Obesity and the need for Bariatric surgery

At Total Physiocare we not only see a range of musculoskeletal injuries, but we also cater for various other conditions like obesity and weight loss programs. Alex, one of our Physiotherapist has compiled a post in regards to this.

Obesity and the need for Bariatric Surgery

Obesity is a chronic disease affecting the health of millions of people worldwide. Obesity is defined as an excessively high amount of body fat in relation to lean body mass resulting from caloric intake that exceeds energy usage. It causes a great deal of un-necessary morbidity and mortality, substantially reducing quality of life, and increasing the demand and cost of health care services. Bariatric surgery is the only current treatment that has been shown to achieve durable weight loss. Obesity is the second leading cause of preventable death following smoking. Currently 20 percent of Australian adults (2.6million) are obese with a BMI over 30.

Comorbidities of Obesity

Obesity increases the risks of developing Type 2 diabetes, coronary heart disease, stroke, hypertension, obstructive sleep apnea, depression, cancer, dyslipidemia, polycystic ovary syndrome, incontinence and arthritis.

Causes of Obesity

  • Genetics
  • Metabolism
  • Eating and exercise habits
  • Environment
  • Psychological factors

Bariatric Surgery

Bariatric surgery is the fastest growing area of surgical practice in Australia today. This reflects both the ability to provide a solution to an otherwise un-soluble problem and is evolving into safer, less invasive procedures. There is variation in preferred procedures across different countries, which are often due to insurance factors and regulations. In Australia, laparoscopic adjustable gastric banding (LAGB) is the procedure of choice in more then 90% cases, with gastric bypass making up most of the rest. All bariatric procedures have been able to achieve 50 percent of excess weight loss. Today there are essentially three procedures in use.

  1. Laparoscopic adjustable gastric banding (LAGB): involves inserting a specially made “band” around the top of the stomach via keyhole surgery. No organs are cut, removed or rearranged, hence the procedure is quick and completely reversible. The section of stomach sitting above the band (pouch) can only hold a small amount of food. As a small amount of food is eaten, it fills the pouch and a sensation of fullness is felt and hunger is reduced. The food then slowly passes through the band into the rest of the stomach and is digested in the normal way. The key to success with gastric banding is to be consistent in eating healthy nutritious solid food.

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  1. Sleeve Gastrectomy: The sleeve gastrectomy limits the amount of food you eat by reducing the size of your stomach to hold approximately 1/10th of the stomachs orginal size. During this procedure, a thin vertical sleeve of stomach is created using a surgical stapling device via keyhole surgery. The rest of the stomach is removed. The stomach sleeve restricts the amount of food you can eat, reduces hunger and makes you feel full with a small meal. Weight loss is generally more than 60 percent of excess weight.

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  1. Roux-en-Y Gastric Bypass: In this procedure the stomach is divided to create a small gastric pouch. Next a Y-shaped section of intestine is joined to the gastric pouch. This allows food to bypass the lower stomach and move directly into the intestines. The procedure may be performed laparoscopically (keyhole) but on occasions requires an open (large incision) approach. The small gastric pouch limits the amount of food that is eaten by helping you feel full and the bypass amplifies this effect and reduces hunger by the release of natural appetite inhibiting hormones in response to food entering the intestines earlier. Excess weight loss is 65-80 percent and has eliminated Type 2 diabetes in 82 percent of patients.

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Application Process: To qualify for bariatric surgery there is an Inclusion/Exclusion Criteria

Inclusion Criteria

  • BMI >35
  • Identifiable medical, physical, psychological problems associated with their obesity and have made prolonged efforts to relieve those problems by non-surgical means.

Exclusion Criteria

  • BMI < 35 kg/m2
  • Age younger then 18yr or older then > 65 y
  • Medical condition that makes surgery too risky
  • Clinically significant or unstable mental health concerns
  • Not tried or optimized lifestyle or medical treatments
  • A history of poor compliance with lifestyle, medical, or mental health interventions
  • Pregnant, lactating, or plan for pregnancy within 2 y of potential surgical treatment
  • Lack of safe access to abdominal cavity or gastrointestinal tract

Costs of Surgery

Gastric band

  • Private insurance: $2,500 to $5,500
  • Uninsured $10,000 to $16,000

Gastric sleeve

  • Private insurance: $4,000 to $6,000
  • Uninsured: $16,000 to $18,000

Gastric bypass

  • Private insurance: $4,000 to $6,000
  • Uninsured: $16,000 to $18,000

Benefits of Major Weight Loss

  • Type 2 diabetes, was eliminated by gastric bypass in 82% of obese patients.
  • 60% of people with HTN return to normal BP ranges
  • Obstructive Sleep Apnea resolves in most people
  • Dyslipidemia return to normal levels
  • Fertility increases in women with polycystic ovary syndrome
  • Depression partially resolves in most people
  • In general Quality of Life returns to normal and life expectancy improves

Nutritional Recommendations after Bariatric Surgery

  • Eat 4-5x/day (3 small meals + 1-2 snacks)
  • Choose mostly solid food (1 cup)
  • Make time for meals (15 to 30 minutes) and chew food well
  • Avoid textures difficult to chew (eg, tough meats)
  • Avoid consuming fluids within 30 min of eating any solid foods
  • Consume beverages between meals and snacks
  • Avoid carbonated beverages and higher-sugar foods

Future Recommendations

If you think you are a candidate for Bariatric Surgery, at TotalPhysiocare we can provide suitable exercise programmes specific to patients pre and post op bariatric surgery. Just give us a call on (03) 9457 7474 or stop by to enquire about the different services we can offer you to help make your weight loss journey successful. We also have an Exercise Physiologist who can supervise your exercises pre and post operatively.

Written by Alexandra McIntosh (Physiotherapist)

Email: alex.mcintosh@totalphysiocare.com.au

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