To avoid regaining weight and the pain of losing weight, you should know the solution

Being overweight or obese has become a global public health issue. In addition to the appearance problems, more important are the health problems derived from obesity, such as the "three highs" of high blood pressure, high blood sugar (diabetes), high blood lipids and cardiovascular disease, stroke, sleep apnea or other metabolic and mental illnesses, and even increased risks of colorectal cancer, bladder cancer, breast cancer, and endometrial cancer. The World Health Organization has considered excessive obesity a disease. If the problem of obesity is not taken seriously, it will inevitably cause harm to personal health in the long run and should not be taken lightly.

Although everyone's body shape and body composition ratio (for example, bones, muscles, and fat) are different, the degree of obesity is still measured by the "body mass index" (BMI = weight divided by the square of height). For example, for a person who is 90 kg and 170 cm tall, BMI = 90 divided by 1.7 and then divided by 1.7 = 31.1. A BMI between 18.5 and 25 is considered normal weight, 25-30 is overweight, 30-35 is obese, and above 35 is classified as morbidly obese.

Common ways to lose weight

(Photo provided by Far Eastern Hospital)

Minimally invasive laparoscopic surgery

Currently, weight loss surgeries are almost all performed using minimally invasive laparoscopic surgery. The principle is to reduce calorie intake or absorption by reducing the capacity of the stomach or shortening the length of small intestine absorption, thereby achieving the effect of weight loss. The bariatric surgeries we perform are mainly sleeve gastrectomy (commonly known as "stomach reduction") or gastric bypass surgery.

 Sleeve gastrectomy (gastric reduction) surgery:

It involves partially removing the stomach, shrinking it into a tube (Figure 1). The volume of the stomach is reduced to about 20% of its original size. In addition, the part of the stomach that secretes ghrelin is also removed, thereby achieving the purpose of reducing food intake and suppressing appetite. Gastric reduction surgery is relatively simple, short in operation time, with low complications and risks. In addition, because part of the small intestine is not bypassed, the absorption of some nutrients is less affected. Two years after surgery, an average of about 60-65% of excess weight can be reduced (for example, a 100 kg patient, if the ideal weight is 70 kg, the excess weight is 100-70=30 kg, and the expected weight loss is 30x65%=19.5 kg). The disadvantage is that it is easier to aggravate or produce new gastroesophageal reflux after surgery. Because it is relatively simple, safe and has good results (Figures 3 and 4), gastric reduction surgery has become the mainstream weight loss surgery both globally and domestically, accounting for about 60-70%.

 Gastric bypass surgery:

The stomach is first divided into a small stomach at the proximal end and a large stomach at the posterior end, and then the small stomach is connected to the small intestine and bypasses about 150 cm of the small intestine (Figure 2). Because the absorption of nutrients almost all takes place in the small intestine, gastric bypass surgery can simultaneously achieve the purpose of limiting food intake and reducing absorption. The weight loss effect is better than gastric reduction surgery. An average of about 65-70% of excess weight can be reduced two years after surgery. The effect is also slightly better in treating diabetes caused by obesity; however, the operation is more complicated, takes longer, and has slightly higher complications and risks. It is also more likely to cause problems with the absorption of some nutrients because food does not pass through the proximal small intestine, and long-term supplementation of nutrients such as vitamins, iron and folic acid is required.

(Photo provided by Far Eastern Hospital)

Careful evaluation is required before surgery, including blood tests for blood sugar and blood fat, ruling out obesity caused by thyroid and adrenal diseases, consultation with nutritionists and psychiatrists, cardiopulmonary function, gastroscopy, abdominal ultrasound, etc. The surgery is performed under general anesthesia and takes about 2 hours. Hospitalization for 3 to 5 days is required after surgery.

Because excessive obesity can lead to a considerable number of diseases and increase medical expenses, NHI will cover the cost of weight loss surgery for patients who meet specific conditions starting in 2020. However, in order to achieve better surgical results or improve surgical safety, surgeons may recommend the use of some self-paid medical equipment that is not covered by NHI. A small number of weight loss surgeries that do not meet NHI reimbursement standards must be performed at full self-payment.

You can start trying to drink water 6-8 hours after the operation. If there is no discomfort such as abdominal distension or abdominal pain, you can start drinking clear liquid food the next day after the operation. You can take liquid food within 1 to 3 days after the operation, and semi-liquid food within 4 to 7 days. You can eat some solid food after about 1 week, but the type and amount of food you eat still need to be gradually increased and controlled according to the advice of the doctor and nutritionist. The principle of "small meals, slow eating" can achieve the best weight loss effect while taking into account nutritional needs.

in conclusion

Regardless of the type of weight loss surgery, there will usually be a significant effect of weight loss in the first 3-6 months, and then the rate of weight loss will slow down and last for about two years. After two years, some patients will even gain weight again. To achieve sustained and optimal weight loss results, it is necessary to adjust your diet and lifestyle and develop a habit of regular exercise. Our weight loss team will provide continuous assessment, follow-up and health education services before, during and after surgery.