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Gastric band gives hope to the morbidly obese

January 25, 2005

By Melody Tan

When your excess weight begins to affect your health and quality of life negatively, it is time to think about seeking medical help.

While most people may think that the only major problems faced by the morbidly obese are social, their obesity is accompanied by a host of illnesses and health conditions known as co-morbidities.

According to information provided by Dr Haridas G Baladas, a consultant surgeon and chairman of Alexandra Hospital's bariatric surgery team, these co-morbidities include: diabetes, high blood pressure, high cholesterol, sleep obstruction, gastro-oesophageal reflux, knee, hip and back arthritis, sub-fertility in females and loss of libido in males.

Many of these health problems are serious, and some can result in complications such as heart disease, stroke, kidney failure, blood vessel disease, blindness from retinopathy and amputation.

Morbidly obese people with co-morbidities often spend years undergoing painful and expensive treatment for their health problems, yet cannot be cured completely, as the only way to be rid of co-morbidities is to slim down.

This, however, is easier said than done.

Explained Dr Baladas: "Before the advent of bariatric surgery, obesity was treated by diet, exercise and medication.

"These might have been suitable for slightly obese patients who only had to lose a few kg to reach a healthy weight range. In morbid obesity, however, patients have to lose 20 to 60kg to see any medical benefit."

Unfortunately, the degree of will power needed to lose such a large amount of weight is extraordinary, and morbidly obese patients are only human.

Bariatric surgery, on the other hand, has a success rate of over 90 per cent in helping patients to lose enough weight and be healthier.

First introduced in the 1960s, bariatric surgery has been refined over the years and now focuses mainly on laparoscopic adjustable gastric banding.

This procedure is done through laparoscopy, or keyhole surgery, which means a few small incisions are made instead of one large incision which will require a week's hospital stay for recovery. With keyhole surgery, patients can be discharged in one day.

Said Dr Baladas: "As the procedure is minimally invasive, there is very little pain and patients are able to walk on the evening of surgery.

"Ninety per cent of our patients are discharged on the first day after surgery."

Patients who have undergone this procedure normally take medical leave for an average of two weeks.

Under this procedure, a silicon band such as the Swedish Adjustable Gastric Band (SAGB) is placed around the patient's upper stomach, making its capacity smaller so that patients feel full faster while eating.

Food travels slowly through the constriction after a meal, so the patient will not feel hungry for several hours.

Over the years, adjustments to the band via its water-filled adjustment port - tucked inside fat in the abdominal area - can be made, causing the band to shrink or grow larger to suit the patient's needs.

Adjustments are done under local anaesthetic.

As a patient loses weight, he will lead a healthier life.

Dr Baladas, who has performed over 160 cases of gastric banding, cites the example of a 33-year-old female patient who weighed 103kg when she first came to see him.

The woman had been suffering from diabetes, high blood pressure and obstructive sleep apnea (a potentially-fatal condition where the sufferer stops breathing while asleep and wakes up to gasp for air).

After her gastric band was inserted, the woman lost 39kg to weigh a healthy 63kg.

With the gastric band, there is hope for morbidly obese patients to lead a healthier and lighter life.

The 1998 National Health Survey reported that 6 per cent of Singaporeans were diagnosed as obese. Since then, there have been over 200 gastric bands implanted in Singaporean who are morbidly obese

For Asians, a Body Mass Index (BMI) of 32 to 36.9 accompanied with weight-related illnesses or conditions is the definition of severe clinical obesity. A BMI of 37 and higher indicates morbid obesity.

Both groups of people are generally considered suitable candidates for an adjustable gastric banding surgery such as the Swedish Adjustable Gastric Band.

Calculate your BMI by dividing your weight by the square of your height. Eg 55kg / (1.6m x 1.6m) = 21.5