Muhammad Naim Ibrahim has struggled with weight issues for most of his life. He would constantly feel lethargic, suffer from joint pains, and have difficulty getting a good night’s rest due to snoring.

At his heaviest, he weighed about 130kg. The excess weight took a physiological and mental toll on his body, causing him to feel tired throughout the day and making it harder for him to focus on work.

Determined to turn his life around, the 28-year-old decided to visit Dr Lim Huay Cheen, a surgeon who specialises in bariatric and upper gastrointestinal surgery at Regency Specialist Hospital.

After a detailed medical examination involving blood tests and an endoscopy, as well as multiple consultations with a nutritionist and numerous medical experts, Lim recommended a gastric bypass surgery. This is a minimally invasive procedure suitable for those with life-threatening comorbidities apart from obesity.

Today, after having lost 42% of his weight post-surgery, Naim is thriving and leading a healthier active lifestyle. Shedding the kilos and dropping from 5XL to S with the help of a complete lifestyle change – including a nutritious diet and regular fitness regime – has renewed his confidence and motivation.

Quick fix?
In a nation with the highest prevalence of obesity among adults in Southeast Asia, it is estimated that every one in five Malaysians is obese.

Bariatric or metabolic surgery, as it is also known, is often perceived to be a “quick-fix” method of weight loss. People often think they will come out of surgery looking slim and having lost all the excess weight.

But this isn’t true. Bariatric surgery is merely an intervention that can help resolve or prevent conditions such as heart disease, high blood pressure, diabetes, and sleep apnoea. It could even lower a person’s risk of premature death by 30 - 50%.

Weight loss after bariatric surgery, however, is a gradual process that can take 1.5 to two years post-surgery, and requires a commitment to healthy eating and regular exercise.

During bariatric surgery, the surgeon chiefly makes changes to the digestive system – the stomach and/or the small intestine – which affects how much food can be eaten and how much nutrition is absorbed.

There are different types of bariatric or metabolic surgery, including:

• Gastric band surgery: This involves placing a silicone around the upper section of the stomach, reducing the amount of food a person can consume. This procedure does not involve removing any part of the stomach, and is in fact reversible.
• Roux-en-Y gastric bypass: This reduces the stomach to the size of a small walnut, which is then attached to a part of the small intestine called the roux. As a result, food bypasses much of the stomach and the upper part of the intestine, and the person absorbs fewer calories and less fat but also fewer nutrients. This is the most common type of bariatric surgery.
• Sleeve gastrectomy: About 80% of the stomach is removed, and what is left is a tube-like or banana-shaped pouch. The person is unable to eat as much food as before. This surgery also lowers the production of a hormone called ghrelin, which results in less of an appetite.

In the case of gastric band surgery, patients may lose about 50% of their body weight after 1.5 to two years, provided they adhere to a diet and exercise regimen. With gastric bypass and sleeve gastrectomy, patients can lose about 40 - 50% of body weight.

Who is eligible?
Bariatric surgery is specifically indicated for those with class II obesity (BMI 32.0) and above who have pre-existing medical conditions and are unable to lose weight, as well as those with class III obesity (BMI equal to or greater than 37.0).

Bariatric surgery previously required the surgeon to make a big incision in the abdominal area. Today, it can be done with laparoscopy and keyhole surgery – minimalist procedures that allow the surgeon to access the stomach through a small incision and a camera – which involve less bleeding and scarring.

As a result, patients generally only have to stay in the hospital for one to two days post-procedure.

That said, bariatric surgery is only the start of a person’s road to better health, which is why Lim always evaluates a patient’s willingness to adhere to lifestyle changes after surgery.

Patients are also required to attend regular follow-up appointments, where they will be guided on recovery and lifestyle changes.