Understanding Bariatric surgery is an in-depth presentation discussing this medical procedure performed to help individuals with severe obesity achieve weight loss and improve their overall health. It involves modifying the digestive system to restrict food intake or alter nutrient absorption. Common techniques include gastric bypass, gastric sleeve, and gastric banding. Bariatric surgery requires careful patient selection and ongoing postoperative care.

1. UNDERSTANDING
BARIATRIC SURGERY
Dato Dr Anitha Haniffa
Consultant General Surgeon
CEO MAHSA Specialist Hospital
Director of MAHSA Group

2. PRESENTATION AGENDA
What
Who
Why
Which
When
How

3. WHAT IS OBESITY?
WHO and NIH guidelines for Asian:
• Overweight: BMI 23 - 24.9 kg/m2
• Obese: BMI >25 kg/m2.

4. PREVALENCE OF
OBESITY
Obesity is a growing global health concern.
Prevalence has tripled since 1975 (WHO)
In 2016, > 1.9 billion adults were overweight; and
over 650 million adults and 340 million children
were classified as obese
WHO estimates by 2025, the numbers will go
up by another 167 million.
The need for effective interventions is crucial.

5. OBESITY AND
TRADITIONAL METHODS
OF WEIGHT LOSS
Diet and exercise often struggle to produce
sustainable weight loss and, the weight
reduction needed in individuals with severe
obesity.

6. Physiological Factors Psychological Factors Genetic Predisposition
▪ Leptin Resistance
▪ Altered Energy Expenditure
▪ Hormonal Imbalance
▪
▪ Gut Microbiota
• Emotional Eating
• Food cravings
• Reward seeking
• Chronic stress
• Disordered eating habits
• Lack of self esteem
• Low motivation
• Unrealistic expectations
• Metabolism
• Appetite Regulation
• Fat Storage and Distribution
• Response to Exercise
WHY IS THAT?

7. TREATMENT OPTIONS
FOR OVERWEIGHT
Lifestyle Modifications
Dietary Interventions
Physical Activity
Behavioural Therapy
Medical Management
Multidisciplinary Support

8. TREATMENT OPTIONS
FOR OBESITY
Comprehensive Lifestyle Modifications
Medical Supervision and Monitoring
Structured Weight Loss Program
Pharmacotherapy
Bariatric Surgery
Long-Term Support and Follow-Up

9. Indication:
 In both overweight/obese
 when lifestyle modifications and weight
loss medications have not achieved
sufficient weight loss or
 when surgery is not feasible or desired.
 Can serve as a temporary tool to
jumpstart weight loss,
Note: but long-term success relies on
adopting and maintaining a healthy lifestyle
Types:
 Fluid-Filled Balloons
 Gas-Filled Balloons
INTRA-
GASTRIC
BALLOONS

11. WHAT IS BARIATRIC SURGERY?
 Bariatric surgery is a surgical procedure for weight
loss.
 Has emerged as a viable option for achieving substantial and long-
term weight loss, as well as improving or resolving obesity-related
comorbidities
 It is not a standalone solution but rather a part of a
comprehensive approach to weight management.
 Lifestyle changes and medical management are still
primary interventions for weight loss.

12. HEALTH
BENEFITS OF
BARIATRIC
SURGERY
• Sustained Weight Loss
• Enhanced Quality of Life
• Potential Long-Term
Remission
• Psychological and Emotional
Benefits
• Reduced Mortality and Health
Risks
• Improved Fertility and
Pregnancy Outcomes
• Multidimensional Gains

13. CRITERIA FOR
SURGERY
 Body Mass Index (BMI) ≥ 37.5 kg/m²
 BMI ≥ 32.5 kg/m² with metabolic syndrome
and/or otherobesity-related comorbidities
Obesity-related comorbidities, such as:
▪ Type 2 diabetes
▪ Hypertension
▪ Sleep apnea
▪ Dyslipidemia
▪ CVS disease
▪ Non-alcoholic fatty liver disease (NAFLD)

14. REFERRAL PROCESS
• Initial assessment and evaluation of general condition
• Identification of eligible candidates
• Discussion and Education with primary physician
• Referral to bariatric surgeon
• Bariatric surgeon evaluation
• Multidisciplinary assessment
• Lifestyle change monitoring and chronic disease Mx by primary physician
• Surgery and follow-up care
• Ongoing care and support by primary physicians and surgeon and

15. TYPES OF GASTRIC SURGERY
Restrictive
(LSG/Banding)
Reduced gastric
volume
Malabsorptive
(BPD/BPD-DS)
Diversion
of digestive liquids
Shorten bowel
Combined Procedure
(RYGB)
Both restrictive and
malabsorptive
components

16. GASTRIC BANDING SLEEVE GASTRECTOMY
TYPES OF GASTRIC SURGERY

17. ROUX-EN-Y GASTRIC BYPASS MINI GASTRIC BYPASS
TYPES OF GASTRIC SURGERY (cont.)

18. MYTHS & CONCERNS
 Fear of Surgical Risks
 Nutritional Deficiencies
 Fear of Regaining Weight
 Misunderstanding of Dietary Restrictions
 Perception of "Easy Way Out"

19. LONG TERM
CHALLENGES
A. Nutritional Deficiencies
B. Weight Regain
C.Psychological and Emotional Factors
D. Body Changes and Loose Skin
E. Long-term Medical Management
F. Lifestyle Maintenance

20. MULTIDISCIPLINARY
APPROACH Fitness Physio
Ortho/
Sports
Anaes/
Intensivist
Surgeon
Physician
GP
Dietician

21. COLLABORATIVE
CARE
Crucial in optimizing patient
outcomes.
Holistic approach in addressing
both pre- and postoperative
needs.
Includes:
1. Ongoing Communication
and Coordination
2. Preoperative Management
3. Postoperative Support
4. Long-Term Maintenance

22. TAKE AWAY’S
 Effective Rx option for patients with severe obesity, providing sustained
weight loss, improvement in comorbidities, and enhanced quality of
life.
 It is not a standalone solution
 Nutritional deficiencies can occur after surgery and require regular
monitoring and appropriate supplementation.
 Obesity is a serious health concern with profound implications for both
individuals and society. As healthcare providers, it is crucial to counsel
patients about the impact of obesity and help them access the care
they need, including considering bariatric surgery when appropriate.

23. OPENING FEBRUARY 2024
A 250 bed, state-of-the-art private healthcare facility with a comprehensive range of
specialties such as medical, surgical and mental health services; in addition to ambulatory
care, rehabilitation, aged care, and other community programs.
MAHSA SPECIALIST HOSPITAL

24. THANK YOU