Is weight-loss surgery the best way to manage obesity?

Rosedale Suspension Bridge in Rosedale, AB. (Dr. Noorali Bharwani)
Rosedale Suspension Bridge in Rosedale, AB. (Dr. Noorali Bharwani)

Much has been written and discussed about obesity but we are nowhere close to solving the problem. In fact, the problem is getting worse.

Many factors can contribute to excess weight gain including genetics, a person’s eating pattern, physical inactivity, and sleep routines.

A person whose BMI (body mass index) is greater than or equal to 25 is considered overweight.

A person whose BMI is greater than or equal to 30 is considered obese.

Why non-surgical methods of managing obesity have failed?

As we know to lose weight one has to eat less, eat healthy and exercise regularly. But due to various reasons most people are unable to follow this rule. Those who religiously follow the rules do succeed in losing weight. But the success doesn’t last for too long. Old habits die hard.

In 2003, a study published in the Journal of the American Medical Association found that if you can get people to reduce how much food they eat by about 25 per cent, and you get them to do at least 30 to 40 minutes of exercise five days a week, you can achieve a weight loss of nine per cent. This means a 200-pound person could lose about 20 pounds and successfully maintain it for at least a year. We don’t know how many people maintain this after one year.

Is weight-loss surgery the answer?

Surgery for obesity is called bariatric surgery (from the Greek words “baros,” meaning weight, and “iatrikos,” meaning medicine).

The first weight-loss surgery performed was a gastric bypass surgery in 1954 by Dr. A.J. Kremen. Over the past 65-years, many medical advances in bariatric surgery have occurred. In the last 25-years, the procedure has gained popularity with patients.

Following bariatric surgery, patients lose about 62 to 70 per cent of excess weight and maintain this loss for more than five years. However, this can also result in nutritional and vitamin deficiencies.

Bariatric surgery can have significant health benefits in addition to weight loss, including improvement in cardiovascular risk factors, fatty liver disease, diabetes management, and reduction in mortality.

A recent study published in the Canadian Journal of Surgery (Five-year outcomes after surgery for class 1 obesity: a retrospective analysis of a Canadian bariatric centre’s experience, by Studer et al, November 16, 2022) concludes bariatric surgery for class 1 obesity was safe and had long-term efficacy, with remission or reduction of related comorbidities. Class 1 obesity is a person with BMI of 30 to <35.

“Our results show that bariatric/metabolic surgery has long-term efficacy, with reduction or remission of related comorbidities, and is an effective treatment modality for patients with class 1 obesity,” says the article. This was a retrospective chart review of patients with class 1 obesity who underwent different types of gastric bypass surgeries.

The authors conclude that bariatric surgery is safe treatment modality for class 1 obesity, with an acceptably low postoperative morbidity rate of 2.7 per cent and no deaths.

Weight-loss success after surgery depends on individual’s commitment to making lifelong changes in eating and exercise habits. This requirement is same if one decides not to have surgery. Post-op complications are rare but can be serious like pulmonary embolism, anastomotic leaks or respiratory failure. A person may experience dumping syndrome, low blood sugar, malnutrition, vomiting and bowel obstruction.

All surgical procedures have advantages and likely complications. A person with obesity with medical issues has a choice and decision to make. Long-term success depends on one’s ability to follow guidelines for diet, exercise and lifestyle changes.

Is bariatric surgery the best way to manage obesity? Bariatric surgery is not a cure for obesity but rather a tool to help one lose weight.

The other option is to reduce daily diet by 25 per cent and do 30 minutes of exercise five days a week. Worth trying!

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Stress and Rise in Obesity will Worsen Outcomes from COVID-19

Silvertip Golf Course in Canmore, Alberta. (Dr. Noorali Bharwani)
Silvertip Golf Course in Canmore, Alberta. (Dr. Noorali Bharwani)

It is one year since the COVID-19 pandemic hit the Canadians. Our government had no choice but to shut down all kinds of activities and impose physical restrictions.

These restrictions have saved many lives. Nobody can deny that. But there have been many down sides to these restrictions. We can mention a few: anxiety, loneliness, depression, lack of physical activities and weight gain.

I have FIVE questions for you:
1. Have you put on weight in the last one year?
2. Are you eating a healthy diet?
3. Are you mentally and physically active?
4. How are you coping with stress?
5. Are you getting enough sleep?

Obesity is a common, serious, and costly chronic disease.

Having obesity puts people at risk for many other serious chronic diseases and increases the risk of severe illness from COVID-19. Everyone has a role to play in turning the tide against obesity.

I wasn’t surprised to read Vietnam is the least obese country with 2.1 per cent of the population classified as obese. Among the developed countries, the United States is the most obese (36.2 per cent).

If you are obese then the risk of hospitalization due to COVID-19 infection increases. Obesity decreases lung capacity and reserve and can make ventilation more difficult. Obesity also increases your risk of dying from COVID-19. Studies have demonstrated that obesity may be linked to lower vaccine responses for numerous diseases (influenza, Hepatitis B, and tetanus).

What can we do about obesity? Obesity is a complex disease with many contributing factors. Simple answer would be – eat healthy, eat less and exercise more. This requires lot of patience and perseverance. Other option would be to seek professional help so that you can stick to a rigid protocol.

Eating a healthy diet has many advantages. Plenty of fruits and vegetables, lean protein, and whole grains as well as the appropriate number of calories is important. This keeps your weight under control and improves your immune system. As everyone knows a healthy diet is also good for your heart and diabetes.

Besides eating a healthy diet, physical activity is one of the best things people can do to improve their health. It is vital for healthy aging and can reduce the burden of chronic diseases and prevent early death. Only half of adults get the physical activity they need to help reduce and prevent chronic diseases. More needs to be done.

Regular physical activity helps you feel better, sleep better, and reduce anxiety.

Insufficient sleep has been linked to depression, as well as chronic diseases that may increase the risk of severe illness from COVID-19. COVID-19 has made life stressful for millions of people. That will certainly affect your sleep pattern, eating habit and your relationship with friends and family. If that is the case then you should seek professional help.

Take care, eat healthy, lose weight, be physically active, sleep well and get immunized. If stress and depression is affecting your health you must get help from a professional. Sooner you do that, better for you and your family. Everybody wants to be happy and healthy.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!