Weight Loss Surgery

Bariatric surgery, also known as metabolic or weight loss surgery, is a specialized field within general surgery that focuses on treating obesity and related metabolic disorders. These procedures aim to achieve substantial weight loss and improve overall health by altering the anatomy or function of the digestive system. Unlike cosmetic surgeries, which primarily enhance appearance, bariatric surgeries address serious health issues such as type 2 diabetes, hypertension, and sleep apnea.

Bariatric procedures facilitate weight loss and metabolic improvements through several mechanisms:

• Restriction: Reducing the stomach’s capacity limits food intake, promoting early satiety.

• Malabsorption: Altering the digestive tract decreases nutrient absorption, contributing to weight loss.

• Hormonal Modulation: Changes in gut hormones influence hunger, satiety, and glucose metabolism, aiding in weight management and remission of conditions like type 2 diabetes.

Beyond significant and sustained weight loss, bariatric surgery offers numerous long-term health benefits:

• Cardiovascular Health: Reduced risks of heart disease and stroke.

• Metabolic Improvements: High rates of remission for type 2 diabetes and improvements in lipid profiles.

• Quality of Life: Enhanced mobility, psychological well-being, and overall life satisfaction.

Why Cuba

In Cuba, bariatric surgeries are performed with exceptional precision by highly skilled surgeons who prioritize patient safety, effective weight loss, and long-term health benefits. Cuba’s healthcare system is internationally recognized for its excellence, offering comprehensive preoperative assessments, advanced surgical techniques, and meticulous postoperative care to ensure optimal recovery and minimize potential complications. Surgeons in Cuba adopt a personalized approach, tailoring minimally invasive bariatric procedures to each patient’s unique needs, thereby enhancing comfort, reducing postoperative discomfort, and promoting faster healing.

Importance of Bariatric Surgery

Bariatric surgery serves as a critical tool in combating obesity—a condition associated with numerous health risks, including type 2 diabetes, hypertension, cardiovascular diseases, and certain cancers. By facilitating substantial weight loss, these procedures not only enhance physical health but also improve psychological well-being and quality of life.

Conditions Necessitating Bariatric Surgery

Bariatric surgery is primarily indicated for individuals with: 

Severe Obesity:

• Defined as a Body Mass Index (BMI) exceeding 40.
• This level of obesity is associated with a significantly increased risk of mortality and morbidity, including conditions such as heart disease and stroke.
• Individuals with a BMI over 40 often struggle to achieve sustained weight loss through non-surgical methods alone.

Obesity with Comorbidities:

• Individuals with a BMI over 35 accompanied by serious health issues such as type 2 diabetes, sleep apnea, or hypertension.
• These comorbid conditions can lead to a diminished quality of life and increased healthcare issues.
• Bariatric surgery has been shown to improve or resolve these obesity-related comorbidities, leading to better overall health outcomes.

Causes of Severe Obesity

The development of severe obesity is multifaceted, involving:

Genetic Factors:

• A family history of obesity can predispose individuals to weight gain.
• Certain genetic mutations can affect appetite regulation and energy metabolism, making weight management more challenging.

Lifestyle Choices:

• Poor dietary habits and physical inactivity contribute significantly to excessive weight.
• High consumption of calorie-dense, nutrient-poor foods and sedentary behaviors are major contributors to weight gain.

Metabolic and Hormonal Influences:

• Conditions like hypothyroidism can affect metabolism, leading to weight gain.
• Hormonal imbalances, such as insulin resistance, can promote fat storage and increase appetite.
• Certain medications, like antidepressants and corticosteroids, can also contribute to weight gain by altering metabolism and appetite.

Symptoms Associated with Severe Obesity

Individuals with severe obesity may experience:

Severe obesity presents a multitude of challenges that can significantly impair an individual’s quality of life. These challenges can be categorized into physical symptoms, metabolic complications, and psychological effects.

Physical Symptoms:

• Breathlessness: Excess body weight can lead to increased oxygen demand and reduced lung capacity, resulting in shortness of breath during routine activities.
• Joint Pain: The additional weight places undue stress on weight-bearing joints, such as the knees and hips, accelerating wear and tear and potentially leading to osteoarthritis.
• Reduced Mobility: Physical discomfort and joint pain can limit movement, making daily tasks challenging and decreasing overall physical activity.

Metabolic Complications:

• Elevated Blood Sugar Levels: Obesity is closely linked to insulin resistance, which can progress to type 2 diabetes if unmanaged.
• Increased Cholesterol Levels: Excess weight often correlates with dyslipidemia, characterized by high levels of low-density lipoprotein (LDL) cholesterol and triglycerides, increasing the risk of cardiovascular diseases.
• Hypertension: Obesity contributes to high blood pressure, further elevating the risk of heart disease and stroke.

Psychological Effects:

• Low Self-Esteem: Societal stigma and personal dissatisfaction with body image can lead to diminished self-worth.
• Depression: The psychological burden of obesity, coupled with potential social isolation, can contribute to depressive disorders.
• Anxiety: Concerns about health, appearance, and social acceptance may result in heightened anxiety levels.

Pre-Surgical Diagnosis and Evaluation

A comprehensive pre-surgical evaluation is crucial to ensure the safety and effectiveness of bariatric surgery. This evaluation typically includes:

Medical Assessment:

• Review of Medical History: A thorough examination of the patient’s medical records to identify existing health conditions, previous surgeries, and any factors that may influence surgical risk or outcomes.
• Physical Examination: A detailed physical assessment to evaluate the patient’s overall health status, including vital signs and physical fitness.
• Laboratory Tests: Essential tests such as complete blood count (CBC), liver and kidney function tests, lipid profiles, and blood glucose levels to detect any underlying abnormalities that need to be addressed before surgery.

Nutritional Evaluation:

• Dietary Habits Assessment: An analysis of the patient’s current eating patterns to identify areas needing improvement and to plan post-surgical dietary modifications.
• Nutritional Status Evaluation: Determining the patient’s nutritional health to ensure they can meet the demands of surgery and recovery, and to correct any deficiencies beforehand.
• Education on Dietary Changes: Providing guidance on necessary dietary adjustments before and after surgery to promote optimal healing and long-term success.

Psychological Screening:

• Mental Health Evaluation: Identifying any psychological conditions, such as depression or anxiety, that could impact surgical outcomes or the patient’s ability to adhere to lifestyle changes post-surgery.
• Behavioral Assessment: Understanding the patient’s eating behaviors and relationship with food to tailor support and interventions effectively.
• Support System Review: Evaluating the patient’s social support network, which plays a vital role in recovery and long-term success after surgery.

Criteria for Bariatric Surgery

Candidates for bariatric surgery typically meet the following criteria:

• BMI Thresholds: BMI over 40, or over 35 with obesity-related health conditions.
• Previous Weight Loss Attempts: Demonstrated unsuccessful efforts with non-surgical weight loss methods.
• Commitment to Lifestyle Changes: Willingness to adhere to post-surgical dietary and lifestyle modifications.

Bariatric Surgery Procedures

Bariatric surgery encompasses several procedures designed to facilitate significant weight loss by altering the digestive system’s structure and function. Each of these surgical options offers distinct mechanisms and benefits, and the choice of procedure depends on individual patient factors, including medical history, weight loss goals, and potential risks.

The primary bariatric surgeries include:

• Gastric Bypass (Roux-en-Y):

This procedure involves creating a small stomach pouch from the upper portion of the stomach and connecting it directly to the middle segment of the small intestine, effectively bypassing a significant portion of the stomach and the initial section of the small intestine. This alteration not only restricts food intake but also reduces nutrient absorption, contributing to weight loss.

• Sleeve Gastrectomy:

In this procedure, approximately 80% of the stomach is surgically removed, leaving a slender, tube-like structure. This reduction limits the amount of food the stomach can hold, promoting early satiety. Additionally, the removal of a large portion of the stomach impacts the production of ghrelin, a hormone that regulates appetite, thereby reducing hunger sensations.

• Adjustable Gastric Banding:

This less invasive procedure involves placing an inflatable silicone band around the upper portion of the stomach to create a small pouch above the band, with the rest of the stomach below. The size of the opening between the pouch and the lower stomach can be adjusted by adding or removing saline from the band through a port placed under the skin. This adjustability allows for personalized control over food intake. However, due to variable long-term outcomes and the need for regular follow-up for band adjustments, the popularity of adjustable gastric banding has declined in recent years.