What’s Up Doc?: Is surgery the best way to handle obesity?

By DR. NOORALI BHARWANI on December 20, 2022.

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’sÂ 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 minutes of exercise five days a week, you can achieve a weight loss of 9 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 a 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 62-70 per cent of excess weight and maintain this loss for more than five years. However, this can 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, Nov. 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.

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 the individual’s commitment to making lifelong changes in eating and exercise habits. This requirement is the 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.

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!

Dr. Bharwani is a general surgeon, freelance writer, photographer and author of A Doctor’s Journey and Doctor B’s Eight Steps to Wellness