By Omeshnie Naidoo
At 16, Blaine Coetzer is the youngest South African man to have undergone a laparoscopic adjustable gastric band operation, one of the most popular weight-loss procedures today.
Around the world, people who have been unable to lose weight by conventional means are increasingly following in the footsteps of celebrities like Diego Maradona and Sharon Osbourne in having this form of keyhole surgery.
The teenager from the KwaZulu Natal Midlands town of Howick, weighed 134kg before he had a band inserted around his stomach in September. Just two weeks later, he was a kilogram lighter.
While it's too early to see the physical changes in Blaine's appearance, his mother, who underwent the procedure in October last year, has lost a considerable amount of weight.
After 12 months of wearing the band, 34-year-old Dianne Coetzer lost 30kg. For this mother and son the band has been a lifeline. Until they had them inserted they had numerous health problems linked to weight they could not keep off.
Despite being an active child, Blaine has always been overweight. He goes to the gym and plays rugby, but has an insulin intolerance condition that he says has made it difficult for him to shed the kilos.
He says his teenage years have not been easy. "People look at you differently if you're the big guy, even if you don't eat a lot of junk and do play sports," he says.
Dianne, who is a nurse at St Anne's Hospital in Pietermaritzburg, also had medical problems. She is hypertensive, diabetic and has had two back operations.
She heard about the operation at work and, after a friend had it done, decided she would do it rather than go for a third back op.
"When I first started to lose weight I lost plenty of hair as well," says Dianne. "A teaspoon of linseed oil helped with that. Alcohol slows down the weight-loss process, so it is best to avoid it. The body copes better if meals are small, balanced and regular," she says.
Since the bands were inserted, the family has had to make many changes to their lifestyle and break some old habits, but say they've never felt better.
Their doctor, Dick Brombacher, a specialist bariatric surgeon at St Anne's Hospital, says gastric banding is performed in a laparoscopic procedure. This is a minimally invasive procedure in which a thin tube with instruments and a tiny camera is inserted through a small incision in the abdomen.
An adjustable band, like a belt, is inserted around the upper part of the stomach, dividing the stomach in two. The upper pouch is a very small pocket - which can accommodate only the equivalent of two tablespoons of food - and the lower pouch consists of the rest of the stomach.
There is a balloon inside the surface of the band which is slowly filled during post-operative visits. This is done through a small reservoir which is positioned under the skin in the abdomen.
During the post-operative visits the surgeon makes the opening between the upper and lower pouch smaller or larger by injecting saline into the reservoir through the skin.
A small opening lets the stomach empty more slowly, so that patients feel full and satisfied for longer. The operation costs about R60000 and includes an initial consultation with the surgeon, anaesthesiologist and psychologist, in-hospital physiotherapy and any pre-operative blood tests or laboratory work.
Brombacher has performed 117 of these procedures so far. Only three of them were paid for by medical aids.
According to Brombacher, surgery might sound like a drastic measure, but when managed by a holistic team of specialists whose primary objective is safety, expert clinical governance and the sustainability of treatment, it becomes a very realistic alternative for obese patients.
Ideal patients are those who have repeatedly failed attempts at behavioural and medical therapy to lose weight, those with a body mass index greater than 40, or an index of greater than 35 with serious co-morbid conditions.
They can be between 16 and 65, but must be capable of understanding this procedure and its implications; and be committed to prolonged lifestyle changes that require immense discipline.
"Patients with bands can eat what they like, but only about two tablespoons of food at a time," says Brombacher, warning that over-indulgence can lead to band erosion, which is when the band finds its way into the stomach.
It can be removed, but the patient will be off the programme.
He says one of the advantages of the gastric band, compared to other weight-loss procedures, is that it is less invasive. It is a "scalpel-free" operation. "It is also completely reversible and physiologically sound, as the food still goes through the stomach. Other procedures cause dumping syndrome or are permanent," he says Brombacher.
"Weight-loss surgery is not something that one can consider lightly.
"Candidates for gastric surgery must be given the opportunity to try weight-loss by conservative means before considering it," he says.
According to Netcare, 50 percent of women in South Africa are overweight, 15 percent of them being morbidly obese. Obesity is associated with conditions such as high blood pressure and coronary heart disease, Type 2 diabetes, stroke, gall bladder disease, certain cancers, insulin resistance and lower back pain.