Weight Loss (Bariatric) Surgery Contact: Dr. Upendra Reddy Marreddy (MS, FRCS) Phone: +91 8790077333 Email: u.marreddy@gmail.com Website: www.upendrareddy.com Facebook: facebook.com/upendramarreddy

1. Dr. Upendra Reddy Marreddy (MS, FRCS)
Consultant Bariatric & Upper GI Surgeon
Weight Loss (Bariatric) Surgery

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Dr. Upendra Reddy Marreddy
• Surgical Experience
– Highly experienced Obesity and Gastrointestinal surgeon who worked as
consultant Upper GI surgeon in Greater London, with 10 years experience
of more than 1500 bariatric operations and 10000 GI surgeries.
• Surgical Training
– Senior Bariatric Fellow from Homerton Bariatric surgery unit (2years)
– Specialist Registrar in Gastrointestinal, Bariatric & General surgery from
London Deanery hospitals (5 years),
– All India Institute of medical sciences- New Delhi (Junior & Senior
Residency-6 yr.).
• Research
– Research fellow and Lecturer in Surgery from Barts and The London
Medical School
– Presented Papers: 10 @ IFSO Hamburg Germany, 5 @ Bristol BOMSS, 10 @
IFSO New Delhi, 3 @ DDW New Orleans (USA), DDW Washington (USA)

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Agenda
• Obesity: Impact on Health
• Weight Loss Surgeries
• Post-Operative Care

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What is Obesity?
• Obesity: Obesity is excess fat accumulation, 20% or more over an
individual's ideal body weight. It is associated with increased risk of
illness, disability, and death.
• Morbid Obesity: Overweight by over 30 kgs. Or using Body Mass
Index (BMI) i.e. Weight(kg)/Height(m)2 of 37 or higher

5. Obesity in India
• Obesity has reached epidemic proportions in India, 5% of overall
population is affected by Morbid Obesity
• They are GENETICALLY prone to waist circumference increase-
scientists have discovered single nucleotide polymorphism named
rs12970134s.
• Amongst the states, AP males are ranked as 5th most obese overall
in India, as far as females they are rated 10th obese amongst the
states

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Obesity Epidemic
Lack of Activity Over indulgence!
Thrifty genes

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Medical and Health Implications
• With BMI > 30
– 70% increased chances of coronary artery disease
– 75% increased chances of stroke
– 400% increased chances of diabetes
– 55% increased chances of mortality

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Co-Morbidities with Obesity
Pulmonary disease
abnormal function
obstructive sleep apnea
hypoventilation syndrome
Nonalcoholic fatty liver
disease
steatosis
steatohepatitis
cirrhosis
Coronary heart disease
Diabetes
Dyslipidemia
Hypertension
Gynecologic abnormalities
abnormal menses
infertility
polycystic ovarian syndrome
Osteoarthritis
Skin
Gall bladder disease
Cancer
breast, uterus, cervix
colon, esophagus, pancreas
kidney, prostate
Phlebitis
venous stasis
Gout
Idiopathic intracranial
hypertension
Severe pancreatitis

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What are the Options?
1. Diet, Exercise, Behavioral Changes
 up to 10% loss of excess body weight
 ineffective long-term, less than 5% sustain
significant weight loss
2. Weight Loss Drugs
 minimal sustained weight loss
 side effects prevent long-term use
3. Weight-Loss Surgery
 55 to 75% loss of excess body weight

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Who qualifies for weight loss surgery?
Normal Weight
(BMI 18.5 to 22.9)
Overweight
(BMI 23 to 24.9)
Obese
(BMI >25)
Severely Obese
(BMI 32.5 to 37 )
Morbidly Obese
(BMI >37.5 )
BMI 18.5-22.9 BMI 23-24.9 BMI >25 BMI 32-37 BMI>37.5

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Bariatric Surgery is an Option if:
• 20-30 kgs above your Ideal Body Weight
• Body Mass Index:
– 32.5 or greater with co-morbidities
– 37.5 or greater even without any co-morbidities
• Age of 18 to 65+ (assessed on individual basis)
• Failed attempts at weight loss
• Health complications related to obesity
• No psychological contraindications
• Understanding of the surgery/risks
• Compliance with diet/exercise requirements

12. Bariatric Surgery is NOT Liposuction
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• Liposuction is purely cosmetic
surgery that aims to produce
an attractive body-shape.
• Although liposuction might
seem attractive, it does not
achieve the results in
improved health and durable
weight loss.
• Liposuction is performed by
Plastic/Cosmetic Surgeons.
• Bariatric surgery, however, is a
stomach operation which
reduces caloric intake and the
way fat is deposited.
• Bariatric surgery can achieve a
sustained and lasting weight
loss for the treatment of
morbid obesity.
• Bariatric surgery helps
improve health and increase
the life-span.
• Bariatric surgery is performed
by Bariatric Surgeons.

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Surgical Options
• Restrictive
– Stomach Capacity reduced
– Feel Full More Quickly
– Food/Calorie Intake Reduced
– Weight Loss

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Surgical Options
• Restrictive and Malabsorptive
– Stomach Capacity reduced
– Part of the small intestine is bypassed or rerouted
– Reduced assimilation of food
– Weight Loss

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Adjustable Gastric Band (AGB)

16. Adjustable Gastric Band (AGB)
Advantages Disadvantages
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• Lowest mortality and
complication rate
• Least invasive surgical
approach
• No stapling, cutting, or
intestinal re-routing
• Adjustable
• Reversible
• Low malnutrition risk
• Shorter surgery
• Slower initial weight loss than
Gastric Bypass
• Regular follow-up critical for
optimal results: Need
adjustments
• Requires implanted medical
device

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Vertical Sleeve Gastrectomy (VSG)

18. Vertical Sleeve Gastrectomy (VSG)
Advantages Disadvantages
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• No Malabsorption – No
micronutrient deficiency
• No Strictures ? No Marginal
Ulcerations ?
• Maintains oral access to GI
and Biliary tract
• Creates restriction more than
obstruction
• Lesser Follow up
• Non-adjustable
• Irreversible

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Roux-en-Y Gastric Bypass (RYGB)

20. Roux-en-Y Gastric Bypass (RYGB)
Advantages Disadvantages
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• Rapid initial weight loss
• Time tested, proven efficacy
• Best for metabolic
abnormalities such as
diabetes, Hyperlipidaemia etc.
• Stomach cutting, stapling and
intestinal re-routing required
• Portion of digestive tract is
bypassed, resulting in
nutritional deficiencies- easily
managed by two pills a day
• “Dumping syndrome” can
occur- sensible choice of foods
and eating habits prevent this
• Non-adjustable
• Difficult to reverse! Very
expensive!

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How much Weight Loss?
• Depends on the surgery and the follow-up
• 75% of excess weight with Gastric bypass at the end of one year
• 45% of excess weight with Band but increases to 65% at 2-3 year
follow up with adjustments
• Amount of weight loss varies from person to person
• Must be compliant with follow-up!!!!!

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Possible Risks and Complications
• These will be discussed during the first appointment.
• With the experience and skill at hand, these surgeries post no more
risk in my hands than common surgical procedures, such as Gall
Bladder removal surgery.

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Life After Surgery
• Lifestyle Change
• Diet Restrictions (Type, speed, Consistency, Volume)
• Vitamins and Medication
• Regular Follow-Ups
• Exercise

24. People who are not successful?
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• Go back to old eating habits
• Avoid exercise
• Eat high fat diet
• Eat High caloric diet
• Graze, Snack
• Drink “regular” soft drinks or
high calorie beverages (ex.
Juice, alcohol)

25. People who are successful
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• Change lifestyle
• Change eating habits
• Are physically active
• Exercise daily
• Follow new diet
• Follow up with their doctor as
advised

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Good News
• Weight Loss
• Improved Self Esteem
• Improvement in co-morbidities
– Diabetes
– Hypertension
– Hyperlipidaemia
– Sleep apnoea
• Improved Quality of Life

27. Thank You
Dr. Upendra Reddy Marreddy (MS, FRCS)
Phone: +91 8790077333
Email: u.marreddy@gmail.com
Website: www.upendrareddy.com
Facebook: facebook.com/upendramarreddy