BARIATRIC SURGERIES IN QATAR: RISKS AND BENEFITS
“How come all the sizes are so big?” Sara Hamed overheard the woman shopping next to her complain. She wanted to disappear, because there was nothing fit her in the store. She strolled through the mall and glared at the thin people passing by.
“Sometimes I feel like I’m the fattest person in the country. Dieting does not work and there is never enough time to exercise. My only way out is to cut off my stomach. That is what I will do this summer,” Hamed said.
According to the March 2014 World Obesity Report, Qatar ranks fourth in the number of overweight and obese males and first in the number of females, with 40 percent of the population overweight and another 35 percent obese.
Bariatric surgeries are a part of the National Social Health Insurance System (SEHA) for obese Qatari nationals, according to the Supreme Council of Health (SCH). Last year Hamad Medical Corporation conducted 900 surgeries and over a thousand were conducted in other hospitals.
Dr. Mohammed Al Emadi, chief bariatric surgeon at Al Emadi Hospital, explains that “surgical therapy should be considered for individuals who have a body mass index (BMI) of greater than 40 kg/m2 or have a BMI greater than 35 kg/m2 with significant co-morbidities and can show that dietary attempts at weight control have been ineffective.” He adds that fitness for both surgery and anesthesia are also considered.
“The choice of procedure is partly determined by local expertise. It is crucial that all operations be performed by a highly experienced and specialized surgeon in a specialized multidisciplinary unit or center,” Al Emadi said.
Al Emadi graduated from Royal College of Surgeons. He founded Al Emadi Hospital and is the chairman of the board of directors, performing the highest number of bariatric procedures in the Middle East.
Restrictive bariatric procedures, such as the gastric banding and the gastric sleeve, decrease the size of the stomach, which makes the people who undergo the procedure feel full with smaller amounts of food, while still getting the nutrients. Malabsorption surgeries limit the amount of nutrients a body can absorb, as it removes or rearranges the digestive system, but they are usually performed with a restrictive procedure, such a gastric bypass.
Yousef Mohammed, 21, underwent the gastric sleeve operation a year and a half ago, and he lost 55 kilograms. He chose to undergo this surgery because he tried dieting and exercising, but did not lose weight, he also read about the procedure and said that he found that it had no side effects. “I have more confidence, as the change of my body and the way I look allow me to do things I was not able to do before, like wearing summer clothes and playing,” said Yousef Mohammed.
The Supreme Council of Health (SCH) issued National Guidelines on Weight Loss Surgery in July 2014, which state that operations should not be, “mere cosmetic procedures, but should rather be only performed for medical reasons.”
“In our center, we start with a restrictive procedure, the Laparoscopic Sleeve Gastrectomy (LSG), followed by a malabsorptive procedure (Mini Gastric Bypass) later, if necessary, as a revisional procedure.” Al Emadi said.
In Qatar, the restrictive process of sleeve gastrectomy is the most common procedure performed, as it allows the body to still absorb nutrients, unlike other procedures that restrict food from the intestine. SEHA does cover other forms of procedures as well, since the requirements may differ from patient to patient.
Al Emadi explains that SEHA covers primary surgeries that include sleeve gastrectomy, Roux-en-Y Gastric Bypass, laparpscopic adjustable gastric banding, gastric mini bypass, staged restrictive and malabsorptive procedure, and the endoscopic intragastric balloon. It also covers the revisional surgeries of this list.
While some decide to undergo bariatric surgeries to look better or to improve their self-esteem, others go through it to deal with everyday pain or to fight off chronic diseases. Most patients who undergo weight loss surgeries have a significant decrease in blood pressure, blood sugar and cholesterol levels.
Ali Mohammed, 37, started having disturbed sleeping patterns in 2011 due to juggling marriage, work and studying. Within three years, he gained over 30 kilos. Then, he started getting skin abscess and underwent seven operations to remove the large ones as they appeared. After his sixth surgery, doctors discovered that he was diabetic.
Due to the lowered immune system, many overweight diabetics suffer from skin abscesses, which is a condition where the skin gets inflamed as the body fights off bacteria trapped under skin folds. This inflammation is caused by the body fighting off these bacteria. Dead cells and hair follicles gather around as well, causing pressure on the skin thus causing pain.
Ali Mohammed underwent the gastric sleeve operation eleven months ago and has stopped getting the large abscesses. He has also become more energetic, yet he has lost the feeling of hunger and thirst. “I now eat because it is an obligation, and I have to remind myself to drink.” He explains that these eating habits cause constipation, which leads to severe cases of hemorrhoids.
El Emadi says that there are a number of risks a person should consider before undergoing a bariatric surgery. While some face non-specific perioperative complications, the instances of these complications can be decreased through the use of Low Molecular Weight Heparin LMWH prophylaxis, which are anticoagulant medications. Others suffer from surgery specific complications, such as nausea, malnutrition and excess skin.
G.H., 21, is a female student who also underwent a gastric sleeve procedure in Qatar. She had the surgery in 2013 and lost a total of 25 kilograms. After the surgery, G.H. realized that there were side effects on her studies, “I am always sleepy. I can’t study and I have no concentration,” and on her health, “I am still suffering from stomach burns when I eat certain food, such as spicy food, and I have to take vitamins to maintain my performance.”
While bariatric surgeries may help some people overcome health issues, such as obesity and type 2 diabetes, it may not be for everyone. Al Emadi explains that “bariatric surgery carries the potential for serious complications, morbidity and possible mortality.” He adds that “contradictions that should be considered include, but are not limited to: unacceptable risk of cardiac complications, poor myocardial reserve, significant chronic obstructive airways disease or respiratory dysfunction, non-compliance of medical treatment, significant psychological disorders, or significant eating disorders.”
Bariatric Surgery Complications