Obesity & Bariatric Surgery

World Health Organisation defines overweight and obesity as abnormal or excessive fat accumulation that presents a risk to health.

Obesity is a major risk factor for several chronic diseases including diabetes, cardiovascular diseases, and cancer. This can seriously affect a person’s health, and for certain individuals, it could be fatal.

The issue of being overweight and obesity is alarming in Malaysia. According to the National Health and Morbidity Survey (NHMS) 2019 , 50.1% of Malaysian adults are overweight and obese. Out of the 50.1% of Malaysian adults, 30.4% were overweight and 19.7% obese.

Obesity is more than just outward appearance; it is a medical issue that needs to be addressed because of its link to non-communicable diseases in Malaysia such as cardiovascular diseases (heart attacks, stroke, hypertension, hypercholesterolemia), diabetes, cancers, and chronic respiratory diseases.

The following are some risk factors that increase an individual’s risk of obesity:

• Lifestyle choices: Unhealthy diets, sedentary lifestyle, and liquid calories (soft drinks, alcohol) contribute to weight gain.
• Age: Although obesity affects both young and old, hormonal changes and decreased activity levels as you age increases your risk of obesity. Additionally, you also lose muscle as you age and this decreases our metabolism, thus leading to weight gain.
• Genetics: Obesity runs in families. Genes inherited from parents could influence how much body fat you have. Genes may also affect your metabolic rate.
• Medication and diseases: Weight gain has been associated with certain diseases, such as PCOS, Cushing syndrome, hypothyroidism, and osteoarthritis. Medication such as antidepressants and anti-seizure medications could also cause weight gain which might lead to obesity.
• Economic and social issues: Both economic and social factors are linked to obesity. An individual who lives in an area with limited healthy food options, or if they could not afford healthy food is more likely to develop obesity. Having a safe place to walk, play, and exercise is also important.

The most commonly used measurement for obesity is the Body Mass Index (BMI), which is a simple measurement metrics to classify overweight and obesity in adults.

BMI is calculated by dividing an individual’s weight (in kilograms) by his or her height (in metres) squared.

BMI = body weight (kg) / height x height (m²)

An individual is considered overweight when their BMI ranges between 23 - 27.4 kg/m 2 and obese when their BMI is above 27.5 kg/m 2 .

The waist circumference can also be measured to determine abdominal obesity in an individual.

Abdominal obesity occurs when the measurement of waist circumference is:

• Above 90 cm in a man
• Above 80 cm in a woman

Obesity is linked to numerous health complications. Some of these complications are chronic and can be life threatening if medical intervention is not provided:

• Heart disease
• High blood pressure
• Type 2 diabetes
• Stroke
• Certain cancers, including breast, liver, pancreas, and kidney cancer
• Digestive issues, including gallbladder and liver diseases
• High cholesterol
• Sleep apnoea
• Arthritis
• Infertility
• Severe COVID-19 infection

Weight-related issues can also cause:

• Discrimination
• Depression
• Shame
• Guilt
• Social isolation

Bariatric surgery is an operation that helps an individual to lose weight by making changes to the digestive system. This procedure is performed by either making the stomach smaller or by bypassing a part of the small intestine.

Bariatric surgery is an option for people with BMI above 32 kg/m 2 with medical conditions. To be eligible for surgery you will need to consult a multidisciplinary bariatric team.

1. Laparoscopic Sleeve Gastrectomy

   Laparoscopic Sleeve Gastrectomy is a surgical weight-loss procedure in which about 70% of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana. Limiting the size of your stomach restricts the amount of food you can consume. It also prompts hormonal changes that assist with weight loss.

2. Laparoscopic Roux-en-Y Gastric Bypass

   Laparoscopic Gastric Bypass involves creating a small stomach pouch and bypassing a part of the small intestines. The rest of the stomach remains functional and remains connected to the intestine. This surgery results in hormonal changes, which leads to better control of blood sugars in diabetic patients and results in other metabolic improvements.

A non-surgical procedure to treat obesity is to insert an intragastric balloon. An intragastric balloon is an inflatable medical weight loss device that is temporarily placed into the stomach of patients who are overweight or obese.

This device can be endoscopically inserted into the stomach or as a swallowable device without endoscopy.

This device aids in weight loss if surgery is not an option. The balloon limits the amount of food the stomach can hold and thereby creates an early feeling of fullness and satiety.

Healthy food choices and activities are two main ways to overcome obesity. Individuals can avoid weight gain and therefore, obesity by:

• Exercising moderately 20 to 30 minutes a day. Head to the park for a walk, go swimming or biking
• Choose healthy food such as fruits, vegetables, and protein. Avoid food that are high in sugar, trans fats and processed food
• High calorie food should only be taken in moderation

At Gleneagles Hospitals, the multidisciplinary Bariatric Team consists of healthcare professionals such as doctors, nurses, physiotherapists, dietitians, and pharmacists dedicated to help ensure the treatment success and wellness of the patient throughout his / her weight loss journey.

Contact us for your preferred weight loss option or schedule on appointment for a personalised treatment.

1. World Health Organization (2022) Obesity, Available at https://www.who.int/health-topics/obesity#tab=tab_1 [Accessed 8 April 2022]
2. Mayo Clinic (2 Sept 2021) Obesity, Available at https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742 [Accessed 8 April 2022]
3. National Health and Morbidity Survey (NHMS) 2019, Available at 4_Infographic_Booklet_NHMS_2019_-_English.pdf (moh.gov.my) [Accessed 11 May 2022]