Weight Loss Procedures
Bariatric Surgical Procedures
If you’ve been struggling with your weight for some time, you’re not alone. More than 14 million Australians are obese or overweight, and obesity is now a global health concern.
While a healthy body requires a small amount of fat to normally function, being overweight or obese means you have considerably more fat than your body actually needs.
Weight loss surgery, also known as bariatric surgery, is a safe, effective and powerful option for attaining long-term weight loss if you have developed a significant weight problem. It is the only treatment that has been shown to result in major and durable weight loss, because conservative attempts to lose weight, such as diets, fail for many people.
Weight loss surgery can help you not only achieve a much better standard of living, but it also improves your overall health and longevity in the long term. It can also reduce your risk of many obesity-related diseases.
The extent of weight loss achieved depends not only on the surgical procedure, but also by making positive and lasting changes to your lifestyle and eating habits. Physical activity and good food choices will help you maintain long term weight loss, and give you a better quality of life.
The benefits of weight loss
Excessive weight loss isn’t only about improving your appearance. It’s a life-changing step that can impact your family and social life, provide new career opportunities and improve your overall health and wellbeing.
If you’re struggling with your weight, you may be sleeping poorly, lacking energy and generally feeling sluggish. Losing your excess weight is the first step towards overcoming these issues and feeling healthier in your day-to-day life.
Being lighter gives you more energy to be active, enjoy life and do many things that may not be possible when you‘re overweight.
Losing weight is about helping your self confidence, your self esteem and more importantly…..saving your life. Our belief is to give you the best results possible to help you enjoy your life with your loved ones. And the added benefit – you’ll look good too!
You’re more than welcome to give us a call to talk through how we can help you achieve your goals. Together, we can get you on the road to better health.
During a sleeve gastrectomy (SG) a narrow gastric tube is fashioned in-between the food pipe (oesophagus) and the small bowel, while the majority of the stomach (80%) is removed. The continuity of the stomach is not interrupted compared to a bypass procedure-
Single anastomosis gastric bypass
By completely dividing the upper part of the stomach a small gastric pouch is formed, which results in a drastic reduction of the gastric volume. Further a bypass of the first section of the small bowel is created.
Roux-en-y gastric bypass
By completely dividing the upper part of the stomach a small gastric pouch is formed, which results in a drastic reduction of the gastric volume. Further a bypass of the first section of the small bowel is created during which the bilio-digestive enzymes joining the digestion of the nutrients about 1.5m downstream after the stomach.
Loop-Duodenal Switch (SADI-S / SIPS)
The Loop Duodenal Switch (SADI-S or SIPS) combines a moderate restriction (reduced portion sizes) of a sleeve gastrectomy with a moderate reduced absorption (bypassed small bowel).
Revision surgery involves either the conversion of one weight loss procedure into another, in a single or two stage process, or adjusting a previous procedure. This can be due to different factors, including inadequate weight loss or gradual weight gain, or reflux.
Intra-gastric Balloon (Orbera)
The Intra-gastric balloon, is a non-surgical weight-loss procedure which involves the insertion of a specialised balloon inside the stomach to occupy space and limit the food carrying capacity of the stomach.
What is obesity?
Nutrition surveys over the past 20 years have proven that we are eating more food today than we used to. In fact, Australian intake surveys found children increased their energy intake by over 200 calories per day between 1990 and 2010.
The latest global estimates indicate that an additional 1.2 billion people will be overweight or obese by 2030, with the greatest proportion of those new qualifiers being residents of the UK, USA or Australia.
Obesity is defined as having a Body Mass Index (BMI) of 30 or over, calculated by dividing your weight in kilograms by your height squared in metres.
|Category||Body Mass Index (kg/m2)||Over Ideal Body Weight (%)|
|Normal||18.5 – 24.9||-|
|Overweight||25.0 – 29.9||-|
|Obesity (class 1)||30 – 34.9||>20%|
|Severe obesity (class 2)||35 – 39.9||>100%|
|Severe obesity (class 3)||40 – 49.9||–|
Reasons for obesity
The reasons of becoming obese vary and differ from person to person. At some stage there is often an imbalance in between calorie intake and physical exercise but also some medications or medical conditions can contribute to significant weight gain. Another less influencing factor are the genes. Genetics play a role in developing obesity but also determine how difficult it is to lose weight in the long term.
Once obese it affects your health and wellbeing. There is a dramatic increase in developing metabolic diseases, such as type 2 diabetes, high cholesterol, which leads to heart disease, stroke, pulmonary embolism, depression and osteoarthritis.
Some research has linked obesity to certain cancers, including renal cancer, bowel cancer and pancreatic cancer, and – unsurprisingly – obesity is known to shorten life expectancy.
Obesity can lead to hormonal imbalances which can impact fertility.
Can weight loss surgery
improve quality of life?
Quality of life is one of the most important things. Dr Puhalla asks all of his patients why they want to have weight loss surgery, and by far one of the most common answers is “a better quality of life”.
In his experience, after watching hundreds of patients going through this transformation, their daily living has drastically changed. They enjoy being more active and social. Playing with their kids is so much easier without excess weight. Often mentioned are the theme parks on the Gold Coast, where numerous patients tell me they are finally able join their kids on the fun rides.
Furthermore, patients enjoy socialising, and have much better self-confidence, which in turn sparks new activities and hobbies. These outcomes have been confirmed by multiple studies.
Source: Sojostrom L et al NEJM 2004; Bobowicz M et al Obesity Surgery 2011.
Does weight loss surgery prolong life?
Many patients are interested in the long-term outcomes after weight loss surgery. Studies have found that people with obesity have a shorter lifespan compared to people with normal body weights, and obesity has surpassed smoking as the leading cause of preventable death in the USA
While surgery may seem a radical approach to managing obesity, with some deeming it too risky, the positive outcomes far outweigh the risks. Many studies have found that weight loss surgery reduces risk of early death, as many health concerns are lessened or resolved after weight loss.
Source: Sojostrom L et al New Engl JMed 2004; Peeters A et al Ann Intern Med 2003; Adam et al N Engl J Med 2007; Maciejewski et al JAMA 2011; https://www.princetonhcs.org/care-services/.
Supplements and vitamins
after weight loss surgery
Weight loss surgery is recognized as a highly effective treatment for obesity and obesity related health problems. It reduces the chance of a stroke or heart attack by 42 % and mortality by 30%. All weight loss operations alter the body’s anatomy and the way food gets absorbed. These alterations can make people more vulnerable for nutritional deficiencies (vitamins and micro-nutrients). These deficiencies can make you feel unwell and you can become symptomatic, both short and long term after weight loss surgery, which is why long-term follow up is important.
To make sure you stay healthy and well, we see you for regular follow up appointments, with a full panel of blood tests to thoroughly check your vitamins and micronutrients. This way, we can find any potential concerns early and address them accordingly. Our highly experienced dietitians will guide you through the dietary requirements before and after surgery, and can guide you through the best food choices for your individual needs. Specifically formulated weight loss multivitamins (such as Promeum from Baricare) have shown to be better than basic or standard multivitamins.
Source: Lupoli R et al World J Diabetes 2017; Homan J et al Obes Surg 2019.
What is the best weight loss operation?
Different weight loss operations have been developed over several decades. Some have been very popular in the past but over time, negative side effects or poor long-term outcomes were found, and have subsequently become less favourable (such as the lap band). Other weight loss operations have also emerged (such as the laparoscopic sleeve gastrectomy) and increased in popularity. Common operations are the:
- Sleeve gastrectomy,
- Roux-en-Y gastric bypass,
- Single anastomosis gastric bypass (also called Omega – or Mini gastric bypass),
- Loop duodenal switch + sleeve gastrectomy (also called SADI-S or SIPS).
The long-term weight loss achieved after each of the different surgeries varies. The SADI-S tends to have the best long-term weight loss, followed by the single anastomosis gastric bypass, Roux-en-Y gastric bypass, and then the sleeve gastrectomy. Other factors can influence weight loss, such as the use of a minimiser ring.
However, each operation varies in technicality, and each has different effects on the body. As each person is different, there is no single operation that is suitable for everyone. Many individual factors play a role in deciding which operation is the best fit. Here are some factors that I take into account:
- Body mass index
- Food choices
- Type of work
- Health conditions (e.g. diabetes)
- Weight loss history
- Previous weight loss surgeries
- Previous operations
- Recent smoking history
- Personal goals and priorities
The best weight loss operation is the procedure that best suits your individual needs.
Source: Colquitt JL et al, Cochrane Data Syst Rev 2014, August 8;(8): CD003641, Wang FG et al, Int J Surgery 2018, 56: 7-14, Fink JM et al Obes Surg 2017 27(4):1098-1103
Can weight loss help improve fertility?
With a worldwide increase in obesity, the number of obese patients who require fertility treatment is also increasing. A high percentage of body fat has been found to cause an imbalance of the human sexual hormones, which can cause reduced fertility in women and men. For women with obesity facing fertility problems, weight loss significantly improves the chance of ovulation and pregnancy without having a higher risk of miscarriage. Males have received much less attention in this regard compared to women, however it has been discovered that weight loss in obese men can improve infertility, and with the improved body image and self-confidence associated with weight loss, erectile problems often improve.
Source: Best D et al Human Reprod Update 2017 23(6): 681-705; Rosenblatt A et al Obes Surg 2015 25:1281-1292.
What is revision weight loss surgery?
Despite each weight loss operation having substantial benefits, there are some potential implications. These implications can be better managed if they are thoroughly discussed and explained during your consultation, however they should not interfere with your weight loss, healthy diet and lifestyle. Furthermore, some issues arise post-operatively that cannot be foreseen before surgery, which can result in some patients needing a second operation. This is called revision weight loss surgery.
In Australia, this term was used initially to adjust a slipped lap band. Nowadays, lap bands are much less common, so revision weight loss surgery is mainly considered for either heartburn or reflux that does not respond well to medication, or for unusually high weight gain years after a primary procedure. Revision surgery is often more complex than primary surgeries, therefore a thorough discussion with the surgeon, along with medical investigations, is required to develop the best plan for your individual needs.
Revision surgery is typically performed laparoscopically, and the average amount of weight loss is typically less compared to primary procedures.
Source: Oliver IM et al Cir Esp 2019.
Should I consider weight loss surgery?
Generally speaking, weight loss surgery could be an option if you:
- have a Body Mass Index (BMI) of 40 or higher
- have a BMI of 35 or higher and also have obesity-related diseases or health concerns (e.g. hypertension, diabetes, arthritis, sleep apnoea, depression)
- weigh more than 45 kg above your ideal body weight
- have not been able to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting and exercise
A team approach
Maintaining weight loss is a long-term commitment. It requires ongoing support from a variety of health professionals, including nutritional, exercise and behavioral advice.
Dr Puhalla believes in holistic patient management. He involves experienced dietitians and a weight loss psychologist to provide ongoing support before, during and after your surgery to give you the guidance you need to make your weight loss surgery a success.
So what should you expect?
To prepare for surgery you will be required to be on a very low calorie diet for 2 weeks prior to your surgery date. This includes using Optifast meal replacements (or similar), as well as eating plenty of ‘free’ vegetables and drinking plenty of water.
Your dietitian will guide you and support you through this pre-operative stage.
The purpose of this phase is to:
- Reduce the size of your liver
- Reduce fat around your abdomen to make it easier to access your stomach during surgery
- A reduction in any pre-existing metabolic abnormalities (e.g. hypertension, high blood glucose levels, high blood cholesterol)
- Increase confidence that you will be able to comply with the post-operative dietary restriction
Following surgery you will need to consume a liquid diet for two weeks. In weeks three and four, you will have pureed diet. Following this, you will move on to more textured foods, including soft, sloppy, and then solid foods.
In the long term you should expect:
- Reduced portion sizes
- Good quality food with an emphasis on ensuring adequate protein
- Daily supplementation with a multivitamin and other nutrients as individually prescribed by your dietitian
- Regular meals and snacks
- Separation of food and fluid
- That some foods which you eat regularly now may not be well tolerated
Our highly skilled dietitians have extensive bariatric surgery knowledge and are committed to working with you to support you through your surgical experience and into the future.
Your dietitian appointments are usually scheduled for 2 weeks and 4 weeks post-surgery, then monthly at 2 and 3 months, followed by 6 months and 12 months. Each visit can be attended in person, or via telephone or Skype if required. Additional appointments and exercise consultations may be of benefit and this can be arranged privately. Private health and / or Medicare rebates for these visits may be available.
Frequently Asked Questions
Yes, you will need a referral to see Dr Puhalla. A referral from your GP is valid for 12 months, while a referral from a specialist is valid for 3 months.
The initial consultation costs $250, with a Medicare rebate of $76. The pre-operative appointment costs $90, with a Medicare rebate of $38. You will need a valid referral to claim the Medicare rebates.
No, weight loss surgery is not currently available in the public health system.
Yes, Dr Puhalla accepts uninsured patients. You can apply to the ATO for early release of your super, for which we can assist you. Medicare rebates are available for some fees, however you are liable for all costs.s
Unfortunately, Medicare and health fund rebates do not cover the full cost of providing you with medical care. This is because the rate at which successive governments have indexed the Medicare Schedule fees has been substantially lower than increases in the Consumer Price Index (CPI) and average weekly earnings. The reality is that Medicare rebates do not cover the cost of providing you with a safe and high quality service. The fees charged by this practice have to cover all of our practice costs.
Please bring a copy of your referral, along with your personal details, including Medicare card, private health insurance, and a list of medications. You will need to fill out personal details and medical history forms on arrival.
Yes, it is essential that you see a dietitian to support you on your weight loss surgery journey. This is to ensure that you have the best possible outcome relating to your weight loss and overall health.
Dr Puhalla will discuss your options with you to help you decide the best procedure for you. Your individual preferences, lifestyle and health are considered when determining your type of surgery.
Typically, the hospital stay is one to two nights. If you are undergoing revisional surgery or have a complex medical history, you may need to stay longer.
Depending on the procedure, you will need one to two weeks off work. We can provide you with a medical certificate if required.
We recommend you start driving a week after surgery, initially limiting yourself to shorter drives before returning to normal driving.
Current wait times are around three to four weeks for appointments and surgery bookings. We also have a cancellation list, as patients often have to move their appointments, which means you may be able to be seen sooner. Please advise our team at the time of booking if you would like to put on the cancellation list.
The entire process typically takes around 8 to 12 weeks. Depending on the investigations needed, and whether or not you have private health insurance, this may be able to be shortened to around 4 weeks. We will do our best to meet your schedule, however we recommend you allow at least 8 weeks for the entire process.