Weight Loss

Patient should be cared for under a comprehensive integrated center that have the patient needs taken care of. A dedicated team of Bariatric surgeon, dietician and related specialties is usually required to motivate and guide the patient in going through the correct steps to maximize the weight loss after bariatric surgery.

At Surgicare Bariatric and General Surgery clinic, we implement a comprehensive work up and goals guided plan prior to surgery as well as after bariatric surgery to reduce the risk during and after the surgery, as well as making sure the patient understand the journey that he or she will be taking after the surgery. Dietician will come on board as well guiding the correct eating habits. Relevant specialties will be referred to for comprehensive work up. 

Bariatric or metabolic surgery actually refers to the same type of surgery. While the term bariatric surgery is more targeted at surgery performed with the intention for patient to lose weight, metabolic surgery is more targeted at surgery to be performed to improve the metabolic parameters of the patient including reducing cardiac risk parameters, improving diabetes and possibly resolving it in some cases, improvement in hypertension profile. 

The discussion you should have with a specialized trained Bariatric Surgeon will be the beneficial effects of surgery versus the risk of surgery. He will also discuss the different options available according to your individual Body Mass Index and related co-morbidities, and then make the relevant recommendations. 

I work with a team of specialist who will help take care of my patients after bariatric surgery. A specially trained Bariatric dietician is very important in helping our patient achieve his/her nutrients requirement after surgery. Failure to pay attention to such nutrition may lead to long term problems of nutrition deficiency. 

Before undergoing Bariatric and Metabolic surgery (weight loss procedure), I will get the patient through a proper assessment to ensure the side effects after surgery such as those described in your questions are minimized. Working with an anesthetist who is specially trained with Bariatric and Metabolic surgery is also important in reducing the post operative nausea and vomiting.

Here in Surgicare Bariatric and General Surgery, I work with a team of doctors who are specially trained in Bariatric and Metabolic surgery, to ensure our patients have the best outcome and minimize their side effects after surgery.  

Within the same day after Bariatric and Metabolic surgery, my patients are able to walk to the toilet and around the room. They are usually discharged from hospital within 1-2 days after surgery. They will be encouraged to resume walking activities as soon as they are discharged. As for cycling and biking, perhaps a week or two after surgery will be a reasonable time period for him/her to get back to those activity.

Depending on the type of Bariatric and Metabolic surgery performed, existing chronic condition such as Diabetes, hypertension or hyperlipidemia will see improvement within a certain period of time. It may also improve to an extend that it may enter remission. 

The exact mechanism of resolution of morbidities related to obesity improvement after Bariatric and Metabolic surgery may be unknown, but we know that there is a good chance of decreasing the dose requirement of medications for Diabetes, hypertension after surgery. For a certain group of people, there may also be a chance of causing these conditions to be in remission. 

Speak to your Bariatric surgeon to find out more, individualized to your own condition and whether it is recommended that Bariatric and Metabolic surgery is suitable for you.

After Bariatric and Metabolic surgery, one's diet will have to be changed drastically. It would be best to be advised by a specially trained Bariatric dietician. For example, the emphasis would be more protein based, rather than carbohydrate and fat based. Once you have achieved the protein intake requirements for the meal, one would usually be full and not wanting to ingest any more food. 
Our Bariatric dietician will guide you along the way after surgery. 

After undergoing Bariatric and Metabolic surgery, it would also take dietary changes to maximize the effect of surgery, and achieve maximal weight loss. One's diet may never go back to previous ways, so as to achieve better weight loss, and cause remission of medical conditions. 

Yes, lots of my patients have remarkable turn around in their lives after bariatric surgery. There is improvement in Diabetes control, Hypertension, Hyperlipidemia. Some patients mentioned that their back pain, ankle pain, knee pain have disappeared. 

Not just medical conditions improvement, there are also documented psychosocial improvements. One would feel more confident and go out to socialize more, getting a job, getting a life partner.

Depending on the severity of obesity, there are different classification and grades of obesity. Bariatric and Metabolic Surgery (the correct term) is most effective for patients with higher grade obesity or those with associated obesity related medical conditions. 

Effectiveness of surgery will be looking at excess weight loss of 50-80%, compared to medication or insulin shots which will be lower. This will have to be weighed against the risk of surgery. For people who qualify and want the surgery, Bariatric and Metabolic surgery is an effective, safe and long term solution against obesity and it's related co-morbidities. For the higher grades obesity or those with medical conditions associated with it, the benefits of Bariatric and Metabolic surgery far outweighs the risk associated with it. 

Make an appointment and speak to your bariatric surgeon who will be able to answer your queries individualized to your needs.  

Bariatric surgery is more targeted at losing weight. Metabolic surgery is more indicated for surgery for the improvement of metabolic parameters, such as reducing the risk of hypertension, diabetes, heart attack and stroke. Differences is in the terminology. Type of surgery is the same.

The correct term we use now is Bariatric and Metabolic surgery. The 2 most common operations are laparoscopic sleeve gastrectomy and laparoscopic roux-en-y gastric bypass (also known as gastric bypass)

These surgeries are known to be most effective and long lasting for people with severe obesity, as they not just limit the food intake, but also make hormonal changes, alter the body set point and metabolism.

Hi Euna
Currently there are no good medications that can treat specifically fatty liver (non-alcoholic fatty liver disease, NAFLD; non-alcoholic steatohepatitis, NASH) which are approved by FDA. 

As you rightly pointed out, fatty liver is a complication of obesity. Fatty liver is related to diabetes . So any kind of weight loss, be it by lifestyle modification, medications or bariatric surgery, will always reduce liver fat and improve NAFLD.

The latest medication which is oral GLP-1 agonist (semaglutide) is FDA approved for weight loss. It is still relatively new so may not be available in your country yet. 

Hi Young-Friesen
Thanks for the question. The ideal diet would be choosing foods that have low glycemic index such as whole grain, vegetables and fruits. Avoid the carbohydrate loading that high glycemic index such as white rice, white bread, and as previously mentioned the foods /drinks with high sugar contents. Furthermore, high calorie deep fried foods may not help. Other than choosing hte right foods, make sure you stick with good lifestyle habits - don't eat too fast, avoid late night supper, don't skip breakfast (There are research studies out there that have shown these lifestyle habits increases the risk of fatty liver )

Exercises I would recommend consistent cardio exercises about 30-45mins about 2-3 x per week. Sometimes, in the elderly or those with physical issues (knee arthritis), I would suggest regular walking or swimming.

Hi Kerstin,
This is a great question. Many people think those with liver condition such as fatty liver will have symptoms. This is quite the opposite! On the contrary, patients with chronic liver conditions like fatty liver do not have symptoms at all until very late stage where cirrhosis (liver hardening) occurs. Then they may feel fatigue. In more severe cases of liver cirrhosis from NAFLD (non-alcoholic fatty liver disease), patients may develop ascites (fluid collection in the abdomen), muscle wasting, or intestinal bleeding.

For the condition of fatty liver related to obesity - the best way is to reduce obesity and getting back to normal weight.

The lifestyle modification in this era I would say is to avoid ultra-processed foods, foods high in sugar content (such as sugar beverages, candies), avoid overeating, avoid eating too fast, regular exercises (at least 45 mins of cardiovascular workup about 2-3 times a week). 
Going outdoors, reduce screen time, avoid late dinner/supper, sleep well, avoid "stress-relief eating".
All these are difficult to achieve, so the treatment plan and lifestyle modification has to be tailored to the individual.

From time to time, drink and enjoy your coffee - coffee is actually good for fatty liver :)

Hi Pa-Kihn
Thanks for the question. I would say there are many medications out there in the market which aims to reduce weight and in term reduces the severity of the fatty liver. You are absolutely right, reducing the amount or severity of liver fat, reduces the risk of progressing to more severe form of fatty liver like cirrhosis.

There are also several drugs in the research pipeline that aims to work on the different pathways of fatty liver to reduce the 'liver fat'. For now, I would say the most effective medications that reduces the degree of fat in the liver are those medications that works for you and can help you lose weight. 

GLP-1 agonist for example, works on the appetite pathway as well as reversing the insulin resistance (that will eventually lead to diabetes). So patients on this drug tend to have reduced appetite, reduced intake, and improvement in insulin sensitivity which reduces the amount of the fat in the liver.

If you can lose 7-10% of your body weight, you have a very good chance at reducing the amount of fat in the liver. I always tell my patients lifestyle modification is more important than medications alone, because you carry the lifestyle changes with you for the rest of your life!!

HI Wilfred
Thanks for the question. In general, a healthy diet and regular exercises can reduce excessive weight gain.

Sometimes people do calorie counting to avoid too much caloric intake. In terms of weight gain, I would mention three areas 
1) healthy lifestyle includng diet and exercises
2) medications
3) avoid stress 
4) surgery

Hi Augustine, 
That is a good question. Usually we would recommend patients to avoid sugar-containing beverages such as bubble tea, soda, bottled juice. Excessive alcohol intake can also worsen the fatty liver.

Deep fried foods will need reduce as well. Fatty liver is often associated with diabetes, obesity, high cholesterol, gout. So awareness is needed to avoid foods that will worsen these associated conditions as well.

Some studies have suggested coffee is good for fatty liver, whereby those consistently taking coffee have reduced complications and mortality from fatty liver. Whilst coffee is good for you, remember to limit this to <3 cups per day. Of course, I would also suggest to drink coffee without sugar :)

On the side, weight loss is best management plan for fatty liver. Let it be exercises or some form of diet intervention. Weight loss of 7% or more has been shown to reduce liver inflammation from severe fatty liver. Exercise is the best option here because of the added benefits of cardiovascular improvement. 

Hope this helps

Hi Stephen,
Fatty liver is defined as the accumulation of fat in the liver which is excessive for the normal physiological state. Fatty liver can be due to many causes - most common causes include obesity and alcohol use (usually excessive). In the setting where someone does not drink alcohol or drinks very little alcohol and has fatty liver - the doctors usually termed this as "non-alcoholic fatty liver disease" or NAFLD, in short.
Other causes includes steroid use, hormonal conditions such as hypothyroidism to name a few. 

Typically NAFLD is related to increased 'fructose' intake and recent weight gain. Fructose is the common sugar ingredient we find in sugar-containing beverages such as Coke, fruit juice, Bubble tea, etc. Excessive intake of these artificial sugars can increase your risk of fatty liver.  Other lifestyle factors that will increase the risk of fatty liver includes regular nightshift work, propensity to eat supper before bed time, lack of exercises. 

Remember with the COVID pandemic, many people are now working from home (WFH), so doctors have seen greater proportion of patients who suffers from weight gain during this period - such will lead to increased risk of fatty liver

NAFLD can be hereditary IF there is a family history of type 2 diabetes. Fatty liver (NAFLD) is a condition which is closely associated with diabetes. Those with fatty liver has increased risk of developing diabetes in their lifetime. Conversely, those with diabetes are at increased risk of having fatty liver too. 

Hope this information answers your question! 

Hi Renega
Thanks for your question.
The most common causes of fatty liver globally is obesity /overweight and excessive alcohol intake. Generally when we talk about fatty liver, we often associate it with 'fat' and being overweight.

Your doctor can do investigations like liver test to see if there is any 'inflammation'. Ultrasound scan can be done to confirm or exclude fatty liver. 

Another sensitive way is to perform Fibroscan (transient elastography) which can quantify the degree of liver fat and ascertain the degree of 'liver scarring' present. Such test is available in certain Gastroenterologist clinic,  you may need to call to find out if the Fibroscan is available.