The Issue of Metabolism in Obesity

29 July 2019

Metabolic syndrome is a constellation of Type 2 diabetes, hypertension, high cholesterol and obesity in the abdomen (central obesity). Obesity, is not just a discussion of cosmesis but also a major risk factor for many diseases and health issues. Dr Ganesh Ramalingam is a member of the committee for obesity – The OMSSS (Obesity and Metabolic Surgery Society of Singapore) and emphasises strongly the link between obesity and metabolic syndrome.

Many people are fervently trying to lose weight to look good and restore their health. Dr Ganesh approaches this obesity epidemic in a holistic manner. In his practice, he has discovered that there is no one universal method of weight loss that works for everyone and allows them to keep it off in the long run. There is no doubt that, some manage to do it through proper diet and exercise alone while others require a combination of diet, exercise and surgical intervention. In other words, any weight management programme has to be tailored to the individual.

This is due to the obvious social, psychological, physical and even genetic differences of each and every person. Dr Ganesh Ramalingam performs one option in this lifelong, multi-faceted management of obesity and metabolic syndrome is Bariatric surgery. The procedures that can be broadly divided into laparoscopic and endoscopic options.

Intragastric Balloon
The endoscopic option is the Intragastric Balloon. The procedure is done together with a gastroscopy under sedation. The balloon is then left in the stomach for 6 months and the average weight loss is about 10 – 15 % of the total weight (approximately 8-12kg).
The balloon fills the stomach and allows the person to eat only small amounts. This calorie reduction is augmented by healthy dietary advice and exercise that Dr Ganesh will go through during the follow-up. All these will create a new healthy lifestyle habit that will continue beyond the 6 months even after the balloon is removed.

Two Surgical Options
The two commonest surgical options for morbid obesity done in recent times are the Laparoscopic Sleeve Gastrectomy and the Laparoscopic Gastric Bypass. The Laparoscopic Gastric Banding that was previously done commonly in Singapore is now less frequently advised.
A Laparoscopic Gastric Bypass entails bringing the small bowel up to the stomach, rerouting food from the stomach directly into the small intestine and bypassing the liver – pancreas complex. It’s also known as metabolic surgery, because it immediately alleviates the trio of disease associated with metabolic syndrome: Diabetes, High Blood Pressure and High Cholesterol.

Laparoscopic Sleeve Gastrectomy
The Laparoscopic Sleeve Gastrectomy reduces the size of the stomach, longitudinally, by about 50-60% of its volume. This will reduce the amount of food consumed and the speed of which food is consumed. The surgery will be done under general anaesthesia and performed using keyhole (laparoscopic) technique. Hospital stay post-surgery is about 2-3 days and the expected weight loss is about 60 to 70% of your excess weight over 1 to 2 years. This procedure can give a longer-term weight loss.

Laparoscopic Gastric Bypass
The Laparoscopic Bypass is the other Bariatric procedure that is commonly done in Singapore. It involves reducing the size of the stomach and connecting the small intestine to this reduced “pinch” of stomach. It is also done laparoscopically and the expected weight loss and maintenance is marginally better than the Sleeve Gastrectomy. It is also known as “Metabolic Surgery” as it has increased benefits for people with metabolic syndrome.

Diet and lifestyle changes are expected regardless of the procedures performed. These are always emphasised by Dr Ganesh as the fundamental pillars in weight reduction and improvement of metabolic syndrome.

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