Could surgery be the answer to obesity?

A South African woman named Dineo* long struggled with obesity.

Her vices included takeout food, creamy desserts and chips, and she
drank two litres of sugary drinks a day. “It relaxed me,” she recalls. Her
weight crept up to 141 kg. Yo-yo dieting never worked. In 2008, she
miscarried her second child due to weight-related complications. The
stigma of being overweight led to depression.
Then she learned about bariatric surgery, a procedure that involves
reducing the size of the stomach with a gastric band, removing a portion
of the stomach, or shortening the intestine to a small stomach pouch.
“Medical aid covered 80 % of the cost and the shortfall was over
100,000 rands [USD 6,800],” she says. “I needed to do something as I
was starting to become immobile. I could drive but barely walk. So I
started saving money.” Dineo had the surgery six months ago, and has
since lost about 40 kg.
Around the world, 1.9 billion adults are overweight and 650 million are
obese. There is currently no country on track to meet targets to halt
obesity, which is a major risk factor for noncommunicable diseases such
as cancer, diabetes, cardiovascular and hepatic diseases. Together, these
count for more than 70% of deaths worldwide. The social stigma of
obesity can lead to social isolation, suicidal thoughts and avoidance of
medical care.
In South Africa, 30% of the population is obese and an additional 20%
are overweight. Professor Tess van der Merwe, honorary president of
the South African Society for Obesity and Metabolism, says there are
two approaches that actually work to tackle the disease. “The first is
intense cognitive behaviour modification combined with the Dash diet
[low-sodium foods that help lower blood pressure and are rich in

SOURCE: THE HINDU NEETHU’S ACADEMY

 potassium, magnesium and calcium] and weight-bearing exercise, such
as Pilates. This strategy aims to undo automated learned responses to
food,” she explains. “The second option for obese to morbidly obese
people is bariatric surgery.”
Van der Merwe has been studying obesity patterns in South Africa for
three decades.
She believes the first step towards fighting the condition is to foster
understanding. “Families, the media and the medical community need to
get away from the narrative that we have been using with obese
patients, the derogatory manner in which we have been treating them,”
she says. “We now know that obesity is not all about gluttony and sloth.
It is a brain-centric issue, not a fat-cell-centric problem – and epigenetic
inheritance is far more impactful than we had previously thought.”
New research shows that the pituitary gland, in the back of the brain,
keeps the body at its highest consistent weight in memory. This is called
the body stat and is probably an evolutionary response against famine or
starvation. “What we have done incorrectly in the past is to allocate the
disease process to the frontal lobe, the reasoning centre. From that arose
terminology like ‘food addiction.’ The ridiculousness of those kinds of
statements has only become apparent in the past five to seven years,”
says Van der Merwe, noting that, as a result, patients are embarrassed
even when they don’t eat to excess. “Our calorie intake is only about
180 calories more than it was two decades ago, and our fitness has
reduced, but it does not equate to this epidemic,” she notes.
Bariatric surgery’s immediate benefits include guaranteed weight loss,
immediate reversal of comorbidity conditions such as diabetes and high
blood pressure, and prevention of long-term health issues related to
obesity.

SOURCE: THE HINDU NEETHU’S ACADEMY

 Preceded and followed by psychological counselling, the intervention
requires the patient to follow a strict lifelong diet to avoid
complications. He or she must take a lifetime of vitamins and
supplements, because the digestive system is forever altered.
Endocrinologist Dr. Sundeep Ruder says that while surgery is effective,
it should be looked upon only as last resort, because of the risks
involved. “The biggest drivers of obesity are environmental factors,” he
says. “It is very expensive to make surgery accessible to the masses of
obese people in the world. But it is considered an alternative after we
fail with lifestyle interventions.”
Private healthcare surgery costs up to 500,000 rands in South Africa,
but obesity is so prevalent in the country – including in low-income
communities– that bariatric surgery is now being tested in the public
sector. Professor Zach Koto, a renowned surgeon who specialises in
minimally invasive keyhole surgery, is leading the multidisciplinary
project. “There are lots of issues at play, so you need a psychologist,
endocrinologist, physiotherapist, anaesthetist and a surgeon,” he notes.
“We want to offer a comprehensive service in all the academic hospitals
in South Africa,” Koto adds, believing there should be dedicated
facilities for these procedures. “We want to make this available to those
who can’t afford it.”
But the surgery is far from a miracle solution to obesity. “It is only for
patients who qualify and show they are willing to maintain,” Koto says.
“People think the surgery is a silver bullet, but it needs a support
structure and a complete lifestyle change.”

SOURCE: THE HINDU NEETHU’S ACADEMY