Scientific Weight Loss for a Healthy Life
Huiqi YANG, General Surgeon and Hernia Specialist
In recent years, the term “weight loss” has become a popular mantra, especially among women. People can be very sensitive to the issue of obesity, even to the extent that they turn a blind eye to the very real health risks it poses. Some are even surprised to learn that obesity can lead to death. In the end, who is considered “obese”? Can diet and exercise alone produce satisfactory weight loss? I hope to discuss these issues and the benefits of minimally invasive adjustable gastric banding which, combined with proactive choices for individuals and their families, is a proven way to fight obesity and live a healthier life.
Obesity and health risks
Obesity is the excessive accumulation of body fat, leading to weight gain and poor health. The body mass index (BMI) is one of the evaluation criteria for obesity and is calculated by weight (kg) divided by the square of height (in meters). For most Western countries, people with a BMI value greater than 30 are considered obese and those with more than 40 are considered “morbidly obese”; in Asia, those with BMI values greater than 35 or greater than 32 when associated with health complications, are considered obese.
Complications of obesity include hypertension, diabetes, hyperlipidemia, cardiovascular disease and sleep apnea. Morbid obesity can also seriously affect quality of life. In addition, due to changes in the outward appearance of obese patients’ bodies, many obese patients experience feelings of shame or self-loathing, which can lead to severe depression and other mental illnesses. With the rapid increase in diagnosed illnesses in contemporary China, more and more social emphasis is being placed on obesity and its complications, and treatment technology has made great progress.
The treatment of obesity
Obese patients should initially try a combination of diet and exercise therapy, preferably under the guidance of doctors and nutritionists who can develop individualized treatment programs and diet plans. In addition, drug therapy can also help patients achieve weight loss by suppressing appetite and controlling fat absorption.
For those who cannot achieve their desired weight loss through diet, exercise or medication, surgical treatment may help. Bariatric surgery can help patients with severe obesity achieve sustained, significant weight loss, while at the same time improving their overall health and alleviating obesity-related complications.
With the development and improvement of bariatric surgery worldwide, the main types of bariatric surgery performed today include gastric bypass surgery, sleeve gastrectomy and adjustable gastric banding. Gastric bypass surgery and sleeve gastrectomy cause irreversible anatomic changes to the gastrointestinal system. Adjustable gastric banding surgery, on the other hand, is one of the most popular surgeries in developed countries because it is reversible, produces few complications, and has been proven to be very safe and effective.
Adjustable gastric banding
The adjustable gastric band is made of soft silicone and is firmly connected to the expandable balloon. In gastric banding, laparoscopic surgery is performed in the upper part of the stomach, with the gastric band slowing down the emptying of the stomach and thus restricting the amount of food the stomach can accommodate, helping the patient eat less and lose weight. The size of the gastric band (sometimes called a Lap-band) can be adjusted to control the volume of liquid the balloon can hold and thus the amount of food that the patient can ingest.
Adjustable gastric banding helps patients achieve safe weight loss without removing or damaging internal organs. In addition, with the laparoscopic technique, patients experience less trauma, a quicker recovery and fewer complications.
All people considering bariatric surgery must undergo a preoperative evaluation to diagnose the cause of their obesity as well as document any obesity-related complications and surgery-related medical problems. At Beijing United Family Hospital, primary care providers, surgeons and anesthesiologists all participate in a patient’s preoperative evaluation.
A patient’s primary care provider will first perform a comprehensive health assessment. Patients need to undergo a series of laboratory tests to assess their health status and the possible biological causes for their obesity. The patient’s primary care provider will analyze the examination results to determine whether the patient can achieve weight loss through diet, exercise or medication.
Once it is determined that a patient is a good candidate for gastric banding surgery, he or she will meet with a surgeon for further preoperative evaluation. Before this surgery, patients may need a chest X-ray and ECG to evaluate their cardiopulmonary health; or an epigastric ultrasound and endoscopy to assess their liver and digestive system functioning. Because optimal bariatric surgery outcomes require a commitment to lifestyle changes, patients considering gastric banding treatment must also undergo a preoperative assessment of their confidence in making long-term lifestyle changes as well as their psychological health and well-being.
Finally, an anesthesiologist will do a preoperative assessment of the patient’s risks related to anesthesia and postoperative analgesia and discuss these with the patient.
Patients will experience gradual weight loss after the surgery. For example, for a patient currently weighing 200 kilograms, their optimal healthy weight should be around 100 kg (adjusted for height, gender and other factors). In general, surgery can help this patient lose about 35% of their initial body weight, or 50-70 kg for this patient. The expected rate of weight loss is 1 to 2 kg per week, with the patient ideally achieving a stable weight after two years.
In the long term, the amount of weight a patient loses depends on their commitment to lifestyle changes including to their diet and exercise habits. At Beijing United Family Hospital, a registered dietitian will participate in the entire process, from preoperative to postoperative, to assess the patient’s eating habits and recommend recipes. With the continued help and support of nutritionists and primary care providers, patients can implement the recommended diet and exercise programs and significantly improve their quality of life.