Why, who, when and what of
weight loss surgery
Dr Pradeep jain, M.Ch
Dept of GI Cancer and Bariatric Surgery
Fortis Hospital Shalimar Bagh
Namokar Gastro Clinic
IA 46 A Ashok Vihar Phase 1 Opp Mont Fort School
Excess body fat leading to deleterious
effect on health
BMI ( Body Mass Index )
Weight (kg) / square of height ( meters
Problem of obesity in India
National health survey (2007)
15% of Indian population fat
Out of these 1/3rd are morbidly
WHY ARE WE SO
• Consumption of foods high in
(excessive sugar and fat)
• Consumption of too much food
• Not enough exercise/sedentary
• Inheriting “fat genes” from our
Fat ? So what ?
Weight comes with a price
High blood pressure
Impact of BMI on Longevity
Impact of Obesity on Mortality and Years of Life Lost
Graph represents years of life lost for white men.
Fontaine KR, Redden DT, et al. Years of life lost due to obesity. JAMA 2003;289:187.
Why should treat obesity at all
To increase survival
Improve quality of life
Decrease medicine intake
Decrease hospital expenses
Sustained weight loss
Good quality of life
Resolution of obesity related diseases
Low risk treatment modality
What to do ?
Disadvantages of medical
• Most patients (95-97%) regain most or
all of the weight that was lost within
2-5 years following diet or drug
• The average amount of weight loss is
relatively small – 5-10 kg
• Drug therapy may be associated with
Medical vs Surgical Therapy for
Medical (lifestyle changes and pharmacotherapy) vs
Surgical Therapy for Obesity
Percent Excess Weight Loss
Source: O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive
medical program. Ann Intern Med. 2006;144:625-633.
Why Surgery ?
Only known method for sustained
Risks are far less than risk of
continuing with morbid obesity and
Lead to hormonal changes leading to
resolution of co morbidities
Schneider BE, Mun EC .Surgical Management of Morbid Obesity. Diabetes care 2005;28(2): 475-80
Contraindication for bariatric
History of substance abuse, eating
or major psychiatric problem which is
untreated and/or unresolved
Patients who are too ill or too high a
risk for surgery
Women who may become pregnant
Types of surgery
What is the postoperative diet
Liquid diet for 2-3 weeks
Puree diet for 1-2 wks
Soft diet for 1-2 wks
Normal diet after that
Avoid sweets, aerated drinks , drinking
water with meals
Concerns after surgery
Is it safe ?
What are the side effects or complications ?
Will I continue to loose weight and become
below normal ?
What will be my diet after surgery ?
Will I require medicines through out life?
Will there be any problem in getting pregnant
Will there be regain of weight after some
How much time it will take to reduce weight ?
Will my tissues and skin get loose after
Is it reversible?
Bariatric Surgery Has a Low Incidence of Mortality
Mortality Rates (%)
rate when performed at a Bariatric Surgery Center of Excellence; Bariatric Surgery: DeMaria EJ, Pate V, Warthen M et al. Baseline data from American
Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database, Surgery for
Obesity and Related Diseases. Article in Press.
2Dolan JP, Diggs BS, Sheppard BC et al. The National Mortality Burden and Significant Factors Associated with Open and Laparoscopic Cholecystectomy: 1997–
2006. J Gastrointest Surg. 2009; 13:2292-2301
3Lie SA, Engesaeter LB, Havelin LI et al. Early postoperative mortality after 67,548 total hip replacements. Acta Orthopaedica 2002; 73(4):392-399
4Ricciardi R; Virnig BA, Ogilvie Jr. JW. Volume-Outcome Relationship for Coronary Artery Bypass Grafting in an Era of Decreasing Volume. Arch Surg.
Medical Co-Morbidities Resolved
Type 2 Diabetes
Wittgrove AC,Clark GW. Laparoscopic Gastric bypass roux-n-y-500 patients. Obes Surg 2000. And others.