​Society does not have much sympathy with people who are overweight … “Even in medical circles, people sometimes incorrectly believe that overweight people should simply eat less, that they are lazy and don't stick to their exercise and diet plans," says Dr Jeanne Lubbe, a specialist consultant with the Division of Surgery at the Faculty of Medicine and Health Sciences.

Reality is far more complex than that...

Lubbe has launched a research project on the advantages, costs and disadvantages of bariatric (metabolic) surgery as a remedy for obesity at Tygerberg Hospital, the only state hospital that offers this treatment. In addition to helping people to lose weight, it is also a remedy for diabetes and high blood pressure, as well as a number of symptoms linked to obesity.

Worldwide, two types of bariatric surgeries are performed on obese patients. Both of these are offered at Tygerberg Hospital.

The first is a partial gastrectomy, during which the biggest portion of the stomach is removed, and a thin tube takes food from the oesophagus to the small intestine. Therefore, less food is consumed at any given time.

The second procedure is a stomach bypass, which has two components. Firstly, the stomach is transformed into a compartment of about a tenth of its original size. Patients can therefore consume much less food at one time. Secondly, a gastric bypass can also be done, so that consumed food does not move through the whole small intestine, and less food is absorbed by the body.

Patients are anaesthetised for some three hours during both procedures, and pain is effectively controlled. According to Lubbe the operations are done laparoscopically (with a camera), which reduces the pain. “Patients get out of bed within two hours after the operation, and are discharged within two or three days. During the first two weeks they only consume liquids, after which they eat pulped food and then normal food."

Lubbe says overweight people exert huge economic pressure on the state, with 30% of South African men and 60% of women being overweight. “These patients converge on diabetes, orthopaedic, cardiology and vascular clinics."

Bariatric surgery is not always a priority for the state, because of the huge number of patients who require a variety of all types of surgery. “Financial shortfalls in the healthcare system means that overweight patients have to await their turn patiently, but we are hoping to perform these operations regularly on a limited scale," says Lubbe.

People with a BMI (body mass index) above 40, or above 35 with diabetes, qualify for the surgery. BMI is calculated as body mass (kg) divided by the square of the length (in m) – therefore kg/m2.

No miracle

The operation is no “miracle" and brings about an intensive lifestyle change. Patients who qualify become part of a diet and support group, and also consult with a clinical psychologist and/or endocrinologist.

Dr Lubbe explains: “We have a comprehensive metabolic programme. Close family members need to go on the journey with their loved ones, and need to understand the dietary changes and the exercise regime required before the surgery. Patients need to prove that they will be able to adapt to a new way of living before undergoing the surgery."

As patients become slimmer, most of the symptoms linked to obesity are reduced, or even disappear. The best example is that of diabetes, a condition that almost always improves. “The surgery is much more effective than medication or insulin injections," says Lubbe.

Compared to other abdominal operations, the mortality rate due to bariatric surgery is low – only 0,5%.

“However, if patients don't follow a balanced diet afterwards, they can put on weight again. And if they don't take their vitamin supplements, they can become malnourished," Lubbe warns.

According to her more women than men are prepared to undergo this surgery, and it isn't readily performed on growing children.

Two years after the operation, between 60% and 70% of patients show a reduction in “excess" weight, 80% of patients' diabetes improves, and 25% of patients experience a reduced chance of early death as a result of symptoms connected to obesity.

Until now, metabolic surgery has often been associated with glamorous women, such as Sharon Osbourne and the actress Roseanne Barr. Soon, it could be within reach of selected patients, also those without the bank balance of a movie star. 

Caption: Dr Jeanne Lubbe.

Photo: Damien Schumann