What is weight loss surgery?
Weight loss surgery (Bariatric surgery) is a series of procedure that aims at revising the gastro-intestinal anatomy. This revision is done with intent of reducing the stomach size and/ or to minimize the amount of nutrient that is absorbed [1].
This is a treatment recommended for a patient whose obesity is medically complicate, severe and has high risks which sometimes include death. The candidate for this surgery has to undertake pre-operative and post-operative multi disciplinary care to benefit from the surgery. These cares includes nutritional, physiological, behavioural and medical care [2].
How to determine if a person is a candidate for weight loss surgery
To determine the necessity of this surgery in a patient, a combination of the presence of signs that would affect the benefits the surgery offers or increase the risk it poses, and clinical data are put into consideration.
The criteria listed below are considered before the procedure. It should be noted that the criteria are not limited to the lists.
1. The candidate for this surgery must be at least Eighteen years of age.
2. He/ she must have been suffering from severe obesity for a minimum of 5 years.
3.The candidate’s obesity must not be as a result of metabolic causes.
4. The candidate must currently be under supervision by a physician for obesity treatment.
5. The candidate must not show evidence of active substance abuse.
6. The surgery must be performed in a facility that all the needed equipment for the surgery patient to be cared for.
7. The surgery patient must have a Body mass index of 40 or equal to 35 with significant co-morbid conditions such as hypertension, degenerated joint disease, respiratory and circulatory insufficiency, dyslipidaemia, diabetes mellitus, hypertension, arteriosclerosis or obstructive sleep apnea.
8. There must be a multi-disciplinary team that includes a mental health professional (license qualified), surgeon, nutritionist and physician. They must have experience in pre operative and post operative management of weight loss surgery patient.
9. The candidate for the surgery must have completed the pre-operative stage satisfactorily.
10. He/ she must be made aware of the risk of surgery. [3]
Procedure for Weight Loss Surgery
There are five different options of procedure for the weight loss surgery.
These procedures are:
1. Gastric Bypass
2. Biliopancreatic Diversion
3. Sleeve Gastrectomy
4. Vertical Banded Gastoplasty (VBG)
5. Adjustable Gastric Banding - LAP band. [4]
These five different procedures can be categorized into 3: Restrictive, Malabsorptive, and combination of the two.
Restrictive: These are procedures that do not interfere with the normal digestion and absorption of nutrients and calories; it only reduces the quantity of food that the stomach is capable of holding. Procedures that fall into this category include Adjustable Gastric Banding, Vertical Banded Gastroplasty, and sleeve gastectomy.
Malabsorptive: these are procedures that reconfigures and shorten the digestive tract to reduce the quantity of nutrients and calories that is absorbed. Procedures that are only malabsorptive in nature are not commonly performed anymore.
Combination: These are procedures that reconfigure and shorten the digestive tract to reduce the number of calories it can absorb and also limits the quantity of food that the stomach can hold. The procedure
options in this category include Gastric Bypass, and Biliopancreatic Diversion.
Distinctive features of the Weight Loss Surgery
In the gastric bypass, a pouch is created from the upper part of the stomach. This pouch serves as storage for food. Instead of a stomach, what the surgery patient will have is a pouch. Two parts of the intestine are connected to this pouch. The pouch limits the amount of food that can be taken while the connected
intestine will not be able to absorb much nutrients and vitamins.
In the adjustable gastric banding, a band is placed to go around the top of the stomach. The intestines are left untouched. This surgery result in a limit in the amount of food consumed but does not cause malabsorption. [5]
These procedures are not without their risk. This risk include:
Diet Plans for Post – Weight Loss Surgery
It is a misconception of most people that the surgery procedure is required for anyone wants to lose weight and remain healthy. After the surgery, the patient life style will totally change. This change will manifest mostly in his/her eating habit. Those who go back to their former eating style do not record success. An entire new life style of eating will take effect from after the surgery. This will be itemized in 3 stages. [6]
Stage one: 24 hours after the surgery takes place. Food intake should be total liquid. This can include Sugar free Jello, Juice, Broth and Water.
Stage two: If there are no complications, stage two begins until 3 weeks. During this period and until the 8th week, the patient should stay away from pepper, spicy foods and hot sauce to give the pouch time to heal. High protein foods should be eaten to avoid hair loss, feeling of tiredness and delayed healing of wounds. A total of 8 cups of water (64 oz. should be taken daily). Fried food, sugar, caffeine and carbonated beverages should be avoided. Also, there should be no drinking during meals to avowing complications like dumping.
Stage three: This stage begins from the 3 week and at this stage, non-pureed red meat, hard fruits, cook fruit, and cooked and raw vegetables can be taken. Vitamins and supplements should also be taken daily. \
Weight Loss Surgery And Insurance Coverage
Most health care plans are very careful when it comes to weight loss surgery and other high risk surgery. They may deny the request for insurance coverage until they have conducted their own formal review of the cost, indications and outcomes of the procedure.
The insurance approval will be time taking before it is obtained. The only option is to be patient. To have the process speedy you should ask the surgeon to present a convincing case for you. The employer too should be asked to join in the appeal. Together the patient, surgeon and employer, a formidable team is
made and the approval will be gotten as quicker than the would have if working alone.
References
Weight loss surgery (Bariatric surgery) is a series of procedure that aims at revising the gastro-intestinal anatomy. This revision is done with intent of reducing the stomach size and/ or to minimize the amount of nutrient that is absorbed [1].
This is a treatment recommended for a patient whose obesity is medically complicate, severe and has high risks which sometimes include death. The candidate for this surgery has to undertake pre-operative and post-operative multi disciplinary care to benefit from the surgery. These cares includes nutritional, physiological, behavioural and medical care [2].
How to determine if a person is a candidate for weight loss surgery
To determine the necessity of this surgery in a patient, a combination of the presence of signs that would affect the benefits the surgery offers or increase the risk it poses, and clinical data are put into consideration.
The criteria listed below are considered before the procedure. It should be noted that the criteria are not limited to the lists.
1. The candidate for this surgery must be at least Eighteen years of age.
2. He/ she must have been suffering from severe obesity for a minimum of 5 years.
3.The candidate’s obesity must not be as a result of metabolic causes.
4. The candidate must currently be under supervision by a physician for obesity treatment.
5. The candidate must not show evidence of active substance abuse.
6. The surgery must be performed in a facility that all the needed equipment for the surgery patient to be cared for.
7. The surgery patient must have a Body mass index of 40 or equal to 35 with significant co-morbid conditions such as hypertension, degenerated joint disease, respiratory and circulatory insufficiency, dyslipidaemia, diabetes mellitus, hypertension, arteriosclerosis or obstructive sleep apnea.
8. There must be a multi-disciplinary team that includes a mental health professional (license qualified), surgeon, nutritionist and physician. They must have experience in pre operative and post operative management of weight loss surgery patient.
9. The candidate for the surgery must have completed the pre-operative stage satisfactorily.
10. He/ she must be made aware of the risk of surgery. [3]
Procedure for Weight Loss Surgery
There are five different options of procedure for the weight loss surgery.
These procedures are:
1. Gastric Bypass
2. Biliopancreatic Diversion
3. Sleeve Gastrectomy
4. Vertical Banded Gastoplasty (VBG)
5. Adjustable Gastric Banding - LAP band. [4]
These five different procedures can be categorized into 3: Restrictive, Malabsorptive, and combination of the two.
Restrictive: These are procedures that do not interfere with the normal digestion and absorption of nutrients and calories; it only reduces the quantity of food that the stomach is capable of holding. Procedures that fall into this category include Adjustable Gastric Banding, Vertical Banded Gastroplasty, and sleeve gastectomy.
Malabsorptive: these are procedures that reconfigures and shorten the digestive tract to reduce the quantity of nutrients and calories that is absorbed. Procedures that are only malabsorptive in nature are not commonly performed anymore.
Combination: These are procedures that reconfigure and shorten the digestive tract to reduce the number of calories it can absorb and also limits the quantity of food that the stomach can hold. The procedure
options in this category include Gastric Bypass, and Biliopancreatic Diversion.
Distinctive features of the Weight Loss Surgery
In the gastric bypass, a pouch is created from the upper part of the stomach. This pouch serves as storage for food. Instead of a stomach, what the surgery patient will have is a pouch. Two parts of the intestine are connected to this pouch. The pouch limits the amount of food that can be taken while the connected
intestine will not be able to absorb much nutrients and vitamins.
In the adjustable gastric banding, a band is placed to go around the top of the stomach. The intestines are left untouched. This surgery result in a limit in the amount of food consumed but does not cause malabsorption. [5]
These procedures are not without their risk. This risk include:
- Leaks might occur in the connection of the intestines to the stomach in gastric bypass surgery.
- Bleeding can occur as in any other surgery.
- Swelling of the pouch can cause obstruction.
Diet Plans for Post – Weight Loss Surgery
It is a misconception of most people that the surgery procedure is required for anyone wants to lose weight and remain healthy. After the surgery, the patient life style will totally change. This change will manifest mostly in his/her eating habit. Those who go back to their former eating style do not record success. An entire new life style of eating will take effect from after the surgery. This will be itemized in 3 stages. [6]
Stage one: 24 hours after the surgery takes place. Food intake should be total liquid. This can include Sugar free Jello, Juice, Broth and Water.
Stage two: If there are no complications, stage two begins until 3 weeks. During this period and until the 8th week, the patient should stay away from pepper, spicy foods and hot sauce to give the pouch time to heal. High protein foods should be eaten to avoid hair loss, feeling of tiredness and delayed healing of wounds. A total of 8 cups of water (64 oz. should be taken daily). Fried food, sugar, caffeine and carbonated beverages should be avoided. Also, there should be no drinking during meals to avowing complications like dumping.
Stage three: This stage begins from the 3 week and at this stage, non-pureed red meat, hard fruits, cook fruit, and cooked and raw vegetables can be taken. Vitamins and supplements should also be taken daily. \
Weight Loss Surgery And Insurance Coverage
Most health care plans are very careful when it comes to weight loss surgery and other high risk surgery. They may deny the request for insurance coverage until they have conducted their own formal review of the cost, indications and outcomes of the procedure.
The insurance approval will be time taking before it is obtained. The only option is to be patient. To have the process speedy you should ask the surgeon to present a convincing case for you. The employer too should be asked to join in the appeal. Together the patient, surgeon and employer, a formidable team is
made and the approval will be gotten as quicker than the would have if working alone.
References
- Reynolds K, He J. Epidemiology of the metabolic syndrome.Am J Med Sci 2005;330:273-9. PMID 16355011.
- Hedley AA, Ogden CL, Johnson CL, et al. 2004. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA ; 291: 2847–50. PMID 15199035.
- Blackburn G, Hu F, Harvey A, et al. Expert panel on weight loss surgery. Betsy Lehman Center for Patient Safety and Medical Error Reduction. Evidence-based recommendations for best practices in
weight loss surgery. Obesity Research. 2005; 13: 203-305. - American Society for Metabolic & Bariatric Surgery. Story for surgery for obesity. Available at asbs.org/html/patients/story.html.
- Allergan. About LAP-BAND Adjustments. Available at http://www.lapband.com/en/live_healthy_lapband/about_adjustments/. Accessed 21/08/2013.
- Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity
in Adults, The Evidence Report. NIH Publication NO. 98-4083, september 1998. NATIONAL INSTITUTES OF HEALTH National Heart, Lung, and Blood Institute in cooperation with The National Institute of Diabetes and Digestive and Kidney diseases.
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