It’s well-documented that the UAE has a serious weight problem — but when does lifestyle change not able to go far enough, and bariatric surgery become an answer?
Being very overweight poses a far bigger problem than not being able to fit into your jeans. Obesity almost inevitably goes with diabetes, high blood pressure, heart disease, painful joints — greater risks of serious illness and death from Covid-19 — and even some types of cancer.
While overhauling your lifestyle is certainly always helpful, some patients are at a point where they need medical intervention.
Dr Javed Raza is a surgeon at the Bariatric Disease Institute at Cleveland Clinic Abu Dhabi. He tells the Livehealthy Podcast why for some patients, surgery is the best or even the only solution.
What sort of work is done at the Bariatric institute?
The digestive system covers everything from when food enters the body through the mouth and goes down the food pipe (the oesophagus), into the stomach and intestine. At Cleveland Clinic Abu Dhabi we deal with the entire gastro-intestinal tract and all the organs connected to that system, like the liver and pancreas.
My own specialization is metabolic surgery related to weight and the implications of weight on different parts of the body.
When does being overweight do to the body?
Fat is where the body stores energy when there is an excess of it and uses it when food is not available. That’s how humans evolved. Nowadays, food scarcity is not problem, at least not here in the UAE, so when we eat, the surplus gets stored all over our body. The visible surplus shows in our faces, tummy and legs, but there’s also the fat we can’t see, which gets stored internally around the liver, intestine, heart and lungs.
Too much fat affects the physical function of many body systems. It predisposes us to heart disease, diabetes, breathing difficulties and joint problems. We also know that certain cancers are more common in people who are carrying extra weight.
What kind of cancer?
Cancer of the oesophagus and of the stomach are more common in obese people. We know it happens but we don’t yet know why it happens.
How does weight change body function?
Fat is actually very complex and there are many different types. The fat around the tummy is more harmful compared to the fat you get on your thighs or buttocks. It is more common for people with fat around the trunk to get diabetes, heart disease and fatty liver disease, which can develop into cirrhosis if it’s uncontrolled. Fat also affects the mechanics of your body because it puts strain on your joints and back.
What do your patients tend to have in common?
I practiced in the UK before coming to the UAE and obesity is far more common in younger age groups here in the UAE. The split between male and female patients is different too. In the UK, two thirds of my patients were women and one third men. Here in the UAE, it’s more of an equal split.
What is common to both countries is societal change. From leading a physical life, eating natural food and having relatively limited availability of food we have moved to a far less physical lifestyle, high availability of food and far more processed food. Physical activity has changed dramatically from even one generation ago and this is reflected in the youth of the patients. We even see kids as young as 12 or 15 with diabetes, high blood pressure and sleep apnoea. This was unheard of a generation ago — not only here but in the West too.
Which ways do you favor for losing weight?
I’m a surgeon but I’m also part of a team. Any patient that comes in to our institute is assessed by a multi-disciplinary team. There’s a dietician, a specialist in internal medicine, an endocrinologist if there’s diabetes involved and people to handle the psychological side. If the patient has breathing problems, we call in a pulmonologist, if there are heart problems, there’s a cardiologist and together the team will advise on what intervention is necessary.
We run a wellbeing clinic and a weight loss clinic with a program that doesn’t involve surgery. But if a patient’s case is very complex and they are unlikely to benefit from a lifestyle change or weight loss program, they will be referred for bariatric surgery.
Patients with a BMI (body mass index) of over 35 are likely to have diabetes and high blood pressure, so surgery would be considered. If the patient’s BMI is over 40, it is highly unlikely they would be able to lose weight and keep it off without surgery.
What sort of surgery?
There is a range of procedures. For first-time patients, there is the intra-gastric balloon, or the gastric bypass or removing 70-80 percent of the stomach or the more powerful duodenal switch. All those are done laparoscopically.
We also offer robotic surgery for weight loss and some endoscopic procedures in which the stomach is stitched from the inside.
About a third of the operations we do is corrective surgery on patients who had a procedure somewhere else and have had problems or an unsatisfactory result.
How important is the psychological aspect?
It’s very important. We are taking away a very important friend — food. Some people use food as a de-stressor so we need to make sure they have other coping strategies. That’s why we set up a team which includes psychologists or psychiatrists. Sometimes we postpone surgery to ensure that those other mechanisms are in place, not only in the patient’s personal attitude but in their family network. We also run a patient support group. You can have a patient who is thin after surgery but who may be more unhappy than before, so we need to look at that carefully beforehand.
Some places offer surgery within a week, but we quite often take a few months before we do surgery. When we started our program, some thought we would never build up a practice but people have seen the quality of the work we do. We now do more than 500 surgeries a year.
Do most people end up losing weight?
The vast majority have health problems associated with their weight. Typically, after a gastric bypass, those problems are resolved in more than 70 percent of patients. Weight loss is just one aspect. The gain in health benefits is an even more powerful outcome of surgery.
We had a patient who was on very high doses of two types of insulin, with high cholesterol and high blood pressure. Six months after a gastric bypass, they were off all insulin, they didn’t need medication for blood pressure and they were walking regularly.
I’ve seen several young people who have gained the confidence to go back to education and fathers who were able to play with their children when they couldn’t before.
Being in bariatric practice has given me the happiest moments with the most positive feedback. As a doctor, it makes you feel you’re really making a difference.
What are the complications that can arise?
Any patient who has it should be on vitamin supplements long term, and there must be long-term follow-up because complications might not arise until years later.
There can also be technical complications due to scar tissue because of the way the procedure was performed. If we’re talking about the worst outcome, mortality, it is less than after a gall bladder operation in a standard hospital. By and large, bariatric surgery is very safe.
What should people ask before having bariatric surgery?
Look at the experience of the surgeon. Are they offering more than one type of procedure? How many procedures have they done and what were the outcomes? How experienced is the team — the anesthetics department and the dietician? If something goes wrong, does the hospital have the ability to treat complications? As a patient, you always have the right to ask all those questions.
• Dr Javed Raza was a guest on the Livehealthy podcast on May 5, 2021
Anna Pukas has reported from all over the world as a foreign correspondent for British media. She is now an editor based in Abu Dhabi.