Bariatric Surgery in South Africa: Slim Through Surgery

Her obesity has long bothered Dineo *. The woman from South Africa had a penchant for fast food, creamy desserts and chips. She drank two liters of sugary drinks a day. "It was relaxation for me," she recalls. Their weight increased over time to 141 kg. Again and again she prescribed diets, the yo-yo effect but the small successes destroyed reliably. In 2008 she lost her second child due to weight-related complications. The stigma of being overweight led her into depression.

Then she learned about the so-called bariatric surgery. The term covers several surgical procedures designed to reduce pathological overweight. With the help of a band, for example, the stomach can be tied up in such a way that only a small pocket remains below the esophagus. The resulting rapid satiety should cause weight loss. In other methods, which can not be reversed unlike the gastric band, for example, a part of the stomach and sometimes the intestine can be removed. This should both cause earlier saturation and cause the body to be unable to absorb the ingested food.

About 80 percent of the cost of such an operation was covered by Dineo's health insurance. The balance of 100,000 Rand, about 6800 US dollars, she had to raise herself. "I had to do something if I did not want to be immobilized, I could drive a car but I could barely walk, so I started saving." About six months ago, Dineo finally underwent surgery. Since then she has lost about 40 kilograms.

Approaches that really help

According to WHO, 40 percent of people worldwide are overweight. There is currently no country in the world whose attempts to systematically halt obesity are successful. Obesity is a major risk factor for noncommunicable diseases such as cancer, diabetes, cardiovascular and liver disease. Overall, 70 percent of deaths worldwide are due to these diseases. Obesity, as a social stigma, can also lead to social isolation, suicidal thoughts and denial of medical care.

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In South Africa, 30 percent of the population is obese and another 20 percent is overweight. Tess van der Merwe, Honorary President of the South African Society for Obesity and Metabolism, says there are two approaches that really help fight this disease. "The first is a conscious behavioral change combined with the Dash diet (low-sodium foods that help reduce blood pressure and are high in potassium, magnesium and calcium.) Exercise sports like Pilates are also helpful learning reactions to eating, "she explains. "The second starting point for obese to morbidly obese people is bariatric surgery."

Inheritance plays a much bigger role than once thought

Van der Merwe has been studying obesity patterns in South Africa for 30 years. She believes that the first step in combating the disease is to promote understanding. "Families, the media, and the medical community need to change their attitude towards obese patients, so far we are dealing with them in a very devaluing way," she says. "We've long known that obesity is not always a result of excess and inertia, and epigenetic inheritance plays a much bigger role than we once thought," she says.

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An important factor is probably also in the brain of affected people. According to new research, the pituitary gland keeps the body on its highest and consistent weight in its memory. This is called Body Stat and is probably an evolutionary reaction to famine. "Our mistake so far has been to associate obesity with the frontal lobe, and that's where terminologies like 'food addiction' came in. How misleading those terms are has only become clear to us in the past five to seven years," admits Van the Merwe, adding that the consequence of this is that patients are ashamed, even if they are not overeating.

No miracle cure for obesity

Precisely because obesity is not only a matter of lack of will, bariatric surgery offers decisive benefits: weight loss is almost guaranteed, along with a reduction in comorbidities such as diabetes and high blood pressure, as well as the prevention of long-term health problems associated with obesity.

Nevertheless, the procedure is not a miracle cure for obesity. "Patients must first qualify and demonstrate that they are willing to change their lives," says surgeon Zack Koto, who specializes in minimally invasive keyhole surgery in this area. "People think the operation is a patent solution, but it needs a support structure and a complete change in lifestyle."

The procedure requires patients to follow a life-long, strict diet to avoid complications. They also need to take vitamins and supplements for the rest of their lives because their digestive system has been permanently changed. To support the patients are therefore cared for in advance and in retrospect by psychologists and accompanied.

Surgery must be the last stopgap

Endocrinologist Sundeep Ruder also warns that while surgical intervention is effective, it should be considered a last resort because of the risks involved. "It's very expensive to offer the surgery to countless obese people around the world, but if lifestyle changes do not work for them, then you have to consider the surgery," he says.

The operation costs in South Africa up to 500,000 Rand and is so far only by private health insurance. Because obesity is common in the country even in low-income people, the use of bariatric surgery is now also checked by the statutory health insurance. Zach Koto leads this interdisciplinary project. "Because it covers several medical areas, we need psychologists, endocrinologists, physiotherapists, anesthesiologists and surgeons," he says. He believes that special facilities should be available for these interventions. "We want to make this anti-obesity drug available to patients who can not afford it otherwise."

* Name changed editorially.