Obesity and Bariatric Surgery in Tunisia
Obesity is a chronic disease that is often difficult to treat with diet and exercise alone. In these cases, bariatric surgery is a viable treatment option, particularly for severely obese individuals suffering from serious health problems exacerbated by excess weight.
Bariatric surgery encompasses a variety of procedures that promote weight loss by reducing food intake and/or absorption. Weight loss can be achieved by reducing the size of the stomach with a gastric band, through surgical resection, or by creating a small gastric pouch connected directly to a section of the small intestine.
How to Calculate Your Body Mass Index (BMI)
Calculating BMI
If you are trying to determine if you are overweight, calculating your Body Mass Index (BMI) is a good starting point. BMI is a common screening tool that measures body fat, and excess body fat is a defining characteristic of being overweight or obese.
While BMI is not a direct measure of body fat, research has shown that there is a correlation between BMI and direct measures of body fat.
BMI measures body fat based on a person’s height and weight and is easy to calculate. To calculate your BMI, you need to divide your weight by your height (in m) squared. This gives a result with the unit of measurement kg/m2
The Body Mass Index Scale
Once you have calculated your BMI, refer to the categories below to determine if you are overweight.
- A BMI between 18.5 and 24.9 is considered to be within the normal and healthy range.
- A BMI between 25 and 29.9 is considered overweight.
- A BMI of 30 or more is considered obese.
- A BMI of 40 or more is considered extremely obese.
Remember: This number should be used as a starting point as BMI is a screening tool, not a diagnostic tool. Since it does not take other important information into account such as body composition and lifestyle, it is best to seek additional evaluations from a healthcare professional to determine if your weight is unhealthy.
Bariatric Surgery Options in Tunisia
Bariatric Surgery in Tunisia: Gastric Band
The gastric band is a type of restrictive operation that involves placing an adjustable circular band around the upper part of the stomach. The physician can adjust the prosthesis to vary the constriction effect. This is a reversible, minimally invasive surgery that allows for about 50% weight loss of excess weight.
Bariatric Surgery in Tunisia: Gastric Sleeve
The gastric sleeve is a restrictive and irreversible operation that consists of resecting a large part of the stomach. The remaining part thus takes on a tubular appearance. In this way, the feeling of satiety is reached more quickly. The removal of a part of the stomach is also associated with the reduction of the secretion of certain hormones responsible for the feeling of hunger. This procedure allows for about 60% weight loss of excess weight, with a low risk of regaining lost weight.
Bariatric Surgery in Tunisia: Gastric Bypass
The gastric bypass is a mixed procedure with both restrictive and malabsorptive action. It involves dividing the stomach into two parts. The small pouch that is created in the upper part is connected to the small intestine, bypassing the tract where nutrient absorption takes place. Although the stomach remains in place, it is essentially an irreversible operation.
Among the advantages, it allows for about 65 to 70% weight loss of excess weight and maintains the result over time. In addition, it can resolve type 2 diabetes and often other obesity-related diseases such as hypertension and sleep apnea. Like all malabsorptive surgical interventions, it can lead to nutritional deficiencies. Therefore, it may be necessary to take oral supplements of iron, calcium, and vitamins.
Bariatric Surgery in Tunisia: Biliopancreatic Diversion and its variant with duodenal switch
In both cases, these are irreversible malabsorptive surgeries. Biliopancreatic diversion involves the removal of about two-thirds of the stomach and the creation of a double intestinal canal in order to delay the encounter between ingested food and digestive juices. This results in reduced digestion and therefore reduced food absorption. In the Duodenal Switch variant, the surgeon dissects the stomach vertically in a manner similar to a pouch gastrectomy. This surgery reduces excess weight by approximately 65 to 75%.
Bariatric Surgery in Tunisia: Gastric Balloon
The gastric balloon is a medical device placed orally under endoscopic guidance in the stomach, with the aim of inducing a feeling of satiety and thus reducing food intake. The initial weight loss is quite rapid (about 15 to 20 kg during the maintenance period of the balloon). Subsequently, the results depend on the patient’s adherence to a controlled diet and physical exercise.
It is generally used in moderately obese patients. In some cases, it is also used for severely obese patients who need to reduce their weight to a value that makes them candidates for a more complex intervention, such as gastric banding or gastric bypass.
How to Choose Your Bariatric Surgery in Tunisia?
The first question patients ask their surgeon concerns the type of operation: “What operation should I undergo? What is the safest surgery?” Unfortunately, there is no universal answer to this question. Each patient is different, both in terms of the severity of their overweight and their expectations. The first element to consider when choosing the best intervention is the severity of the overweight. It is clear that in patients with very severe obesity, it is necessary to resort to operations during which, in addition to reducing the volume of the stomach to accelerate the feeling of satiety, a large part of the intestine is also removed to reduce nutrient absorption, for example with gastric bypass or biliopancreatic diversion.
These types of surgery combine the restrictive effect and the malabsorption effect. Furthermore, they result in a reduction of about 40% over 18-24 months. These types of interventions are very effective when the Body Mass Index (BMI) is >50. For people whose required weight loss is less significant, it is preferable to undergo gastric banding or gastric sleeve.
What does a pre and postoperative diet for bariatric surgery in Tunisia look like?
One of the most frequent questions patients ask their bariatric surgeon is what kind of diet they will have to follow before and after their operation. While bariatric surgeons offer their patients personalized diets according to the surgical intervention performed and the health and lifestyle factors specific to each individual, most bariatric diets follow certain guidelines.
Preoperative Diet
Diets before bariatric surgery are generally high in protein and low in carbohydrates. This type of diet promotes healing and helps reduce the amount of fat in and around the liver and abdomen.
By losing weight before surgery, you are not only safer during the procedure, but you also practice a new way of eating. It is essential to change your diet throughout your life to succeed and make a lasting change.
The preoperative diet mainly consists of protein drinks and other protein-rich, low-calorie foods that are easy to digest. As your operation date approaches, you will likely need to follow a mostly liquid or liquid-only diet. Depending on your weight and general health, your doctor may allow you to eat some solid foods during this time. You may also need to take certain vitamins to ensure you are receiving the appropriate nutrients.
Postoperative Diet
The postoperative bariatric diet involves several stages. It is your doctor or dietitian who will determine the duration of each stage and what you can eat and drink. Portion control is essential at each stage, as it is an essential habit that will help you continue to lose weight and prepare you for how you will eat for the rest of your life.
First stage: Liquid diet
For the first few days after surgery, you will only be able to drink a few clear liquids. This will help your stomach heal. After drinking clear liquids, you will move on to other types of liquids that may include
- Decaffeinated coffee and tea
- Skim milk
- Thin soup and broth
- Unsweetened juice
Second stage: Pureed diet
Once your doctor decides you are ready, you can start consuming pureed foods that have a thick consistency. Note that you can puree many foods using a simple food processor.
Third stage: Introduction of soft foods
Most bariatric patients do not reach this stage until six to eight weeks after surgery. Once you are ready, however, you can start incorporating soft and easy-to-chew foods into your diet, such as
- Soft-boiled eggs
- Ground meat
- Cooked white fish
- Canned fruits
Fourth stage: Stabilization
This last stage occurs when you introduce solid foods into your diet. This usually corresponds to about two months after the operation. Foods will still need to be cut into small bites. Indeed, your stomach will be smaller and large pieces of food can cause problems.
Foods should be reintroduced slowly to determine which ones your stomach can tolerate and which ones it cannot. Avoid foods that are difficult to digest at this stage. These include fibrous or stringy vegetables, popcorn, bread, baked goods, and fried foods.
A Healthy Diet for Life
About four months after surgery, you may be able to start eating normally again. However, portion control will continue to be important. In addition, you will need to base your diet mainly on fruits, vegetables, lean proteins, and healthy carbohydrates.
Results After Bariatric Surgery in Tunisia
The results of bariatric surgery are excellent. Indeed, an average loss of 60 to 75% of excess weight is observed in about 2 years. The objective of surgical therapy is not only to reduce weight, but also to cure or at least improve the clinical condition of associated diseases such as metabolic syndrome and in particular type 2 diabetes. Obesity surgery can help you lose a significant portion of your excess weight. However, it is not a miracle cure. Indeed, it does not guarantee long-term maintenance of the weight achieved.
The best results are obtained when the patient adheres to strict dietary guidelines and practices regular physical activity after surgery. In addition, the person must also agree to commit long-term to medical follow-up and postoperative treatment. These behaviors help to maintain the results of bariatric surgery.
