By Dr Bernard Guillaume

Most individuals consider obesity mainly a social and aesthetic issue. However, obesity is generally linked to a multitude of severe medical problems and associated consequences, such as heart disease, stroke, high blood pressure (hypertension), type 2 diabetes, high blood lipids (cholesterol), sleep apnea, gallstones, infertility, and even certain forms of cancer. It is now known that a Body Mass Index above 40 (BMI > 40), for example, can decrease life expectancy by as many as seven years.

Obesity is a disease and needs to be treated as such. It has become endemic in Western countries with more than 20 per cent of the population affected. Although the rate in Việt Nam is low, with only 1 per cent considered obese, the trend has been growing.

There are multiple reasons we are getting heavier. For the majority, the reason is simple –we eat too much and don’t exercise enough. Genetic predisposition also plays a part. Whatever the reason, the sad truth is, obesity increases health risks.

The first step to losing and maintaining weight loss is setting realistic goals. Many people have lost weight based on unrealistic goals only to regain more than they lost. This can lead to severe emotional distress and a pervasive sense of failure.

As for everything else in life, the best treatment is prevention. Preventing obesity must begin in childhood with a balanced diet and exercise. Treatment of obesity should always be multidisciplinary, including a dietician to teach you when and what to eat, psychological counseling to support you in lifestyle changes, and medical and surgical care if needed.

The surgical option

Why consider surgical treatment? Because you may have attempted many times to lose weight in different ways only to regain it and even more.

Obesity is measured by BMI, which simply put is a ratio between height and weight. We talk about obesity when an individual’s BMI is > 30, and severe obesity with a BMI >35. I consider obesity surgery for those with a BMI>35 who have other conditions, such as diabetes, high blood pressure, fatty liver, or sleep apnea. For others I recommend surgical treatment with a BMI > 40.

The principles of obesity surgery are simple: the size of the stomach is reduced, providing a feeling of satiety with smaller food portions and preventing certain foodstuffs, such as fatty foods, from being digested.

There are three well-established procedures available: gastric banding, sleeve gastrectomy and gastric bypass. Each has its benefits, but being invasive, they also carry some risks.

Gastric banding is the least radical procedure and reduces the size of your stomach so you can consume less food. This procedure, which does not even require a hospital stay, entails placing a simple elastic band across the outer part of your stomach. The drawback is that many patients “cheat” after the procedure and after initial weight loss start eating smaller portions but more frequently, or consume high caloric drinks to compensate for their cravings. Inability to maintain discipline after gastric banding increases chances of failure to 75 per cent.

Sleeve gastrectomy is a more invasive approach during which the surgeon removes 2/3 to 3/4 of your stomach. Although this procedure has helped many patients lose and maintain weight, some start to overeat again, a syndrome called hyperphagia, which can then cause an increased widening of the remaining stomach and a long-term failure rate of 40-50 per cent. 

The gastric bypass is the most radical but also the most effective treatment currently available, with a 75 per cent lasting success rate. This procedure both reduces stomach size and induces “malabsorption”, meaning inability of the digestive system to absorb and digest certain foods. As with any procedure or surgery, there are risks. In 3 per cent to 5 per cent of cases there can be immediate complications related to infection or bleeding. Late complications occur in some cases, related to the surgery or the body’s inability to absorb enough food or vitamins.

Depending on your dietary habits and medical history, your surgeon can recommend one of these procedures and develop a customised treatment plan. Surgery is preceded by six to 12 months of preparations to ensure that you are able to change your habits and maintain a healthy lifestyle. The better you prepare for your surgery, the better the results.

If you have made the decision to lose weight and adopt a healthier and active lifestyle, consider prevention as the best way to long-lasting success; if you elect surgery, thorough preparation and optimal medical follow-up are key. — L’Hôpital Français de Hanoi

*Dr Bernard Guillaume is a French visceral surgeon with over 30 years’ experience in the treatment of digestive tract disease. He has been a pioneer in the development and practice of keyhole procedures and obesity surgery. He works with Dr Bui Trung, a Vietnamese visceral surgeon, treating local and expatriate customers.

If you have any questions or want to book an appointment with our doctors, please contact us at 84 – 24.3577.1100, or email us at contact@hfh.com.vn