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27 October 2008

Morbid obesity – is surgery the only solution?

For various reasons it seems that for many people bariatric surgery is the only answer to obesity. Luckily these procedures are now more widely available in South Africa.

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On 23 October the Pretoria News featured an article on laparoscopic adjustable gastric band operations for the treatment of morbid obesity. Titled “I was Obese until I had a Gastric Band Op... So I let my Son have the Surgery Too”, this article recounts the experiences of Dianne Coetzer and her son Blaine who both have had operations to help them to lose weight. In the 12 months since placement of the band, Dianne has lost 30 kg. Blaine is also the youngest patient so far, to undergo gastric banding in South Africa (Naidoo, 2008).

Update on bariatric surgery
In January of this year I attended a Bariatric Workshop organised by SASOM (The SA Society for Obesity & Metabolism) which featured guest speakers such as Prof Arne Astrup, the President of the IASO (International Association for the Study of Obesity) who spoke on the subject of Very-Low-Calorie Diets (VLCDs). According to Prof Astrup, VLCDs can be successful and some obese patients lose up to 15% of their initial body weight. He also mentioned that low-fat, high-protein diets based on the Atkins principle (the original Atkins diet was high-fat, high-protein), are gaining ground and are of course popular with the public because they initially cause rapid weightloss.

Researchers are, however, finding that high-protein diets cannot be sustained for long periods and that the fallout rate is very high. Most people can only stick to these diets for a limited time and then revert to their old eating habits which usually results in rapid weight gain of all the weight that was initially lost. It would, therefore, seem evident that for many people bariatric surgery is the only answer to obesity. Luckily these procedures are now more widely available in South Africa.

Bariatric Centres of Excellence
Prof Tessa van der Merwe, one of the leading researchers in the field of obesity in South Africa, announced that Netcare have opened a number of Bariatric Centres of Excellence in the following cities and towns: Pretoria, Johannesburg, Alberton, Benoni/Boksburg, Bloemfontein, Durban, Pietermaritzburg, George, and Cape Town. Contact the central information service at 0861 623 7489 or visit: www.netcare.co.za for more information. Dietary Treatment Before and After Surgery One of the speakers at the Workshop, Renate Wilson (2008), who is a registered dietitian, spoke about “Dietary Preparation of the Bariatric Patient: Pre/Post Surgery”. Wilson emphasised that patients who are going to undergo bariatric surgery need careful monitoring by a dietitian before and after surgery. The pre-operative period has 2 phases:

a) Pre-Operative

  • Phase 1 (2-3 months before surgery):
    Patients who are about to undergo surgical procedures to lose weight, must change their eating habits to try and lose up to 7% of their weight before the operation. This improves the success of the surgery. So make sure that you see a dietitian before your op. This will be arranged for you at the Bariatric Centres of Excellence.
  • 2) Phase 2 - just before surgery
    Patients need to go on a soft diet for one week and then on a full liquid diet to get the digestive tract ready for the surgery. Your dietitian will advise what foods are allowed during this period.

b) Post-Operative
After successful surgery, patients must learn to change their eating habits drastically. They should also learn not to eat and drink at the same time because the size or capacity of their stomach has been reduced to such a great extent. It is also important to avoid dehydration, so patients need to sip small volumes of permitted liquids all day long.

Behaviour modification is also essential. Patients must learn to chew their food carefully and thoroughly and to eat slowly. During the initial months, all socialising is taboo because alcohol and large fatty meals are forbidden.

No one should think that they will automatically lose weight after a bariatric operation if they continue to eat high-fat foods and highly refined carbohydrates (sugary foods), thus increasing the patient’s energy intake to levels where weightloss will not occur.

Bariatric patients will also have to take vitamin, mineral and amino acid supplements for the rest of their lives.

Immediately after the operation patients will be on a full liquid diet for two weeks. Thereafter they go on to a pureed diet for another two weeks. This is followed by soft, light diets for two weeks. Your dietitian will then work out a balanced eating plan that you can use for the rest of your life to ensure that you do not suffer negative side-effects, that you lose weight steadily, that you remain healthy and most importantly, that you don’t regain all the weight you have lost with the operation!

It is evident that many individuals who have unsuccessfully tried every diet and slimming pill on the market and are suffering from morbid obesity, can benefit greatly from bariatric surgery. But this is not something that anyone should undertake lightly and without being fully aware of all the risks and changes such an operation will cause in his or her life. Get as much information as possible, think carefully about what it means to have such an operation and only when you have thoroughly explored every aspect and have come to a sensible, non-emotional decision, should you have this type of operation.

What do you think about the topic “Morbid Obesity - Is Surgery the Only Answer?” If you have any diet queries, post a question or message on the message board. I am here to assist you with your Diet and Food Choices, so let’s interact. Remember, I really care about you.

- (Dr I.V. van Heerden, aka DietDoc, October 2008)

References: (Astrup, A (2008). VLCD - The Myths & Strengths. SASOM Bariatric Workshop, 14 Jan 2008, Centurion; Naidoo, O (2008). I was obese until I had a gastric band op ... So I let my son have the surgery too. Pretoria News, 23 Oct 2008, p: 16; Wilson, R (2008). Dietary Preparation of the Bariatric Patient: Pre/Post Surgery. SASOM Bariatric Workshop, 14 Jan 2008, Centurion)

 
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