ANALYSIS:Two basic approaches are taken to medical intervention for patients
WHILE DIET and lifestyle modification remain the interventions of choice in people who are obese, they tend to produce modest weight loss and the lost weight is often regained.
Bariatric surgery (an operation aimed at reducing obesity) has become increasingly popular, especially with the advent of a minimally invasive approach using laparoscopy. Almost 2 per cent of the population is morbidly obese, with a body mass index (BMI) of greater than 40kg/m2; about one in four adults are classified as obese (BMI greater than 30kg/m2).
There are two basic approaches to obesity surgery: restrictive operations aimed at reducing food intake, and malabsorptive surgery which aims to reduce the capacity of the stomach and intestine to absorb nutrients from food.
Laparoscopic adjustable gastric banding (LAGB) is an example of restrictive surgery. It involves placing an adjustable silicone band around the upper part of the stomach. The band can be either loosened or tightened after the operation by inflating or deflating a balloon inside the band. But despite being a well developed and quick procedure, LAGB is not without complications.
Some 13 per cent of patients experience a surgical complication such as bleeding or infection following LAGB. The band can also slip or even migrate within the body, which could be life-threatening.
Success following LAGB is defined as the loss of over 50 per cent of excess weight two years after surgery. Research has shown that those most likely to benefit are younger patients; those whose initial BMI was 35-40; and those who change their eating habits for the better after surgery.
People with obesity considering bariatric surgery should look for: a full pre-operative assessment including assessment of cardiac and respiratory status; a detailed assessment of anaesthetic risk; transfer to a high dependency unit bed for immediate post-operative care; and the 24-hour back-up of anaesthetists, surgeons and intensivists should the person's condition deteriorate to the point where they require admission to a fully equipped intensive care unit.