Taking the bypass route
Durban - With 10 percent of men and 28 percent of women being classified as morbidly obese, South Africa has a weighty problem on its hands. For those who have notched up countless failed attempts at losing excess kilos, weight loss surgery seems an attractive option.
The Bariatric Centre of Excellence at Netcare St Augustine’s Hospital in Durban has done 111 surgeries since it opened in 2006. It has a high success rate of sustained weight loss as well as an impressive reduction in conditions like diabetes, hypertension, sleep apnoea.
The procedure favoured by surgeons at the centre is the gastric bypass, in which a small pouch is created from the stomach and linked to the small intestine, bypassing the larger part of the stomach and duodenum. The patient feels full after eating small quantities of food, resulting in dramatic weight loss.
As with any surgery, there is a risk of complications, and even death, but for most people who undergo the procedure, the outcome is life-changing.
“It is a very effective method of weight loss and there is an 80 percent cure rate for type 2 diabetes because of its effect on the endocrine system,” says Dr Gert du Toit, one of two surgeons at the centre.
“The bypass also affects the ‘hunger hormone’ ghrelin, which is produced when food passes through the stomach and duodenum. When food no longer passes through these areas, patients don’t feel as hungry.”
About 80 percent of bariatric patients have good weight reduction, with an average loss of between 40 percent and 70 percent of excess weight between one and four years. Research findings show that 60 percent of surgery patients continue to maintain the 50 percent level of weight loss over five to 10 years, while many other weight loss methods have higher relapse rates.
Besides improving and even normalising blood glucose levels, hypertension and sleep apnoea, there is also some evidence of improved heart function. Patients report improvements in mobility and stamina as well as mood, self-esteem and quality of life.
“The procedure takes two to four hours and the patient is discharged on about the fourth day,” says Dr Ivor Funnell. “A good patient will lose 10kg a month. Older patients and those with diabetes lose a bit more slowly. The body eventually reaches an ideal weight and does not go beyond that.”
It is possible for the pouch to stretch and the weight can be regained if the patient does not adhere to the maintenance diet instructions so ongoing monitoring is important.
Professor Tess van der Merwe, chief executive of the Centres of Excellence for Metabolic Medicine and Surgery of South Africa and chairwoman of the SA Society for Obesity and Metabolism, warns that this is not a cure-all for obesity - it is also to address a metabolic and endocrine problem.
“Before a patient is accepted for surgery, he or she must be assessed by an endocrinologist and physician,” she says.
“Not all obese patients are suitable surgical candidates and it requires an experienced team of experts qualified in obesity management to assess these patients before and after their surgery.”
Colleen Smith, 54, of Pinetown had a gastric bypass in November after many years of failed dieting attempts and lost 48kg. She is ecstatic with her slim physique, improved self-confidence and energy – but says it is not easy.
“Don’t let anyone tell you it is easy,” she says. “It is hard. For me, the operation was the easy part. I had no pain and I recovered quickly – but the psychological side has been difficult. Your head tells you to eat but your stomach won’t let you.”
Colleen has, however, got used to eating less. Gone are English breakfasts and hearty restaurant meals. These days, breakfast is half a cup of cereal, lunch is three-quarters of a cup of salad and dinner is half a chicken breast.
She, like other bariatric patients, must take multivitamins to compensate for the nutrients she misses out on by not eating a full diet.
Another happy loser is Barry Todd, 38, of Durban, whose wife, Charmaine Schwenn, lost 70kg with a gastric bypass in 2006.
Todd tipped the scales at 147kg, had dangerously high blood pressure and two slipped discs.
“I had gained a lot of weight and had become a bit of a food addict,” he says. “When you are an alcoholic, you can stop drinking alcohol, but as a food addict, you have to eat. We used to go out to dinner up to 10 times a week and I would nibble constantly at home.”
Since his bariatric surgery in April last year, Barry has lost 55kg.
“Our lives have changed for the better. We eat differently now and get full quickly so there is no chance of overeating.
“Before I had the operation I was almost immobile – I was two days away from having an operation to fuse discs in my back. Now I am active, I have no back or knee pain and I have more energy. It really has been worth it.”
Before a patient is accepted for metabolic surgery, strict criteria have to be met. Patients must have tried repeatedly to lose weight by conventional methods, they must have a body mass index (BMI) of greater than 40, or a BMI of greater than 35 with serious co-morbid conditions (such as diabetes, high blood pressure, heart disease risk etc). They must be between 16 and 65 years and be committed to a prolonged lifestyle change that involves long-term follow-up. They are also assessed by a panel that includes a dietitian and a psychologist.
Counselling psychologist Michael Urbasch says patients need to understand that there will be major lifestyle changes.
“They need to be adaptive,” he says. “Whether they have good social support and how the patient’s weight will affect their relationships are all factors that have to be considered. They need to have insight into how they became obese.”
Registered dietitian Mandy Read, who deals with bariatric patients, says patients are on fluids for two weeks after surgery, then purees and gradually progressing to normal foods. Certain items, such as fizzy drinks, popcorn, nuts, are not allowed back into the diet.
Bariatric surgery is available on a limited basis in the state health sector, where only the gastric sleeve procedure is done.
Du Toit and Funnell believe the number of surgeries would be far higher if funding were more easily available. Only a few medical aids fund the full cost, with some paying a portion of it.
Colleen, who weighed 117kg when she went for her first consultation, was prepared to go ahead whatever the cost. After being turned down by her medical aid, she and her husband Roy paid for the operation which cost R127 000, pending an appeal. They were successful and their medical aid refunded 80 percent of the cost. - Daily News