Patient information

Understanding obesity

Obesity is a disease. It is not a lifestyle problem that can be solved by merely exercising more or eating less.

Although these lifestyle changes are effective in a very small percentage of people (5%), the majority of people struggle to lose weight or keep from gaining back any weight lost by making lifestyle changes. Obesity is also the root cause of a number of other negative medical conditions such as hypertension, sleep apnea, high cholesterol, cardiovascular disease and type 2 diabetes.

Obesity stigma refers to the negative ideologies related to obesity. In lay man’s terms, this means that obese people are associated with words like “lazy”, “lacking will power”, “glutton”, “unhygienic”. This obesity stigma is prevalent among the media, schools, workplaces, and even healthcare settings. Some studies have shown that discrimination against individuals based on their weight is more prevalent than discrimination based on race or ethnicity. Other studies show that obese people often earn less than their non-obese colleagues. When this weight stigma is internalised, ironically, it is likely to further drive weight gain and poor health in these obese persons.

Due to the stigma, obese patients often view their obesity as resulting from personal failings alone.

For this reason they may view traditional methods such as diet and exercise as the only “socially acceptable” way to lose weight. Obesity stigma wrongly leads us to think that bariatric surgery is a “shortcut to weight loss” or an “easy way out”. This is not true. Bariatric surgery is a proven medical intervention to treat the co-morbidities related to obesity.

Bariatric surgery is the collective term used to describe a number of surgical procedures that induce weight loss by making changes to the digestive system. Over the past 30 years, bariatric surgery has been proven the most effective tool in treating obesity and its associated medical conditions. Because bariatric surgery decreases complications of obesity, improves quality of life and increases life expectancy by 10-12 years, more and more medical aids are funding these procedures for their members (provided that the surgery is performed by an accredited surgeon).

With an increasing global metabolic and bariatric surgery (MBS) experience, long-term studies have proven it an effective and durable treatment of severe obesity and its co-morbidities. Studies with long-term follow up, published in the decades following the 1991 NIH Consensus Statement, have consistently demonstrated that MBS produces superior weight loss outcomes compared with nonoperative treatments.

After surgery, the significant improvement of metabolic disease, as well as the decrease in overall mortality, has been reported in multiple studies further supporting the importance of this treatment modality.
Concurrently, the safety of bariatric surgery has been studied and reported extensively. Perioperative mortality is very low, ranging between .03% and .2%. Thus, it is not surprising that MBS has become one of the most commonly performed operations in general surgery.

Find a provider

SAMMSS is in the process of accrediting and training units. As units come online we will share their details here.

Medical therapy

Medical therapy for obesity has come a long way over recent years with the development of effective, safe therapy. In the past most of the focus was on appetite suppressants.

Due to an increased understanding in the physiology of obesity, drug development reached new heights when it comes to efficiency and safety. There is a lot of interest in this field and many exciting developments are taking place.

Available medical therapy is not as effective as bariatric surgery. However, it can lead to > 15 % weight loss, leading to a dramatic improvement in your general health.

It is certainly not a matter of one drug being the solution for every patient with obesity. Patients need to be individually assessed to establish the optimal medical therapy as there are many factors influencing the treatment decision. You need to be matched with the specific medication that is most likely to work for you. Follow-up is essential to review this decision and to adjust accordingly if needed.

Endorsed procedures

Roux-en-Y Gastric Bypass

This procedure involves creating a small stomach pouch and rerouting the small intestine to this new pouch. It is considered one of the most common and most effective weight loss procedures.

Sleeve Gastrectomy

This procedure involves removing a large portion of the stomach, leaving behind a smaller “sleeve” shaped stomach. This smaller stomach can hold less food, leading to weight loss.

SADI: Single Anastomosis Duodeno-Ileostomy

This procedure is a variant of BPD/DS, it’s a two-step procedure that includes first a sleeve gastrectomy and then the duodenal switch.

Mini Gastric Bypass

Also known as a single anastomosis gastric bypass or a loop gastric bypass, is a type of weight-loss surgery that is considered a variation of the Roux-en-Y gastric bypass procedure. Like the Roux-en-Y gastric bypass, the mini gastric bypass procedure involves creating a small stomach pouch and rerouting the small intestine to this new pouch. However, in the mini gastric bypass, the small intestine is rerouted in a loop fashion, which creates a shorter connection between the stomach pouch and the small intestine.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

This procedure involves removing a large portion of the stomach and rerouting the small intestine to a new connection with the remaining stomach. This procedure leads to weight loss by limiting the amount of food you can eat and reducing the absorption of calories.

Do you qualify?

Obesity is a chronic disease and needs an appropriate treatment plan to ensure successful therapy.

One option is bariatric/metabolic surgery. For many years this option carried significant stigma, especially relating to the safety of the procedures. Over the last 30 years much research has been done and it has been proven to be an effective, safe treatment option. Considering this extensive research, the entry criteria for bariatric surgery have been updated in 2022

Bariatric surgery should be done under guidance of a multidisciplinary team, consisting of a bariatric surgeon, physician/endocrinologist, psychologist, and dietitian. 

A patient can be considered for bariatric surgery if:

  • You have a BMI > 35 kg/m2.
  • You have a BMI 30 – 34.9 kg/m2 with one obesity associated condition, especially if first line medical therapy failed.
  • In the Asian population bariatric surgery can be considered if BMI > 27.5 kg/m2
  • Adolescents and the elderly can be considered for surgery. Age per se is not an exclusion factor.

The list of obesity related medical conditions are long and examples include the following:

  • Type 2 diabetes
  • Hypertension
  • Dyslipidemia
  • Obstructive sleep apnea
  • Cardiovascular diseases like heart failure, atrial fibrillation, and coronary artery disease
  • Fatty liver disease
  • Polycystic ovarian syndrome
  • Infertility
  • Gastroesophageal reflux
  • Joint disease
  • Chronic kidney disease

Meeting the above criteria does not guarantee that you will qualify for surgery. There are other factors to be considered and decisions are made after a patient-specific evaluation. If you think that you may benefit from surgical therapy for obesity, please contact a multidisciplinary bariatric surgery team to schedule an appointment for a more in-depth assessment.

Funding/Medical aid options

Currently more medical aids are paying for bariatric surgery than in the past, providing that proper procedures and requirements are in place. SAMMSS is actively working with the medical aids to make Bariatric surgery more widely available and more cost-effective.

Below are the details of the medical aids that we are working with. However, currently no medical aid funds bariatric surgery in full. For most units a copayment of R20,000-R60,000 is required, depending on the procedure. Contact your medical aid for more details.

FAQ

Some answers to your questions...

Click on the question to show the answer and if there is something that you are not sure of please feel free to contact us.

Is bariatric surgery effective and safe?
Yes, bariatric surgery is effective and safe.
“With an increasing global metabolic and bariatric surgery (MBS) experience, long-term studies have proven it an effective and durable treatment of severe obesity and its co-morbidities. Studies with long-term follow up, published in the decades following the 1991 NIH Consensus Statement, have consistently demonstrated that MBS produces superior weight loss outcomes compared with nonoperative treatments.

After surgery, the significant improvement of metabolic disease, as well as the decrease in overall mortality, has been reported in multiple studies further supporting the importance of this treatment modality. Concurrently, the safety of bariatric surgery has been studied and reported extensively. Perioperative mortality is very low, ranging between .03% and .2%. Thus, it is not surprising that MBS has become one of the most commonly performed operations in general surgery.”

(Excerpt from the 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery.)

What is BMI?
A person’s Body Mass Index (BMI) is the person's weight in kilograms divided by the square of height in meters. In adults, a healthy BMI is considered as falling between 18.5 and 24.99.

A BMI over 30 indicates that excess body fat has accumulated to the extent that it has an adverse effect on health.

Bariatric surgery is considered in patients with a BMI > 40, or a BMI > 35 with two or more obesity related co-morbidities. The surgery is not done for cosmetic reasons, but rather to resolve the obesity-related conditions that have a negative effect on your health.

Will my medical aid pay for bariatric surgery?

A number of medical aids do pay for bariatric surgery. On some plans it remains an exclusion. Some medical aids contribute only a percentage of the total cost, and the patient will be responsible for the outstanding balance.

  • Discovery
  • GEMS
  • Polmed
  • Bankmed
  • Barloword
  • Sasolmed
  • Libcare
  • Anglo Vaal
  • Netcare

We recommend contacting your medical aid to enquire about their specific terms and conditions relating to bariatric surgery.

How much weight can I expect to loose?

Every patient is different and we often see outcomes for patients that are not predicted. But it is important to have a realistic sense of what to expect. Here is a table that shows the average total weight loss that we see with commonly performed procedures:

Procedure

Average % weight loss

BPD-DS

​50%

SADI

40-50%

RYGBP

35%

OAGB / mini gastric bypass

35-40%

Sleeve

30-40%

Endoscopic sleeve gastroplasty

15-20% (after 2 years, longer data not available)

Gastric balloon

10-15%

Medical therapy such as Suxenda and Oxempic

15%

 

Will I gain weight after bariatric surgery?

The percentage of patients who regain weight after bariatric surgery is generally considered low. It can vary depending on a number of factors, including the patient's adherence to a healthy diet and exercise program, and their commitment to long-term lifestyle changes.

It's important for patients to understand that weight loss surgery is a tool, and not a magic solution, and long-term success depends on the patient's commitment to healthy lifestyle changes such as healthy eating, regular exercise, and behaviour modification, as well as following up with their bariatric team.

Exercise and bariatric surgery
Exercise is an essential part of a healthy lifestyle after bariatric surgery. It can help you maintain your weight loss, improve your physical fitness, and boost your overall health and wellbeing. However, it's important to approach exercise with caution and follow the guidelines recommended by your healthcare provider.

Remember, it's important to approach exercise with a balanced and sustainable mindset. Don't push yourself too hard or set unrealistic goals, and always prioritize your health and safety above all else.

Smoking and bariatric surgery
Avoid smoking after surgery as smoking can impede healing, increase the risk of infection and complications, and hinder weight loss. Therefore, it’s essential to avoid smoking after surgery to promote proper healing and maximize the benefits of bariatric surgery.

Remember that smoking can have a significant impact on your health and well-being, both before and after bariatric surgery. If you smoke, quitting smoking is one of the most important steps you can take to reduce the risk of complications and promote optimal healing and weight loss after surgery.

Alcohol and bariatric surgery
If you are considering or have undergone bariatric surgery, it's important to understand the potential changes that may occur in your body's response to alcohol.

After bariatric surgery, your stomach is smaller, and the way your body processes alcohol can change. Your bariatric team may advise you to avoid alcohol for a period of time following surgery, as it can cause discomfort or other issues.

Even after the initial recovery period, you may find that your body can no longer tolerate alcohol in the same way. This can lead to changes in your social life, habits, and behaviors. It's important to follow your bariatric team’s advice and make changes to your lifestyle as needed to support your health and well-being.

Remember, bariatric surgery is just the beginning of a journey towards a healthier, happier you. Making changes to your habits and behaviors, including your relationship with alcohol, can help you achieve your goals and maintain your results over the long term.

Hair loss and bariatric surgery
It is common for patients to loose some hair about three to six months after bariatric surgery. However, this is definitely not permanent and normal hair growth will resume in time.
NSAIDs and bariatric surgery
Are you considering taking non-steroidal anti-inflammatory drugs (NSAIDs) after bariatric surgery?

It's important to know that these drugs can increase the risk of complications, such as ulcers and bleeding, in the first few months after surgery.

To avoid potential risks, it's best to avoid NSAIDs and opt for alternative pain management options. Always consult with your doctor before taking any new medication, especially after surgery.

Remember, proper post-operative care is critical for a successful bariatric surgery outcome. Stay informed and take care of yourself!