Bariatric surgery: Should one consider it?
I saw a thin lean guy sipping soup at a recent orthopedic
conference. The guy looked familiar but I could not place him. I went to have a
closer look and he turned out to be one of my friends Dr. Fatbelly (name
changed for obvious reasons). He used to weigh around 110 kgs and looked
slimmer than me now! He noticed the question mark on my face and just said
‘done’!
Dr. Fatbelly is an orthopedic surgeon from western suburbs. He
is 8 years senior to me and obesity was always an issue with him. He had blood
pressure issues and recently started showing high sugars as well.
He had tried everything to shed weight but nothing had
worked. Finally he started considering bariatric surgery as an option but was a
bit scared to undergo the knife! However once his sugars started an upward
trend he realized that heart trouble was just a few months away. He finally
built up all the courage he could muster and went through the process. I met
him around 5 months post-surgery and he had already lost 28 kilos! His sugars
were normal and he had given up the blood pressure tablet too. He felt more energetic
and started working 16 hour days again. “I don’t regret the decision anymore”
he said as he finished his “meal’ i.e. soup. “I feel full already” he said.
Obesity not only causes blood pressure and diabetes issues
but also excessive loading of the knees and we orthopedic surgeons have started
seeing a lot of young (less than 50 years) arthritic patients. Typically obese,
100+, sedentary lifestyle ladies and guys come with badly destroyed knee joints
at the age of 35 to 40 years. Knee replacement is not a surgery we like to do
on such young patients. Most of these guys have tried various means to lose
weight and usually have given up all hope. With painful knees they can’t even walk
to burn calories. This starts a vicious cycle, weight gain leading to painful
knees which in turn reduce the activity levels which in turn lead to more
weight gain. Unless one loses neither weight neither the knees recover nor the
activity levels can be brought up to burn calories.
Bariatric surgery helps us out here. Patients lose weight
permanently and the knees breathe a sigh of relief. Bariatric surgery is done
by general surgeons specializing in this field and not by us orthopedic
surgeons. The simple fact that I am
writing about a procedure which I do not even perform should indicate how
serious the problem of obesity in our practice is.
I met one of my orthopedic surgeon friends a few months
later who also had undergone a successful bariatric surgery. I have started
recommending this surgery to my young arthritic patient sand have seen some
outstanding results. All of them are overjoyed. The stay in the hospital now
has reduced to 3-4 days only. The procedure is done through a keyhole i.e. laparoscopic
surgery and the complications rate is pretty low. The only downside I learnt is
that it is an expensive procedure and costs a few lakh of rupees. But then how
much would it cost if you have lifelong diabetes and blood pressure plus a
heart attack thrown in for free! Unfortunately this is considered as a cosmetic
surgery and the insurance companies do not cover the cost. I am pretty sure that the insurance companies
sooner or later realize that it would be prudent to reimburse the cost. The
overall health burden and hence their claim ratios would reduce in the long
term. Lot of people confuses this surgery with liposuction. Liposuction is a
temporary expensive procedure and is meant to be used for cosmesis only. The
fat (lipo) sucked out will eventually come back if the cause of obesity is not
corrected.
Are you one of these young obese guys with blood pressure
and or diabetes and have painful knees? Go ahead you got a procedure which can
bring a lot of joy in your life.
I would end by narrating a true story of one of my patients
to highlight the point I am making. Mrs. Gujrathi a typical 52 year old
gujrathi lady used to come to me with painful knees. She got better. I used to
coax her on every visit to lose weigt. She used to smile sheepishly and go
away. During one of her visits she got her 24 year old son who had back pain. He
too got better but used to weigh 135 kilos. I asked him to loose weight. He
said “doc, I have tried everything and maximum I have achieved is 105kg. I had
just returned seeing two of my colleagues benefiting from this surgery so I
mentioned to him. His eyes lit up and he enquired where all these surgeries are
done. He turned up after 6 months looking depressed. He and his mother had gone
to this famous bariatric surgeon who echoed my thoughts and told then it would
do a lot of good to both of them. Money was never an issue, they could afford
it. His father however refused to entertain all such thought sand said “this
surgery has a lot of complication rate”. I kept quiet.
Two years down the line a young guy came to see me, he had
fallen from his bike and had hurt his wrist. X-rays did not reveal any serious injury
and I told him just rest would be enough. He finally laughed and said ‘doc, you
did not recognize me, did you?’ I am Pranjal Gujrathi. He looked younger and
thinner and was weighing 74 kgs. What he narrated was an astonishing story. He
had got depressed, gained weight; all his marriage proposals were turned down.
He then realized that he had to lose weight. His mother, sister and he then
hatched a plan. He booked his surgery and his mother told his father that Pranjal
had gone for a picnic with his friends to Goa for a few days. He came home in 4
days and his father till date does not know about his son’s surgery! He is now
hatching a plot where his mother also undergoes similar surgery.
My advice to you guys is that if you are obese and have
tried everything under the sun to reduce weight and failed, make sure you see a
bariatric surgeon before you give up! My friend a bariatric surgeon shows a
slide in his talks which states a bypass below the diaphragm (bariatric
surgery) will save a bypass above the diaphragm (heart bypass )!
