1. Am I morbidly obese?
The Body Mass Index (BMI) is probably the best way of assessing obesity. Calculate your BMI with this formula:
BMI = weight in kilograms / height in metres2
You are healthy if your BMI is between 20-23, overweight if between 23-27, obese if between 27-40 and morbidly obese if over 40. These cut-off values tend to be lower than those recommended for Caucasians as it has been found that Asians develop medical complications from obesity earlier. Obesity is related to chronic debilitating illnesses such as diabetes, hypertension, heart disease, some cancers, obstructive sleep apnoea and osteoarthritis. In general, if your weight exceeds 50% of your ideal body weight, the risk of an early death is doubled compared to someone who is not obese.
2. Do I need treatment if I am overweight or obese?
Yes, your quality of life will certainly improve with a weight management programme. We always recommend a combination of dieting, exercise, behavior modification and medication. All these work to a certain degree and may be sufficient if you are moderately overweight. Unfortunately, most studies have shown that they will not be effective in the long run for most people. The only treatment that achieves sustainable results seems to be some form of weight loss surgery.
3. What is weight loss surgery?
Weight loss surgery should be considered if the desired weight loss cannot be achieved by non-surgical methods and the obesity poses a serious threat to the patient's health. The main indications for surgery are a BMI of greater than 40, or greater than 32 in the presence of associated medical complications of obesity.
There are a variety of operations that can be done. All of these operations act either by producing early satiety from gastric restriction (eg gastric banding or vertical banded gastroplasty), or by creating a state of malabsorption in the gastrointestinal tract (eg gastric bypass or biliopancreatic diversion). All these operations can be performed by either conventional open surgery (as we used to do in the past) or laparoscopic surgery (the preferred approach nowadays).
We find that for Asian patients, the Laparoscopic Gastric Banding comes close to being an ideal operation as it is a simple procedure with low risks and is also highly effective. There are many types of gastric bands available commercially but our preference if the Swedish Adjustable Gastric Band (SAGB). Most bands are very similar in design but we like the SAGB as it is a soft band. The results of surgery with different bands are also very similar and it is probably best to let your surgeon choose the product he is most comfortable with.
4. How is the Swedish Adjustable Gastric Banding done?
The SAGB procedure is performed laparoscopically through keyhole incisions. The pliable band is inserted around the upper stomach and stiched into place. This creates a small gastric pouch that limits the quantity of food that the stomach can hold. This produces a feeling of satisfaction and fullness even after a small meal. As the band slows down the emptying of food from the pouch, you will remain full for a number of hours after each meal.
The band is attached to a reservoir port that is implanted under the skin over the breastbone. If required, we can inject some saline into this port to adjust the size of the band after surgery. The procedure can be done in the clinic and allows us to calibrate the amount of weight loss required.
5. How do I prepare for Laparoscopic Gastric Banding surgery?
All of our patients are put on a comprehensive weight loss programme. You will be assessed by an endocrinologist to exclude a hormonal problem which may be the cause of the obesity. You will also receive counseling by a dietician and, if necessary, referred to a psychologist for behavior medication and assessment of eating disorders. We will also perform a gastroscopy (to assess the anatomy of the stomach) and an abdominal ultrasound (to exclude gallstones).
6. What happens after surgery?
Most patients are admitted on the day of surgery and stay inpatient for 2 to 3 days after surgery. You will be put on a liquid diet for month after surgery. You will then be re-introduced to puree and solid foods slowly. In general, we target a weight loss of 0.5 to 1 kg a week. You will loss about 60% of your excess weight 2 years after surgery.
7. What are the risks of surgery?
Laparoscopic gastric banding is a safe procedure. Nevertheless, there are definite risks as in any operation for an obese patient. This may be related to the general anaesthesia or to the surgery itself. Specific complications related to the band include band slippage, erosion or infection.