Morbidly obese people play a host to a whole lot of diseases. Most patients who walk into our clinic suffer from diabetes, high blood pressure, high cholesterol, heart disease, joint pains, gout, polycystic ovarian disease (PCOD), infertility, depression…… the list is endless.
This blog post aims to address the common queries about who is eligible to undergo weight loss surgery and to answer your question whether you are eligible for a bariatric surgery?
At what BMI does one qualify for bariatric surgery in India?
The Asia Pacific Guidelines suggest that:
- Bariatric surgery should be considered for the treatment of obesity for acceptable Asian candidates with BMI ? 35 Kg/m2 with or without co-morbidities
- Bariatric/GI metabolic surgery should be considered for the treatment of T2DM or metabolic syndrome for patients who are inadequately controlled by lifestyle alternations and medical treatment for acceptable Asian candidates with BMI ? 30 Kg/m2.
- The surgical approach may be considered as a non-primary alternative to treat inadequately controlled T2DM, or metabolic syndrome, for suitable Asian candidates with BMI ? 27.5 Kg/m2.
(IFSO-APC Consensus statement 2011)
Is there an age limit for getting bariatric surgery done?
Bariatric surgery can be safely performed in adolescents as young as 15 years. At CODS, we do not recommend bariatric surgery for adolescents younger than 15 years or for children. In patients between 15 to 18 years of age an extensive work up is recommended to determine the bone age. Surgery must be performed only for patients who have achieved the optimum bone growth.
There is no upper limit of age for patients undergoing bariatric surgery. Bariatric Surgery is recommended if the patient is medically fit and it will help to improve their quality of life.
Can a patient with uncontrolled diabetes undergo weight loss surgery?
More than 50% of morbidly obese patients who undergo bariatric surgery suffer from type 2 diabetes. Infact, most of the obese diabetic patients get bariatric surgery done for achieving better control of their sugars. In most patients, blood sugars get controlled during the 7 day pre-operative low calorie liquid diet. However it is recommended to visit your diabetologist/endocrinologist for pre-operative blood sugar control.
After bariatric surgery, number of drugs and insulin use goes down considerably. It is seen in our results, that most patients do not need to take antidiabetic medications beyond 3 to 6 months post their weight loss surgery.
Can a patient who has undergone angioplasty or cardiac bypass surgery undergo bariatric surgery?
Yes, such patients can undergo bariatric surgery. Morbid obesity and associated metabolic syndrome are risk factors for heart disease. Post angioplasty/cardiac bypass surgery if they do not lose weight or control their diabetes, they are at risk to develop further blockages in the heart as well as failure of stents. These patients are usually on blood thinner medications such as clopidogrel or aspirin. 6 months after an angioplasty. it is safe to temporarily stop these medications to facilitate bariatric surgery. This does not put them on any additional risk for stent blockage. However, cardiac fitness is mandatory prior to surgery. These patients must undergo surgery in high volume tertiary hospitals that have all medical facilities and expertise available.
Sustained weight loss after bariatric surgery decreases the risk for further cardiac events in these patients.
Should bariatric surgery be done before or after a knee replacement?
Knee replacements done, by the most expert orthopedic surgeons may fail if the patient is not able to lose weight before or after the procedure. It is advisable to undergo bariatric surgery before knee replacement. Most patients lose about 50% of their excess weight by the end of 6 months. It is advisable to undergo a knee replacement after a minimum of 6 months of bariatric surgery for best results.
Can one conceive after bariatric surgery
Weight loss improves the chances of conception in morbidly obese patients. However it is advisable to wait for a year after undergoing bariatric surgery. First year is the time when one is losing weight at a rapid pace and the baby may not be able to get enough nourishment from the mother. After the first year the intake goes up and the weight loss stabilizes. The chances of pregnancy are good and it is advisable to plan a family.