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bariatric surgery must be very carefully counselled beforehand to ensure that they have realistic expectations about their life and its restrictions after the operation. Following bariatric surgery patients should not regard the process as complete because the surgery alone does not guarantee weight loss. It is necessary post-operatively to start a programme of rigorous dietary control combined with structured exercise and the approach to maintaining weight reduction will be life-long. Normally patients continue to see dieticians post-operatively because they may need vitamin and mineral supplementation and intensive advice about the diet to maintain the steady weight loss. Post-operative counselling is also important. Psychological support, including cognitive counselling, is essential to provide the necessary support. Other problems may also develop. For example signifi cant reduction in weight may be accompanied by the development of loose folds of redundant skin. This may be in the form of an apron hanging from the lower part of the abdomen or from the chest, under the arms and round the neck and the sagging skin may need removal for physical and cosmetic reasons. Grossly obese patients who have suffered anxiety or depression may attribute the problem to their weight and may fi nd that the psychiatric problems do not disappear with weight reduction. Sometimes interpersonal relationships are damaged by losing weight. However, things are not all bad and it is often the case that patients with comorbidities do improve as the weight reduces. Raised blood pressure may come down towards normal and diabetes may improve. Some patients can reduce medications for disorders aggravated by excess weight.
Overall, the results of bariatric surgery are good. Research carried out in America suggests that patients with a gastric band will lose about half of their excess body weight and those with a gastric bypass will lose about two-thirds of their excess body weight. In both groups there will be improvements (and sometimes a cure) of other medical disorders.
No doubt the debate about funding and whether the operations should all be paid for by the NHS will continue. Whether there will be a meeting of minds between the two polarised positions is probably very doubtful. Undoubtedly the surgery will help most people to have more years of healthy life but obesity is generally controllable by the individual and some see it as a self-infl icted wound. This debate is particularly focused at a time of fi nancial stringency when cuts are being sought.
As someone trying to lose a stone at the moment, I understand
how diffi cult, albeit simple, is the mantra “eat less, exercise more”. I’ll let you know how it goes!
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The surgery will help most people have more years of healthy life but obesity is generally controllable by the individual and some see it as a self-infl icted wound
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Commissioning Show 2012: a guide
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