Obesity is excessive fat accumulation in the body. An increasing number of people are affected and is often accompanied by severe health issues. Subjects choose to undergo surgery to fight obesity due to its physical, psychological and social impact. It should be noted that weight loss procedures come under general surgery while procedures restoring extended skin and other tissues sagging are performed by plastic surgeons.

The causes of obesity

The causes of obesity can be either endogenous or exogenous. Endogenous causes are related to heredity and predisposition, while exogenous ones to diet, physical activity and the body’s influence from chronic drug therapies affecting metabolism and psychology.

In addition, two mechanisms play a significant role in food intake: homeostatic and hedonistic. Homeostasis gives rise to the feeling of hunger when the body needs to replenish its energy, and hedonism gives rise to the appetite, which is triggered by stimuli such as smell and sight of food.

The causes of obesity are definitely multifactorial and interconnected. Each case is different, thus only the physician can establish the necessity or not of a surgery.

Ideal candidates

Ideal candidates for obesity surgery are subjects with the following characteristics:

  • Their Body Mass Index (BMI) is over 40.
  • Their Body Mass Index (BMI) is between 35 and 40 and they have obesity related health issues such as: type 2 diabetes mellitus, high blood pressure, osteoarthritis, hyperlipidemia, gastroesophageal reflux disease.
  • They have repeatedly tried to lose weight through diet and exercise, but they have not succeeded or have achieved it to some extent, but have gained weight shortly after.

Types of obesity surgery

All types of obesity operations change the anatomy of the gastrointestinal tract. Their goal is to reduce the volume of stomach, resulting in the reduction in the amount of food and the time food remains in the intestine, hence the intake of fewer calories. In addition, obesity operations affect metabolism, reducing the feeling of hunger and increasing the feeling of satiety.

There are a number of operations and techniques designed to combat obesity. The most common and tested types used by general surgeons are the following:

  • Longitudinal or sleeve gastrectomy; where a large part of the stomach is removed with an incision along the gastrointestinal tract.
  • Gastric bypass; where the surgeon creates a small tube connecting esophagus with the small intestine, bypassing a large part of the stomach.
  • Gastric ring; where a silicone ring is placed on the upper part of the stomach, which can be tightened or loosened through an injection containing a salt solution.
  • Gastric balloon; where a balloon is placed inside the stomach and then inflated with air or saline through gastroscopy. It is effective mainly in subjects of low body mass index because it is a temporary technique lasting up to 6 months.

An obesity operation lasts from 1.5 to 3 hours, depending on the type of surgery applied.

Preoperatively

In order for a subject to undergo some of the above mentioned procedures, a thorough check-up including general check-ups, X-rays, etc., and mental health and eating habits must be carried out.

Anesthesia

Obesity operation is performed in the majority of cases under general anesthesia, which shall be selected by the physician and the anesthesiologist, aiming at patient comfort and safety during the operation.

Postoperatively

After the procedure is completed, 1-3 days of hospitalization is required. For the first few days, the subject shall need a special diet with a lot of water and liquid food (e.g. soups). Then, until the end of the second month, the subject’s diet should comprise soft food (such as yogurt, purées, etc.) and vitamin supplements, while a lifetime healthy diet is required. In addition, frequent mild exercise such as cycling, swimming and walking can be promptly adopted, for faster and lasting results.

Results and Recovery

As operations are laparoscopic, the skin recovery period is very short. However, after obesity operation, the subject should be psychologically prepared for the drastic changes to be experience both in his/ her body and in general lifestyle.

Several months later, when new weight is established, the subject is likely to want to have a remedial surgery to correct the skin sagging after weight loss.

The most common operations proposed are: abdominoplasty, breast lift or gynecomastia surgery, butt lift, arm surgery and face lift.

Cost

Obesity operation cost depends on the extent of the area operated and each individual case (patient). Furthermore, the cost of hospitalization, any pre- or postoperative medical tests required and medication should be taken into account as well.