a number of major diseases. Studies indicate that an individual age of 25 with a severely obese condition has 22% reduction in expected life span. When evaluating the health risks linked to obesity compared with the surgery risks, it is very clear that health risks from obesity far outweigh the risks associated with weight loss surgery for the appropriate patients.

Some of the benefits of bariatric surgery include reducing:

⦁ high cholesterol

⦁ diabetes

⦁ high blood pressure

⦁ hyperlipidemia

⦁ the risk of liver disease

⦁ the risk of heart disease

⦁ obstructive sleep apnea

⦁ cardiovascular diseases

21HOW MUCH WEIGHT SHALL I EXPECT TO LOSE? HOW FAST WILL IT BE?
The weight loss results may vary from patient to patient with the best results certainly achieved from those who are committed to a healthy lifestyle after the surgery. Another important factor is the type of weight loss surgery performed as with gastric banding patients generally lose weight rather slowly within the first year, but more steady than duodenal switch and gastric bypass procedures. Whereas, weight loss is generally within the first six months and stabilizing after 12-18 months for gastric bypass and sleeve gastrectomy. Reports indicate that excess patients lost 1 year after the surgery about 40% for gastric banding, 50% for sleeve gastrectomy and 70% for gastric bypass respectively. It is important to set realistic targets for the weight loss right from the beginning. A loss around 1-1,5 kilograms per week after the surgery is possible, however half a kg loss per week would be more likely for a gradual and steady weight loss.
22WHEN IS THE SURGERY FOR WEIGHT LOSS IS CONSIDERED SUCCESSFUL?
The primary goal of weight loss surgery is to solve the complications caused by obesity, not reaching an ideal weight. We can call the surgery as a success whether 50% of excess weight is lost and not put it back again for a period of 5 years. 95% of patients undertaking gastric bypass surgery reaching this target, while 85% of the patients lose two thirds of their excess weight.
23CAN I BECOME PREGNANT AFTER WEIGHT LOSS SURGERY?
Weight loss surgery has a positive impact to become pregnant as it assists on producing a sudden beneficial change in fertility. However, we do not recommend pregnancy during the weight loss phase until at least 18 months after the surgery.
24WILL I HAVE A LOOSE OR SAGGING SKIN AFTER WEIGHT LOSS SURGERY?
After a significant amount of weight loss, there might be some areas where the skin starts to sag How extensive the sagging will mainly depend on the following factors:

⦁ Age as skin is tend to sag more in the older ages due to skin elasticity

⦁ Amount of weight loss

⦁ Heredity

⦁ Whether you are a smoker or not

The only effective way to deal with loose skin is with plastic surgery. MediExpert can provide customized solutions to your specific needs for all kinds of plastic surgery as well.
25WILL I HAVE A HAIR LOSS AFTER BARIATRIC SURGERY?
Hair loss associated with weight loss surgery is called telogen effluvium and considered as a part of normal hair growth cycle. Hair loss seen in almost half of the patients after weight loss surgery on a temporary basis. Natural hair is only limited between 5-15% and rarely lasting more than six months. Unless there is a genetic reason or a chronic disease, the hair will grow and come back again. Hair loss due to a bariatric surgery can be challenged by taking proper nutrition, mineral supplements and multivitamins.
26DO I NEED TO QUIT SMOKING BEFORE THE SURGERY?
The answer is yes. Since smoking is considered to be is one of the biggest if not the biggest cause of deaths and illnesses. There is also strong scientific evidence that non-smokers who undergo bariatric surgery are less likely to experience anesthesia complications, blood clots, infections, stroke, heart attack and death. Furthermore, smoking has a negative impact for the wound healing after surgery. For some of the reasons outlined, we do ask you to quit smoking at least six weeks before the surgery.
27DOES WEIGHT LOSS SURGERY GUARANTEE PERMANENT WEIGHT LOSS?
Permanent results are achieved as long as the dietary guidelines are followed after the surgery.
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