Bariatric, Metabolic & Diabetes Surgery Singapore
What is obesity?
Obesity is a medical condition that occurs when a person has excess weight or body fat that might affect their health.
In Singapore, bariatric surgery is generally considered only for patients with a Body mass index (BMI) which is a tool that doctors use to assess if a person is at an appropriate weight for their age, sex, and height. The measurement combines height and weight.
A BMI between 25 and 29.9 indicates that a person is carrying excess weight. A BMI of 30 or over suggests that a person may have obesity. This may vary depending on the ethnicity of the individual.
Other factors, such as the ratio of waist-to-hip size (WHR), waist-to-height ratio (WtHR), and the amount and distribution of fat on the body also play a role in determining how healthy a person’s weight and body shape are.
Maintaining a healthy weight or losing through diet and exercise is one way to prevent or reduce obesity. In some cases, a person may need surgery.
What are some of the causes of obesity?
- Excess calories
When a person consumes more calories than they use as energy, their body will store the extra calories as fat. This can lead to excess weight and obesity.
Also, some types of foods are more likely to lead to weight gain, especially those that are high in fats and sugars.
Foods that tend to increase the risk of weight gain include:
- fast foods
- fried foods, such as french fries
- fatty and processed meats
- many dairy products
- foods with added sugar, such as baked goods, ready-made breakfast cereals and cookies
- foods containing hidden sugars, such as ketchup and many other canned and packaged food items
- sweetened juices, sodas, and alcoholic drinks
- processed, high-carb foods, such as bread and bagels
Some processed food products contain high-fructose corn syrup as a sweetener, including savory items, such as ketchup.
Eating too much of these foods and doing too little exercise can result in weight gain and obesity.A person who consumes a diet that consists mainly of fruits, vegetables, whole grains, and water is still at risk of gaining excess weight if they overeat, or if genetic factors, for example, increase their risk.
However, they are more likely to enjoy a varied diet while maintaining a healthy weight. Fresh foods and whole grains contain fiber, which makes a person feel full for longer and encourages healthy digestion.
- Sedentary lifestyle
Many people lead a much more sedentary lifestyle than their parents and grandparents did.
Examples of sedentary habits include:
- working in an office rather than doing manual labor
- watching excess TV
- playing games on a computer instead of doing physical activities outside
- going to places by car instead of walking or cycling
The less a person moves around, the fewer calories they burn.
Also, physical activity affects how a person’s hormones work, and hormones have an impact on how the body processes food.
Several studies have shown that physical activity can help to keep insulin levels stable and that unstable insulin levels may lead to weight gain.
Researchers who published a review in BMJ Open Sport and Exercise Medicine in 2017 noted that, while the designs of some studies make it hard to draw exact conclusions, “A lifestyle incorporating regular [physical activity] has been identified as a key factor for maintaining and improving many aspects of health, including insulin sensitivity.”
Physical activity need not be training in the gym. Physical work, walking or cycling, climbing stairs, and household tasks all contribute.
However, the type and intensity of activity may affect the degree to which it benefits the body in the short- and long-term.
- Sleep Deprivation
Research has suggested that missing sleep increases the risk of gaining weight and developing obesity.
Sleep deprivation may lead to obesity because it can lead to hormonal changes that increase the appetite.
When a person does not sleep enough, their body produces ghrelin, a hormone that stimulates appetite. At the same time, a lack of sleep also results in a lower production of leptin, a hormone that suppresses the appetite.
- Metabolic and endocrine disorders
Various endocrine disorders can also lead to obesity such as hypofunctioning of the thyroid gland and disorders associated with the adrenal gland.
Metabolic disorders can also result in obesity.
A team from the University of Barcelona published a study in the World Journal of Gastroenterology that provides clues as to how liquid fructose — a type of sugar — in beverages may alter lipid energy metabolism and lead to fatty liver and metabolic syndrome.
Features of metabolic syndrome include diabetes, cardiovascular disease and high blood pressure. People with obesity are more likely to have metabolic syndrome.
There is a link between high consumption of fructose and obesity and metabolic syndrome. Authorities have raised concerns about the use of high-fructose corn syrup to sweeten drinks and other food products.
Animal studies have found that when obesity occurs due to fructose consumption, there is also a close link with type 2 diabetes.
Researchers also note that “increased fructose intake may be an important predictor of metabolic risk in young people.”
Hence, there needs to be changes in the diets of young people to prevent these problems.
Some medications can also lead to weight gain.
Results of a review and meta-analysis published in The Journal of Clinical Endocrinology and Metabolism in 2015 found that some medicines caused people to gain weight over a period of months.
However, some medications may lead to weight loss. Anyone who is starting a new medication and is concerned about their weight should ask their doctor whether the drug is likely to have any effect on weight.
A faulty gene called the fat-mass and obesity-associated gene (FTO) is responsible for some cases of obesity.
A study published in 2013 points to a link between this gene and:
- behaviors that lead to obesity
- a higher food intake
- a preference for high-calorie foods
- an impaired ability to feel full, known as satiety
The hormone ghrelin plays a crucial role in eating behavior. Ghrelin also affects the release of growth hormones and how the body accumulates fat, among other functions.
The activity of the FTO gene might impact a person’s chances of having obesity because it affects the amounts of ghrelin a person has.
In a study involving 250 people with eating disorders, published in Plos One in 2017, researchers suggested that aspects of FTO might also play a role in conditions, such as binge eating and emotional eating.
What is Bariatric Surgery?
There are a number of ways you can lose weight, including diet, exercise, medication and surgery. Bariatric surgery is a broad term used to describe a number of procedures that help people lose weight. It works by reducing the amount of food you can eat or reducing the nutrients you can absorb.
According to the American Society of Metabolic and Bariatric Surgery, patients who were severely obese lose at least half of their excess weight through bariatric surgery.
What is Metabolic surgery?
Metabolic surgery is surgery done to treat metabolic disorders associated with obesity. These conditions include Type 2 Diabetes, High blood pressure, high cholesterol and related conditions. Sometimes, these conditions may not be related to obesity.
Why is a bariatric surgery or metabolic surgery done?
Bariatric surgery helps an obese person lose weight by reducing the capacity of their digestion and appetite. A person with a body mass index of 30 or more is considered obese. Other factors like muscle mass and waist circumference also factor into a diagnosis of obesity.
People consider bariatric surgery when the BMI is 40 or above. It might also be recommended for people with a BMI between 30 and 40 if they also have diseases such as diabetes, high blood pressure, fatty liver, or sleep apnea.
Obesity can cause a host of health issues including
- heart disease
- high blood pressure
- liver disease
- digestive issues
- sleep apnea
- back pain
- psychological issues
Obesity is a major health problem worldwide and bariatric surgery provides the most significant and sustained weight loss solution for obese patients. Nevertheless, patients should consider bariatric surgery only after exhausting other options for weight loss like dieting, exercise and drug treatments.
What are the types of bariatric surgery?
Bariatric surgery may be “restrictive,” which reduces the amount of food intake, or “restrictive/malabsorptive,” which restricts intake and interferes with the digestion as well. Currently, there are four standard types of bariatric surgery procedures as follows:
Laparoscopic adjustable gastric banding
- This is a restrictive surgery in which the surgeon places an inflatable band over the top portion of the stomach.
- This divides the stomach into two sections, creating a small pouch on top of the main stomach, connected to it by a small channel.
- This slows down the passage of food that goes into the main stomach, consequently reducing the quantity of intake.
- The opening to the main stomach can be controlled by inflating or deflating the band with a port implanted under the skin.
- This surgery is reversible as the band and port can be removed if no longer needed.
Gastric sleeve or sleeve gastrectomy
- This is a restrictive laparoscopic surgery in which the surgeon removes about 75% to 85% of the stomach and leaves only a small pouch which is stapled.
- This reduces the quantity of food intake and does not affect the absorption of nutrients.
- It reduces the production of the stomach hormone that stimulates appetite and curbs hunger.
- This is sometimes performed as the first step in a series of weight loss surgeries.
- This is not reversible.
Gastric bypass or Roux-en-Y surgery
- This surgery is restrictive/malabsorptive and involves two procedures.
- The surgeon first staples the stomach creating a small pouch.
- Then they cut the small intestine and attach the lower part of it directly to the pouch, bypassing a major part of the stomach and small intestines.
- The bypassed section is then connected farther down the small intestine to allow digestive juices in.
- The bypass causes changes in gut bacteria and gut hormones and induces malabsorption besides restricting calorie intake.
- It is a difficult procedure to reverse this but can be done if medically necessary.
Biliopancreatic diversion with duodenal switch
- This is a restrictive/malabsorptive surgery performed in two steps.
- First a sleeve gastrectomy is performed in which 50% of the stomach is removed.
- Then the surgeon connects the pouch to the end of the small intestine bypassing most of it.
- The bypassed section is connected farther down to allow entry of digestive juices.
This surgery is not reversible.