Now, before everyone starts getting hysterical and cursing the medical profession for this supposedly invasive and drastic procedure in eliminating excess weight, here’s one doctor who is bent on correcting the misconceptions and biases against bariatrics surgery, and making people understand how it really works.
Dr. Hildegardes Dineros, a leading proponent of bariatrics surgery and head of Asian Bariatrics, an advocacy group committed to helping minimize the incidence of severe obesity, is aware of the increasing number of obese people worldwide. Consider the statistics: More than two million Filipinos (17 percent) are suffering from obesity, and 500,000 of them are considered morbidly obese (severely obese).
According to Dr. Dineros, people who are 100 pounds over their ideal weight and with a body mass index of more than 40 are considered morbidly obese. More often than not, the morbidly obese are also suffering from the so-called "co-morbidities" or health conditions associated with obesity. Hypertension, diabetes, and coronary heart diseases are just a few of the co-morbidities that accompany severe obesity.
"The morbidly obese are really the ones who would require aggressive treatment in managing obesity and are likely candidates for bariatrics surgical procedure," says Dineros, a surgeon specializing in general and cancer surgery, laparoscopic, aesthetic and plastic surgery and now, bariatrics surgery.
Simply put, bariatrics surgery is "a surgical procedure designed to address the weight problem of the patient." If the patient has tried all the conservative methods in losing weight – dieting, exercising, taking slimming pills – and if he/she is having health problems because of obesity, then bariatrics surgery is usually recommended.
Unlike liposuction, which has become a fad in the country thanks to showbiz stars led by Rosanna Roces, Dr. Dineros clarifies that bariatrics surgery goes beyond aesthetics. It’s like hitting two birds with one stone, so to speak. Apart from promoting weight loss, it also helps eliminate other health problems associated with obesity. The result is a healthier, if not leaner, patient.
"What we do here is we try to diminish or decrease the capacity of the stomach to contain food when we eat. We also minimize the capacity of the small intestines to absorb nutrients by decreasing the length of the intestines when you do some re-routing of the gastrointestinal tract," says Dr. Dineros, adding that there are three principles involved in all this – malabsorption, restriction or a combination of the two, such as a gastric bypass procedure. A patient opting for bariatrics surgery may choose to have his stomach "stapled" or his intestines cut by as much as five meters (the length of the small intestine is about six to seven meters). All this sounds drastic, all right, compared to diet and exercise but, says Dineros, when compared to other surgical procedures, it’s not really as aggressive.
Dineros tells us that his patients are within the 14 to 58 age range, most of them females. Almost all of them did not lose weight using conservative treatment. He assures that bariatrics surgery won’t go the way of past fads as they are very strict in screening patients. "We won’t operate on a patient who is of normal weight and who is just overweight. We only operate on a patient who is severely obese," he says.
Dr. Dineros also realizes the importance of a holistic approach to obesity, because he doesn’t see it as a disease but a manifestation of a deeper problem. For him, a bariatrics surgery patient has to be provided with a tool to successfully lose weight and never again look back. After carefully observing his patients and reading all about bariatrics patients, Dr. Dineros was able to develop what he calls the "4 As" – awareness, acceptance, aggressiveness and assessment.
Awareness, he says, is all about looking at the problem straight in the eye and having a full grasp of the problem. A patient should understand that obesity is more than just genes or a lousy eating pattern disorder, or even an endocrine system gone wild.
"If you eat because you need nourishment, then you’re okay, but if you eat because it’s pleasing, then you get away from the real objective of eating," he says.
The doctor observes that people attach certain emotions to eating. "We eat when we’re happy or sad, we eat absentmindedly when we’re bored or when we’re watching TV. We always seem to be putting something in our mouths simply because it’s pleasing," says Dineros. The Pinoys should plead guilty to this observation. Oftentimes, we do live to eat and not eat to live. Perhaps it’s time to sit up, stop munching and really think about our eating behavior?
Once a patient becomes aware of the problem, Dineros says acceptance should soon follow suit. "Oftentimes, obese and overweight people deny that they’re obese and need to lose weight. You can be sure your dieting or exercising will not succeed," he says. So, the best thing to do is look in the mirror and tell yourself that you have a serious problem here and only then can you take the necessary steps to solve it.
Elaine Sumulong-Tumagay, mother of two, went through a state of denial when, after failing to shed off excess pounds after trying all sorts of diets after giving birth, she turned to food and ate to her heart’s content. "I refused to weigh for years because I couldn’t accept that I had gained more weight. I couldn’t accept the fact that I was gaining more weight," says the former cheerleader who used to weigh only 112 pounds in high school. She was desperate and her health was suffering. When she tipped the scales at 217 pounds, she said, "Enough is enough" and had bariatrics surgery. Now, at 180 pounds, she’s looking forward to losing more pounds and considers herself as a "work in progress."
Once you’ve made up your mind, you have to be aggressive. "Focus is important here. You can’t afford to go back. Be positive. Be selfless," the good doctor says.
During this time, you’ll feel vulnerable, deprived even. It’s so easy to turn back to food for comfort. For the doctor, giving in to such desires is being selfish, since you’re only thinking of yourself and nothing else.
"Let’s say you’re on a diet. Try not to perceive this as a deprivation. Accept it positively and this will sustain you," he states.
Of course, you need to monitor your progress by assessing how far you’ve come or if you need to do more to reach your goal of losing weight. This is where Dineros’ support group, the Asian Bariatrics, comes in. Every last Saturday of the month, from 10 a.m. to 12 noon at the Quezon City Sports Club, a group of bariatrics patients and potential patients meet up to exchange notes, give advice, or share whatever they want regarding their battle against obesity.
"We’re not saying that you should stop eating. It’s still best to observe moderation. Just eat what you need to eat," advises Dineros.
Bariatrics surgery, being a major operation, could cost from P180,000 up. "Compared to cost-related problems caused by obesity, this is next to nothing," says Dineros. "A patient who has hypertension, is overweight and has cardiovascular disease is spending so much on medicine. His inability to work and propensity for accidents add to the cost. Bariatrics surgery is cost-effective in the long run. Some would spend more than P200,000 for a liposuction or even much more on diet pills, regimen and slimming centers."
Though the procedure has been there for about 40 years, Dr. Dineros explains that complications and risks are much lower now due to the refinement of the technology. If a patient doesn’t fancy an open surgery – this is where doctors open you up the traditional way – then a laparoscopy surgery is the next best thing. Small incisions are made on the designated body part and operation is made using a video. It’s minimally invasive albeit a bit more expensive. Faster recovery and less pain as well. A week after both types of surgery, a bariatrics patient can already engage in regular activity. He is initially put on a liquid diet for the first four weeks and finally on solid food the next month. Mind you, two to three tablespoons are often enough for a patient to feel full. "You will be utilizing calories from your body’s fat deposits," comments Dineros. "Of course, at first you will feel deprived and would have cravings, and this is where the 4 As come in."
Patients are said to lose one-third of their initial weight during the first year and experience a steady decline until they reach their ideal weight. But Dineros clarifies that ideal body weight doesn’t have to follow what’s in the charts. "Once you lose a big percentage of body weight, a lot of the co-morbidities are already gone. Though a person hasn’t reached his ideal body weight but is feeling healthy and is active, then he’s all right. To lose more weight could impair his health."
Those who are not happy about this new technology for losing weight, says Dineros, are often misinformed and are encouraged to read up on the matter before making judgments about it.
As for those who have tried all sorts of diets, taken all kinds of slimming pills imaginable and done the rounds of slimming centers and gyms without losing a pound, bariatrics might just be the miracle cure they’ve been waiting for.