The Star – Lifestyle change for weight loss
Interview with Dr. Ong Kheng Wah, Consultant General Surgeon and Dr. Yeap Chee Loong, Consultant General and Upper Gastrointestinal Surgeon of OMSMC
Bariatric Surgery can either be restrictive or metabolic. Laparoscopic Sleeve Gastrectomy (LSG) is a relatively new restrictive method in which part of the stomach is removed, thus limiting the amount of food one can eat. According to Dr. Yeap Chee Loong, Consultant General and Upper Gastrointestinal Surgeon at Oriental Melaka Straits Medical Centre, LSG is a more popular and direct procedure that effectively reduces the secretion of the appetite-controlling hormone ghrelin.
There is also the gastric banding method, a minimally invasive option where an adjustable silicone band is used to squeeze the stomach into a pouch. An inflatable intragastric balloon also functions to the same effect but does not require surgery. On the other hand, there is the gastric bypass method, which directly connects a small stomach pouch to the small intestine, thus bypassing part of the digestive system.
“Metabolic bariatric surgery such as this adapts a two-pronged approach to weight loss in decreasing stomach volume and food absorption,” says Dr. Ong Kheng Wah, Consultant General Surgeon at Oriental Melaka Straits Medical Centre. Weight loss usually carries an aesthetic connotation, but bariatric surgery is not a form of cosmetic surgery. It is only carried out on obese individuals who are at great risk of or suffer from complications related to their weight.
“We aim to improve related conditions such as diabetes, hypertension and high blood pressure, thus improving health and quality of life,” explains Dr. Yeap. It is not primary option for quick weight loss – obesity is first addressed with diet and exercise consultation, which involves speaking with a dietitian and understanding calorie management. Patients are only considered for this weight loss surgery if they have a body mass index (BMI) above 35 (without obesity-related diseases) or more than 30 (with obesity-related diseases). This is based on the latest International Federation for the Surgery of Obesity and Metabolic Disorders – Asian Pacific Chapter (IFSO-APC) Consensus, which indicates that BMI range may differ for Asians due to a naturally higher percentage of body fat.
“Post-surgery patient compliance is important, especially in maintaining a healthy and balanced diet. Lifelong discretion and care is needed to sustain the effect of the surgery – the procedure is not a magic pill,” says Dr. Yeap. Patients have to closely monitor and control meal portion because their stomach capacity is affected. The stomach is no longer able to accommodate normal amounts of food, so patients can sometimes only eat a few tablespoons five to six times a day. Dr. Ong describes the procedure as part of a programme, not just a surgery. “Follow up for at least two years is essential to ensure patients reach and maintain their targeted weight,” he says.
As with all medical procedures, bariatric surgery has its own set of potential risks, including bleeding and improper healing. Preoperative optimization is carried out with a screening of all vital organs. According to Dr. Ong, severely obese patients are typically more susceptible to surgical complications, including trouble breathing under anaesthesia.
“These risks and complications may make some skeptical, but morbid obesity will cause complications eventually. This procedure is a way for them to reduce the risk of developing other diseases, including heart disease,” says Dr. Yeap. Post surgery, patients must be prepared for and willing to make the lifestyle changes to sustain long-term weight loss.
For more information, contact Oriental Melaka Straits Medical Center.