Obesity is a complex disease that involves an excessive amount of body fat. It is not simply a cosmetic concern; it is a medical condition that can increase the risk of other diseases and health problems. Obesity is a growing public health concern in developed countries, and it is estimated that there are over than 1.5 billion obese people worldwide (Faria et al., 2017). This represents about 5% of all the health-related expenditures in the USA and leads to a significant decrease in life expectancy. Morbidly obese people usually struggle with joint pains, high blood pressure, high cholesterol, diabetes, arthritis and sleep apnea. These health issues have a negative effect on the quality of life for the morbidly obese.
However, it is becoming the norm in society and the quality of life (QoL) for the morbidly obese is deteriorating. Increasing levels of obesity are associated with decreased QoL and increased mortality. The judgements and looks of shame that the morbidly obese patients receive have been shown to affect their QoL (Stephenson et al., 2021). Although the expression “quality of life” is intuitively understood by most people, there is no a comprehensive definition. Quality of life is a “construct of physical, psychological and social domains of health that can be measured by a series of questionnaires,” (Faria et al., 2017, p. 43). Empirical data has suggested that patients with morbid obesity might experience worse QoL than normal-weight patients, including symptoms of psychological and physical discomfort. Obese individuals are more likely to experience discomfort in their every-day life and inter-personal relations. Current physical and mental health related long-term conditions are substantially related to QoL (Stephenson et al., 2021). Suggesting that even healthy people with obesity may be in transition to an unhealthy future.
Weight loss surgery is one of the fastest growing segments of the surgical discipline. Bariatric surgical procedures include sleeve gastrectomies (SG), Roux-en-Y gastric bypasses (RYGB), and gastric balloons (Lim et al., 2018). RYGB was one of the first approved surgical options for morbid obesity. Hence, gastric bypass surgery is increasingly becoming the one lifeline that physicians along with their patients believe to be the “fix all”. It refers to a technique in which the stomach is divided into a small upper porch and then the small intestine is rearranged to connect to both. RYGB surgery is a vastly common way to treat the morbid obesity across the globe. The result of the bypass is that the patient absorbs fewer calories and nutrients from the food they eat.
Bariatric surgeries are initially intended to alter anatomy and change eating behaviour consequently. Both restriction and hormonal modulation achieve weight loss following the surgery. There have been numerous studies showing the positive changes that occur when gastric bypass is performed. These include weight loss, remission of mental problems improvement of clinical markers and obesity-related disease resolution (Kheirvari et al., 2020). However, not many patients are aware of just how drastically their lives may change, and sometimes not for the better. This is an important topic that needs to be addressed since this is not a “fix all” and the rewards are not always worth the surgery. Such study would improve the awareness of the public regarding the bariatric surgeries.
Bariatric procedures are generally safe and effective, but can be associated with devastating complications, some of which may be fatal if not addressed quickly. On the other hand, QoL measures might be correlated not with weight loss, but with fulfillment of patients’ expectations. Patients might not have a drastic weight change immediately after the surgery. However, the belief and hope of further improvement remains and has a positive impact on mental health and the quality of life. Even for patients that remained morbidly obese, RYGB has been reported to have a positive effect on QoL. Nevertheless, the physical implications might still remain plausible if not inevitable.
Negative complications following the RYGB are divided into two groups. The first is early complications and the second is late complications. Early complications include leaks, stenosis, bleeding, venous thromboembolism, and balloon complications (Lim et al., 2018). It has been stated that an “anastomotic leak is the most dreaded complication of any bariatric procedure because it increases overall morbidity to 61% and mortality to 15%”, (Lim et al., 2018, p.1). Moreover, stenosis causes patients to report the sensation of stuck food and the urge to regurgitate, which also have negative effect on the patients. As well as that, according to Lim et al. (2018), “11% of cases in RYGB” report postoperative bleeding that requires intervention (p.2). However, there are very few studies that address these complications. When more of such studies are conducted, the increased knowledge of the field would benefit the practitioners and the patients drastically.
Additionally, there are late complications associated with RYGB that include adjustable gastric band complications, gallstone disease, marginal ulceration, perforation, bleeding, small bowel obstruction and internal hernia. Gallstone disease refers to the patients who have had bariatric operation develop gallstones at a higher incidence than the average population (Lim et al., 2018). RYGB patients may develop small bowel obstructions related to internal hernias or postoperative adhesions. More rarely, “stenosis of the JJA, small bowel bezoars, and small bowel intussusception may lead to obstructions in these patients” (Lim et al., 2018, p. 5). Very few studies have addressed the impact of intra-operative leaks and bleeds on other complications or factors such as operative time, cost and length of stay at the hospital (Kheirvari et al., 2020). Perhaps the most difficult to identify but potentially catastrophic late complication in post-RYGB patients is an internal hernia with small bowel volvulus. Symptoms may be non-specific and intermittent (Lim et al., 2018). Moreover, the patients might experience insufficient weight loss, which undermines the whole idea of the surgery and determines the study area that needs further exploration.
The relation between QoL and weight loss is difficult to interpret, since it appears not to be linear. Some reports conclude that improvement in QoL is related to weight loss and improvement of the co-morbidities. Improved patient satisfaction has also been reported in association with increasing weight loss. There has been an inverse relationship between increasing weight status and decreasing QoL and confirmed the mediating role of long-term conditions in the reduction of QoL and health in people with obesity (Stephenson et al., 2021). The questions regarding the complications of RYGB surgeries and the subsequent QoL changes among the morbidly obese are rarely addressed in the empirical studies, which creates a necessary area to explore. While the positive QoL effects after the surgery include weight loss and subsequent improvements in mental and physical state of the patients, the negative ones are not to be ignored. The negative complications can have an adverse impact on the lives of patients.
Quality of life studies have been completed and have shown that this is a complex decision that should be researched on a case-by-case scenario. In some cases, the patients face little to no side effects as a result of RYGB surgery. However, other cases may be not as positive and the QoL might deteriorate. The complications are real, along with the health issues that can be detrimental to their lifestyle. Gastric bypass surgery has the ability to make a person’s QoL better, but cases show that this is not always the outcome. Therefore, further analysis is needed to determine correlation and causation between the RYGB surgeries and the patients’ QoL levels after the surgery. This study would improve overall knowledge of the situations, as well as benefit the patients and practitioners, who would become more aware of the possible implications.
References
Faria, G. F. R., Santos, J. M. N. & Simonson, D. C. (2017). Quality of life after gastric sleeve and gastric bypass for morbid obesity. Porto Biomedical Journal 2(2), 40-46. Web.
Lim, R., Beekley, A., Johnson, D.C. & Davis, K. A. (2018). Early and late complications of bariatric operation. Trauma Surgery & Acute Care Open 3, p. e000219.
Kheirvari, M., Dadkhah Nikroo, N., Jaafarinejad, H., Farsimadan, M., Eshghjoo, S., Hosseini, S., & Anbara, T. (2020). The advantages and disadvantages of sleeve gastrectomy; Clinical laboratory to bedside review. Heliyon, 6(2). Web.
Stephenson, J., Smith, C.M., Kearns, B., Haywood, A. & Bissell, P. (2021). The association between obesity and quality of life: A retrospective analysis of a large-scale population-based cohort study. BMC Public Health 21, Web.