BMI

Note: This page is being updated. More QnA is being added regularly. Please subscribe to our site for regular articles.

Q. What is weight loss surgery? Is it liposuction??

Er, no. Actually, liposuction is sucking out fat through some cuts made in the belly, butt, thigh or other body part. Usually, 5 to 6 liters of fat are removed. This is purely a cosmetic procedure, and is unsuitable for the severely obese individual.

Bariatric surgery (aka weight loss surgery) is different. We don’t suck out fat, nor do we chop off large chunks of fat. We alter the size and shape of the stomach in some way, and help create weight loss that is substantial and sustained. This means this is what you want!

Q. Why not try diet and exercise?

A. Sure, be my guest! However, if you are very fat you would be wasting time and bandwidth. Why try to prove that falling from a plane without a parachute is not safe? It is already proven over and over again that, in the severely obese individual, bariatric surgery is the only scientifically proven way of losing real weight in the long term. All your gimmicks are short term, not this!

If you want to know why diet and exercise won’t work in the morbidly obese patient, you are not a complete idiot. Please search through this site and educate yourself. Enjoy!

Q. How much does bariatric surgery cost?

A. At Belle Vue Clinic, BMI conducts various weight loss procedures at very modest budgets. However, it is impossible to give you a number now. Do you really need surgery? What procedure is the right one for you? How much of disposables, including staplers, are going to be needed? Would you like staple-line buttresses like Seamguard? Would you like to stay in economy or in a suite? Do you need ICU stay? Will you have a complication? As you can see, there are too many variables. If you really, really want to know, email me your details: ramana@bmi-india.com or rambodoc@gmail.com. I will give you a ball park figure, if possible. Provided you are ready with all the details of your medical records.

Q. What exactly is done in this bediatric surgery?

A. Um, actually, it is BARiatric surgery, not BEDiatric. You do need to be in bed, but that’s like for one day. Before I was a bariatric surgeon, I was a stand-up comedian in a BAR, but they fired me. I make BED jokes.

Bariatric surgery is the name given to a group of surgeries to effect permanent weight loss in severely obese people. The highlights of the surgeries are:

*It is a laparoscopic approach.

* The size and/or stomach is altered in some way. Also the digestive tract may be altered in some cases.

* Minimal hospital stay.

*Rather painless.

*Stitchless.

*Almost bloodless.

*Causes permanent weight loss.

*Relieves and even cures a number of obesity-related conditions like diabetes, high blood pressure, sleep apnea, etc.

*Is a major undertaking in a patient’s life. This is not your slimming center approach!

Q. Can I eat normally/everything after this surgery and still lose weight?

A. If you want to eat like you have always done, this would be the wrong approach. You can’t hope to have a 3000-calorie meal and lose fat at the same time. Well, sometimes you can (we don’t have any posts on the duodenal switch yet), but let us keep things simple here. You need to be committed to your weight loss goals, not your eating-more-food goals. If this fundamental shift in mindset is not there in you, you need to refocus. You could come meet us at Belle Vue Clinic, and we can take this forward. That said, there are procedures, like the gastric bypass, where you can eat only a limited amount of food (kid portions). In operations like the sleeve gastrectomy, the volume of the stomach is more, and your portion sizes can be higher.

Q. What will happen to the skin folds that will hang after I lose weight?

A. If you lose a lot of weight, like a hundred kilos, for example, obviously your skin folds are going to hang loose. In some time, usually a year, there is some adjustment of the slack, and the sag is not noticeable in those who have less weight to lose (to begin with). In extreme cases, the redundant skin needs to be trimmed out. Not a big deal, actually, but a small price to pay for a life altering surgery!

Q. Where can we see the before-after pics of your patients?

A. You can’t. Not because our patients haven’t had fat loss (we would be out of work if it were so), but because we don’t use our patients’ pictures to attract others. Patient confidentiality, heard of it? We believe in it. Your weight loss story is private, unless you want to share it with others. If you are interested in finding out how life is for people who have undergone weight loss surgery, please be in touch with us (see our Contact Us page for details) and we will help you get in touch with many of our patients.

That said, some of our patients, like this one, have posted their own pictures. See if you can have a look.

Q. The Lap Band is what you do? I had a friend do it, and she had a lot of problems with it, finally ending with another surgery. It scares me!

A. Lap Band is only one type of bariatric surgery. We do not prefer it, because:

1. It is purely restrictive in nature.

2. Requires a very motivated patient who would stick to a diet.

3. Up to a third of patients end up with another surgery to remove it because of complications.

4. There are better options

5. Weight loss is the least among the various weight loss procedures, though the short term results are excellent.

6. Patients can cheat the surgery by drinking liquid calories.

Q. Is bariatric surgery permanent, or is it reversible? That way I don’t need to eat small all my life!

A. There are procedures that are reversible: the Lap Band is the most popular, while the Gastric Plication is a new-kid-on-the-reversible-block. However, it is important to understand one’s priorities. Is it a priority for you to eat more? Then you are likely to be unhappy with anything other than eating more food. In the process, you will become obese and sick, and depressed, and the last time I checked, depressed people aren’t happy.  If you make weight loss and health your priority, then you would not think of reversing your bariatric procedure. You would look at the operation not as a temporary fix, but as a permanent way to stay leaner, healthier and be able to eat smaller portions without feeling out-of-control.

Q. Will my diabetes go away for good?

A. Bariatric procedures give around 85-100% resolution of Type II Diabetes Mellitus. Patients who are on more than a 100 units of insulin pre-operatively have an immediate and persistent zero requirement of the hormone post-operatively. Many experts prefer to us the term ‘resolution’ while others call it ‘cure’. Any which way you cut it, it feels good not to take insulin shots or three different oral tablets that could give you side effects like a heart attack. Heard of rosiglitazone?

Q. Can diabetes be considered a surgically curable disease? How??

A. Yes, Type II Diabetes Mellitus can be considered as a surgically curable disease. 80% of diabetics are obese, and bariatric surgery gives persistently normal blood glucose levels in 75-100% of patients. The reason why operations like the gastric bypass or sleeve gastrectomy are so successful is not only that weight loss improves the blood glucose levels, but increases insulin sensitivity. Additionally, incretins are secreted from the gut, leading to more insulin secretion, and preventing further death of the insulin-secreting cells of the pancreas (“apoptosis of the beta cells” in tech-speak).

In obese patients, diabetes cure (or control) is well-known. However, even in the non-obese, metabolic surgery may be feasible. Ileal Interposition is a new procedure spearheaded by Aureo De Paula, a Brazilian surgeon. In this procedure, a long segment of ileum (distal small bowel) is placed in between the upper small bowel (jejunum), leading to incretin release and diabetes control. This form of metabolic surgery is promising and initial results are excellent. However, as this is still an unestablished procedure, we need to be wary of drawing wide-based conclusions from it. It is best to consider it as a promising procedure that may stand the test of time, but we need to treat it as a last resort to stubborn diabetes in the non-obese. When the diabetes is progressing in spite of medical treatment, it may be appropriate to try metabolic surgery as a last resort.

Q. Why are you recommending the gastric bypass for me?

A. Gastric bypass is a well tested and proven procedure. It has superb results in terms of weight loss and remission of diabetes, hypertension, sleep apnea, lipid disorders, etc. In addition, it is an anti-reflux procedure par excellence.

After the bypass, your eating habits will be corrected favorably when you realise that you can’t tolerate refined sugars and sodas.

Q. The Gastric Plication is cheap. Can I go for it?

A. The Plication is a very safe and economical procedure, but we don’t recommend it as a first choice, because it is still new and long term results are not available. Initial reports are encouraging, but that is all we can say. Now, if you need bariatric surgery and cannot afford the standard procedures like the bypass or the sleeve, then this may be considered as a cost-effective procedure that is better than not doing bariatric surgery.

Q. What is my post-operative recovery going to be like?

A. Normally, you would be in hospital for 48 to 72 hours after surgery. We will get you out of bed as early as the same evening of surgery, and send you home on a liquid diet and minimal medicines. We usually do not prescribe antibiotics. Liquid diet is continued for 2 to 3 weeks. Don’t worry about this, as you will feel no hunger, and we would often need to encourage or prod you to drink more! You can be moving around at home once you get back (pain not being a factor in almost all cases), and join work after around ten days.

You are allowed to bathe using soap and water all over from Day One. There are no stitches, so that is an added bonus!

Q. Is bariatric surgery safe? Can I die from it?

A. Yes, bariatric surgery is very safe, as multiple studies and our own experiences have shown. There is a small chance of peri-operative death, around 0.4%. This is almost the same as the mortality rate after other accepted-as-safe procedures like appendectomy.

Q. How do you prevent fatal clots in the lungs?

A. Blood can clot in the leg veins in the obese and those undergoing prolonged lying down, as in many post-surgical states. The clot can then migrate to the right side of the heart and into the pulmonary arterial system, where it gets trapped. This blocks the outflow of blood from the right side of the heart and can cause sudden and fatal cardiac arrest.

Therefore, it seems logical to say that deep vein thrombosis (DVT) and pulmonary embolism (PE) are better prevented than managed.

The three ways we prevent DVT are:

1. Give low-molecular heparin that keeps the blood thin and prevents it from clotting.

2. Use Sequential Compression Devices that pump the veins in the calf to keep blood from stagnating in the veins.

3. Mobilise the patient from the day of surgery.

This last is crucial, especially in the patient who is unable to move easily on account of joint or spine problems or even excessive weight.