A pretty female influencer surprised her followers by posting before and after photos and a video of herself after having a sleeve gastrectomy -- a surgical weight-loss procedure. In the video, the influencer said that her previous weight was 86kg and she lost 18kg in three months following surgery.
The post received a lot of attention on the internet, especially from people who are having difficulty losing weight. However, many people opposed the post and commented that the influencer should have also provided details of any side effects that occurred since sleeve gastrectomy is a major surgery.
There was speculation whether her surgery was sponsored by a clinic because she had initially posted that she did not plan to undergo sleeve gastrectomy. However, she later reconsidered after a clinic contacted her. She explained that she had tried various methods to lose weight, but none of them were successful. She eventually chose to undergo the surgery because she suffered from knee pain, snoring and shortness of breath. After the surgery, all those conditions improved.
Dr Preeda Sumritpradit, a surgeon at the Department of Surgery at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, explained that surgical treatments for obesity have been available in Western countries for 70 to 80 years. Some patients who undergo these surgeries recover from diabetes and eliminate their need for medication or insulin. Therefore, in the past 10 years, obesity surgeries have become more widely accepted and the number of patients who have undergone surgical treatment for obesity has increased accordingly.
"I have not yet seen reviews about sleeve gastrectomy, but they should not emphasise beauty and physical appearances. Sleeve gastrectomy was developed to treat obesity which can lead to various medical conditions such as diabetes, non-alcoholic fatty liver disease and obstructive sleep apnea. I disagree with any review that aims to encourage patients who do not meet eligibility criteria to undergo sleeve gastrectomy. However, for patients who are eligible, sleeve gastrectomy can be an alternative," said Dr Preeda.
According to the Ministry of Public Health's surveys of Physical Examinations of Thai Nationals between 2020 and 2021, 42.2% of Thais aged over 15 years were obese and 39.4% suffered from abdominal obesity. People in Bangkok had the highest prevalence of obesity at 47% and the prevalence of abdominal obesity was highest among women in Bangkok at 65.3%. Being overweight is a risk factor for non-communicable diseases such as diabetes, high blood pressure and hypercholesterolemia.
Since many people are able to lose weight, they do not understand why some with obesity eventually decide to undergo a surgical weight-loss procedure which is considered a major surgery. Dr Preeda explained that people with obesity have several abnormal health conditions including insulin resistance. When insulin resistance occurs, the body's cells are unable to use insulin effectively to take up glucose from the bloodstream. This can contribute to the development of various health problems, including Type 2 diabetes and obesity.
"We found that three out of four patients with obesity have attempted to lose weight, but their bodies were unable to overcome their eating drive. As a result, they later resume eating and regain weight. Due to insulin resistance, they were unable to lose weight successfully," Dr Preeda said.
Since most people with obesity are unable to lose weight by themselves, they turn to more effective treatments such as surgery, also known as metabolic surgery. To be eligible for this kind of surgery, patients must be between the ages of 18 and 65. Another criterion is that their BMI must be 37.5 or higher.
"Patients with obesity must have a BMI of 37.5 or higher to be eligible for metabolic surgery. However, if a patient has a BMI of 32.5 and also a health condition such as Type 2 diabetes, high blood pressure or obstructive sleep apnea, they may be considered a candidate for surgery. Patients must have an understanding of the surgical guidelines and the intention to exercise and control their diet after the surgery," said Dr Preeda.
At present, the two main metabolic surgeries are sleeve gastrectomy and gastric bypass, which are both laparoscopic surgeries. Sleeve gastrectomy involves removing a portion of the stomach which produces hunger hormones. Gastric bypass is a more complex procedure that involves separating the stomach into small and large sections and connecting the small section to the small intestine where nutrients are absorbed. Both these surgeries help limit the amount of food which causes patients to feel full quickly and leads to consistent weight loss.
"Successful results of both surgeries are similar, with 80 to 90% of patients successfully losing at least 50% of excess weight. After the surgery, patients must change their diets. They should control and reduce carbohydrate and sugar intake which can lead to insulin resistance. To achieve even better results, patients should exercise to build up muscles because, in addition to losing fat, they also lose muscle mass," he said.
The positive outcome may encourage people to be interested in these surgeries. However, patients have to make significant lifestyle adjustments. Many patients posted on social media that after the operation, they experienced hair loss and sometimes vomited after eating.
"Many patients experience hair loss because the body prioritises nutrients for more vital organs. Once their weight becomes stable, hair loss usually decreases. As for vomiting, it may take some time for patients to adjust. In some cases, patients may still experience occasional vomiting even years after the surgery. Patients need to take vitamins for the rest of their lives because they may not be able to consume enough through the limited food portions they can eat," explained Dr Preeda.
In addition to the pretty influencer who sparked an interest in sleeve gastrectomy, many patients posted positive reviews of their own procedures. Dr Preeda recommends that people with obesity who are interested in metabolic surgery should consult medical professionals at a hospital.
"Patients who are interested in the surgery that have a BMI of 32.5 and over, which is considered in the obesity range, should consult with medical professionals to see if they are eligible for surgery. Patients should choose a hospital which offers a multidisciplinary approach. This approach involves a team of medical professionals including surgeons, medical doctors, nutritionists and nurses who co-ordinate between medical teams and patients," Dr Preeda said.
"After surgery, patients should follow up for at least one year. I personally follow up with my patients every three months for two years and after that, they should check in once a year. Patients should check if the hospital has surgeons who specialise in this type of procedure. Patients are welcome to ask for information.
"The procedure is effective, but patients must have an understanding of the process."
