Figures from the UK indicate that around 1 in 4 are obese (body mass index [BMI] above 30) and 2% are morbidly obese (BMI above 40). People who suffer from obesity are poorly misunderstood by the rest of population. Some people wrongly think that obese people are lazy and it is their fault to be obese. Most people in western countries eat more calories than they need, storing these excess calories in their bodies as fat. It is not their fault and they need help to lose excess weight.

Being obese is associated with high morbidity and can lead to premature death. The most important associated health problems with obesity are:

• Diabetes, high blood pressure, angina and high cholesterol levels. These all increases the chances of having a stroke and heart attacks and may lead to premature death.
• Asthma and breathing problems particularly on exercise.
• Arthritis and joint pains particularly in the back, knee and hip joints.
• Infertility in women.
• Sleep apnoea which leads to disturbance of sleep, loud snoring and exhaustion.
• Overall, you are likely to die younger if you are obese.

There are a number of ways to treat obesity

• Dieting and/or exercising will make you lose weight, but it will need to be continued for life. Many people will regain all their lost weight when they stop their diet and some will then overshoot their starting weight.
• Some people try acupuncture, hypnosis or behavioural therapy to help them lose weight, but it does not usually work.
• Mechanical measures to enforce dieting like inflating a balloon inside the stomach or wiring of the jaw can make you lose weight for a short period but it will be regained back and also it is not a pleasant way of reducing weight.
• Surgical treatment for those who failed or can not do dieting and exercising is a good way of losing weight. Usually, there is no much discomfort after operation, you do not feel hungry, you achieve the weight loss in 12-18 months and you can easily maintain it.

For people who remain severely obese after trial of non surgical approaches, surgery may be the best next step.

Answers to the following questions might help you in making your decision to undergo weight loss surgery. Are you:

• Unlikely to lose weight successfully with further nonsurgical procedures?
• Well informed about the surgical procedure and the effects of treatment?
• Determined to lose weight and improve your health?
• Aware of how your life might change after obesity surgery (like adjustments to side effects and inability to eat large meals)?
• Aware of possible complications and very occasional failures?
• Committed to lifelong medical follow up?

Do you:

• Have a BMI of 40 or more?
• Have an obesity related health problem like diabetes, joint problems, high blood pressure or sleeping apnoea?
• Have an obesity related physical problem such as body size that interferes with employment, walking or family function?

Success of obesity surgery is possible only with your cooperation and commitment.

Bariatric is the management of obesity and related diseases, and the term bariatric surgery means operations to treat obesity. The most commonly used of these procedures are gastric restrictive operations (lapaparscopic adjustable gastric banding [LAGB] or sleeve gastrectomy). Combined restrictive and malabsorptive procedures include Roux-en-Y gastric bypass, biliopancreatic diversion (BPD) or BPD with duodenal switch. Restrictive operations aim to reduce food intake, whereas malabsorptive operations aim to reduce the capacity of the bowel to absorb nutrients from food. Such surgery carries risk and imposes lifelong commitments from patients and doctors. However the risks of surgery have decreased in recent years, especially with the advent of laparoscopic techniques that have reduced tissue injury and complications.

General risks as in other operations are chest and heart complications, infections, bleeding or blood clots. Specific complications to laparoscopic gastric banding include slippage of the band around the stomach or pouch dilatation. This may need reoperation but chances of it happening are small. Complications related to gastric bypass or biliopancreatic diversion (BPD) include anastomotic leak from staple line (less than 5%) and malabsorptive problems like protein deficiency, anaemia, vitamin or calcium deficiency (all of these can be addressed with appropriate vitamin tablets).

The Roux-en-Y gastric bypass involves dividing the stomach to create a 20-30 ml gastric pouch which is then closed using staples. The remaining portion of the stomach is bypassed and plays a diminished role in digestion. A Y-shaped portion of the small bowel is then attached to the gastric pouch. Laparoscopic gastric bypass is effective in reducing weight. The reported weight loss is between 60-70 % of the excess weight. Diabetes resolved in around 84% of patients, hyperlipidaemia improved in around 97%, high blood pressure resolved or improved in around 87% and sleep apnoea resolved or improved in around 95%.

In the standard biliopancreatic diversion, the lower third of the stomach is removed and the remaining stomach pouch is joined to the bowel at a level much further down than where the stomach normally join the bowel. In the duodenal switch modification, the stomach is divided vertically and the left half is removed. The duodenal is then joined to the small bowel as in the standard biliopancreatic diversion. Biliopancreatic diversion operation usually achieves 70-80 % of the excess weight loss. Diabetes is resolved in around 99% of patients, hyperlipidaemia improved in around 99%. High blood pressure and sleep apnoea resolved or improved in around 75% of patients.

Sleeve gastrectomy involves removing around two thirds of the stomach and leaving a narrow sleeve of stomach. It is relatively simple procedure and can be undertaken as a sole bariatric operation or as initial weight loss procedure followed by duodenal switch or gastric bypass.

In our unit we perform all types of obesity surgery laparoscopicaly (key hole) and this leads to quick recovery and less complications. You will be staying in hospital 2-4 days according to the procedure you had. You will be drinking and eating liquid diet before leaving hospital and will continue on this for 3 weeks. If you had laparoscopic gastric banding, you will follow certain diet for a number of weeks. After sleeve gastrectomy, gastric bypass and biliopancreatic diversion, you will be eating normally but the size of the meal will be much reduced. Most people will be back to normal activities after 2-3 weeks.

You will have regular follow up with your surgeon and the dietician and you will be given a telephone number to ring if you have any problem. After the first year you will be followed up once or twice yearly. You will have blood tests at intervals to check any deficiency, and normally you will take a vitamin supplement tablet every day.