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THE BURDEN OF OBESITY
No one knows just how heavy a burden obesity is than Mrs. Michelle Wilkerson-Butiu. She narrates, "Ever since I was six years old, I was already very heavy. I became conscious of my weight when I reached High School, and I tried to lose the extra pounds. I've done all the diets, including Atkins diet and pure vegetable diet. I even tried diet pills, but none of them worked. I kept on getting those pounds back. When I started having problems with my obesity, especially rashes that developed in the flabs of my stomach, my grandmother asked me why I don't have my stomach reduced? My aunt introduced me to her doctor, who recommended that I undergo bariatric surgery."
Obesity: A Growing Health Problem
According to Michelle's doctor, St. Luke's Medical Center's Dr. Reynaldo P. Sinamban, who is also a member of the American Society for Bariatric Surgery, "Around 2.6 percent of the Philippine population is overweight and morbidly obese. This is not purely an affliction of the affluent. You see it among lower and middle income groups."
Obesity is multifactorial, meaning it is caused by a number of factors, which include…
• Excessive food intake attributed to the "fast food mentality"
• Lack or no physical activity
• Genetics
• Endocrine problems, especially hypothyroidism
The term "morbid obesity" was derived from the number of metabolic complications (or "co-morbidities") that arise when one gains too much weight. Some of these co-morbidities are…
• Diabetes
• Hypertension and heart disease
• Joint problems
• Infertility
• Varicosities
• Snoring
• Sleep apnea
However, obesity's greatest impact is on the psychological well-being of the patient.
"When a patient is overweight, they already have some problems like diabetes and hypertension, which limits him/her from doing physical activities, but the psychological problems are rarely highlighted," Dr. Sinamban laments. "Obese persons can't enter the gym because they're too big. Others would not want to go out of the house at all. They can't date. They can't get work, because the perception is that fat people are lazy. So they suffer in silence. Can you just imagine how difficult it is for an obese patient to take a bath alone, especially among the young? They could not bathe well because they could not reach certain parts. They become ashamed and depressed. As a reward for depression, they eat and gain more weight. It's a vicious cycle. They seem happy and jolly on the surface, but it's only a compensation for their hardships inside."
But now, there is hope for the morbidly obese in bariatric surgery using Johnson & Johnson's BFAD-approved Swedish Adjustable Gastric Band (SAGB).
Candidates for Bariatric Surgery
Dr. Sinamban is often asked if bariatric surgery is the latest liposuction. "Bariatric surgery itself is not a cosmetic procedure. It is a major surgery that addresses the metabolic complications of obesity."
Who are the patients qualified to undergo bariatric surgery? These are patients with a Body Mass Index or BMI (computed as weight/height) of 35 and with co-morbidities. They are also given a psychological evaluation by their team psychiatrist.
"The patient is advised that bariatric surgery is not about sculpturing or contouring of the body. It's more of a health issue," says Dr. Sinamban. "Weight loss is just a bonus. What we're really addressing are the complications."
The good doctor notes that most patients are concerned about the drastic reduction in food intake. "We always prime our patients by making them go on a diet for two weeks before surgery. If there is enthusiasm and compliance for them to lose weight, the chances of success are high."
Bariatric Surgery and the SAGB
Bariatric surgery is performed laparoscopically by creating small incisions in the abdominal wall to allow passage of tubes and instruments. The uppermost part of the stomach is fitted with the SAGB, which is sutured to the stomach lining. Depending upon the weight requirements of the patient, the SAGB is inflated with sterile water that is injected through a port and tube outside the body. This tightens the SAGB around the stomach like a belt, forming a small pouch in the upper part of the stomach. As this stomach is filled with food, nerve fibers send early signals of fullness (satiety) to the brain. Eating more food that is necessary will lead to vomiting.
Michelle recalls her experience after surgery. "I was already ambulatory. At first, I was used to a big stomach so that I don't feel any food going in. The first time I ate after surgery, I felt the good inside the stomach, like it's going through a hole. After three tablespoons of soup, I was really full. I felt like I didn't want to eat more."
Food Intake After Surgery
Immediately after surgery, patients are first placed on a liquid diet for the first four weeks. In the next two weeks, small portions of mashed, pureed foods are allowed. Thereafter, the diet is gradually supplemented with normal foods. Because there is rapid weight loss during the first period, the patient is given vitamin drinks.
As Dr. Sinamban explains, "The surgery disciplines patients to be aware of what types of foods they can take. It's an awareness of calories counting."
Michelle discovered that she had lost her craving for certain foods. "I don't look for foods, like sweets or softdrinks. I am more attuned to the taste of food because I chew it thoroughly. Once I taste the food, it's okay. I won't look at it anymore."
Although surgery with the SAGB is reversible, Dr. Sinamban prefers that patient keep the SAGB for a lifetime to prevent weight regain. "Weight regain is always two times of what you lose. This is the major pitfall of dieting. You lose ten pounds now, but you gain twenty pounds later. It's a yoyo diet. Having the SAGB prevents them from overeating."
The Rewards of Bariatric Surgery
Individuals who are still doubtful about bariatric surgery should see the results.
As Michelle happily attests, "When I went through this procedure, I was very happy with the results. Within six months, I lost 170 pounds from my original 400 plus pounds weight. I am now 230 pounds and targeting my ideal weight of 150 pounds. I know how it feels going through a lot of heartaches, being ridiculed and being trapped by a big body. Going through bariatric surgery is the best decision I had ever made, because I did it for my husband, my son, my family and especially myself. If this worked for me, it can work for anyone."
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