Weight Loss Surgery

The outlook is grim. The World Health Organization estimates that 1.6 billion people worldwide are overweight or obese. The death toll associated with obesity runs to 2.5 million annually, and the numbers haven’t reached their peak. The British Heart Foundation predicts that half the population of the UK could be obese within 25 years. The toll on health and quality of life is enormous. So is the price tag. A 2007 UK report estimated an annual loss in healthcare costs and lost working hours at £45billion (about US$72 billion).

Some of us don’t have to look at the statistics or the crowd to see the problem. We need only look down at our own bulging bellies. If excess weight were merely a matter of vanity or style, we might buy a bigger belt and forget about it, but we cannot.

Overweight and obesity are serious threats to health and longevity. In truth, body fat kills—not directly, but indirectly through its consequences: heart disease, stroke, diabetes, liver disease, and cancer. What’s more, the greater the fat load, the greater the risk of disease, disability, and an early demise.

Surely many of us attempt to lose weight. We all know the mantra, “Exercise more and eat less,” and who among us hasn’t tried? At any given time, 41 percent of Americans are on a diet. Their average weight loss goal is 37 pounds (nearly 17 kilograms). Some of them achieve their goal but, sadly, five years after their diets end, 95 percent of dieters end up heavier than they were before they started.

For too many, weight gain continues year after year, inexorably leading to severe obesity, a chronic condition that is difficult to treat with diet and exercise alone.

That’s where bariatric surgery comes in. For those considered severely obese (an excess of 80 pounds [36 kg] for women and 100 pounds [45 kg]) for men), surgery that reduces food intake, food absorption, or both, can be a lifesaver. The weight loss that follows reduces the risks of developing diabetes and heart disease. It achieves other health benefits as well.

In a study reported by the American College of Allergy, Asthma and Immunology, rapid weight loss after bariatric surgery resulted in a 50 percent reduction in use of prescription breathing medications. In another study, Johns Hopkins researchers showed that women who delivered babies after bariatric surgery reduced their risk of preeclamsia (high blood pressure during pregnancy) by a whopping 75 percent, compared to obese women who delivered before having the surgery.

Why It Works for Medical Travel

It’s a matter of time and money. According to the National Institutes of Health, bariatric surgeries in the US cost, on average, between US$20,000 and US$25,000. Obese patients who need such procedures may have trouble finding ways to pay.

Some private health insurance carriers cover bariatric operations, while others do not. Low-income or age-65+ patients in the US may apply for assistance under government-sponsored Medicaid or Medicare plans, but they may be denied support in some instances. Middle-income, middle-age patients have no such options; they may be forced to foot the entire bill themselves, and that makes medical travel overseas attractive.

Bariatric patients can save 50 percent or more by traveling abroad.

In countries with national health plans, financial support may be available (although fewer than half of all bariatric surgeries in the UK are covered under the National Health Service), but waiting lists can be as long as three or four years. During that time, obesity can worsen and serious diseases such as diabetes can develop. Some patients would rather travel than wait.

Special Considerations

Desperate to achieve weight loss, some patients overlook or minimize the dangers that bariatric surgeries pose. For example, the decreased absorption of food energy, vitamins, and minerals that occurs after a duodenal switch procedure raises the risk of malnutrition and the poor health that can go along with it.

Complications include bleeding, infection, leaks in the intestines, and blood clots in the legs that can travel to the heart, lungs, or brain (causing strokes or heart attacks). Other possible complications include hernias and constrictions in the digestive track, which may result in pain, nausea, vomiting, and an inability to eat.

Patients should also remember that one procedure may not be enough, and that a second or third revisional bariatric surgery may be required. The three main reasons for revisional bariatric surgery are unsatisfactory weight loss after the initial procedure; severe nutritional complications such as protein malnutrition; and intolerable side effects such as blocking or narrowing of the digestive tract.

Planning Tips

Bariatric surgery has boomed in recent years, and clinics have sprouted up on every corner. Some of them employ highly skilled and experienced surgeons; others are downright exploitative with questionable provenance and doubtful integrity. Bariatric patients are prudent to check their surgeon’s credentials and their hospital’s track record carefully before committing to any procedure. If you get a “sales pitch” that puts price before your health, offer a polite but firm, “No, thank you.”

Home-Again Tips

About 10 percent of bariatric-surgery patients lose too little weight after the surgery or regain the weight they lose. Bariatric surgery is not a magic fix. It is not an end but a beginning. Patients must commit themselves to aggressive lifestyle modification practices, including carefully controlled dietary restrictions and exercise routines if permanent weight management is to be achieved. That means good communication with a local doctor and a firm commitment to eating right and staying healthy—for a lifetime.

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Last updated on 22 November 2013