Lapbanding: The Latest Surgery That Takes You From Fat To Fabulous

As Singapore’s top lapbanding surgeon, he regularly sees dramatic changes take place in the lives of his patients after their lapbanding operation.

Lapbanding is the latest and most common form of weight loss surgery in Europe and Australia. In Asia, Singapore was the first country (outside Australia) to offer the surgery.

Among Dr Baladas’ patients, for example, was the 22-year-old man who weighed in at 255 kg (his Body Mass Index was a mind-boggling100) when he first came to see Dr Baladas.

Although the youth was dying of end-stage obesity, he could not be operated on because he was so ill. Dr Baladas was only able to operate on him after an enforced low-calorie diet reduced the patient’s weight to 215kg after three months.

Today, one year after the patient had the lapband fitted, he has lost another 40 kg. In the process, he has regained his life. He will probably go on to lose another 50 kg.

Although trained as a graphic designer, the young man previously could not hold down a job because of his weight-related health complications. Now, however, the slimmer youth has found employment as a designer.

Says Dr Baladas, “He is much happier. He now colours his hair and is doing teenage things; he recently went to a disco.”

An Artificial Reduction Of Your Stomach Capacity

Lapbanding is the latest and safest surgical method to combat obesity. In this keyhole surgery, a hollow silicon band is clipped around the upper part of the stomach. This band effectively divides the stomach into two: a small upper pouch above the band and a larger pouch below the band. This small gastric pouch limits the amount of food that a patient can eat at any one time. As a result, the wearer will feel full after eating a small amount of food. The lapband leads to long-term weight loss by limiting the amount its wearer can eat, reducing his appetite and preventing hunger pangs. The band is removable, adjustable and does not permanently alter the anatomy. More important, it is one of the least invasive obesity operations because neither the stomach nor the intestine is cut.

From Chubby To Chic

Dr Baladas is a pioneer in the lapbanding operation in Singapore. He was one of the first surgeons in Singapore to specialise in the procedure and the only one to have such a large series of patients.

He enjoys the distinction of having performed 240 cases in all. Of these, 95% of patients were a success while 5% did not lose enough weight to be considered a success.

As the leading lapband surgeon in the region, Dr Baladas gets patients from all over the world.

“Our clientele consists of 50% expatriates and foreigners and 50% locals, with our overseas clients coming from Indonesia, Malaysia, Thailand, Vietnam, China, Italy, Australia and India.”

A mix of professionals, rich tai tais, directors of companies and celebrities like TV show hosts and singers, their average age is 37 and their average BMI, 42. “A lot of celebrities have been told to lose weight or they will get fired from their show,” reveals Dr Baladas.

His non-celebrity patients face the same pressure as well, says Dr Baladas. “Work is a very important motivator in pushing people to get the operation. We see a lot of people who face discrimination at work.”

More heartrendingly, there are many who opted for the operation because their partner dumped them.

Recalls Dr Baladas, “Yesterday I had a girl who was 135 kg and she said she has been thinking about it for years. But then she suddenly decided she wanted it now because she just got dumped by her boyfriend. We get a lot of people whose spouses divorced them because of their weight.”

His patients usually decide on the operation after years of futile attempts to lose their flab.

Typically, one year after surgery, his patients’ BMI would drop from 42 to 32. Their average weight loss would be 27.8kg. This represents 54% of their excess weight. Eventually their weight loss would level off at 66% of their excess weight one to two years after the operation.

According to Dr Baladas, the patients who experience the most striking changes post-operation are usually those who were on the lower end of the morbid obesity scale.

“The most dramatic cases we have are those who started with BMI of about 37. These are the ones who go on to look very pretty or handsome after the operation. I had an Indonesian Chinese lady who weighed 100kg when she came in. She went down to 54kg and now looks very pretty. Her circle of friends, her lifestyle, and her social life - all improved dramatically. She now goes to the gym and has lots of friends.”

For Morbidly Obese, Surgery Is The Only Way To Keep Weight Permanently Off

For those who view surgery as an extreme measure in tackling chubbiness, consider this:

The Swedish Obesity Study conducted by the Sahlgrenska University Hospital tracked 3,758 severe and morbidly obese individuals over a span of eight years. Of these, half were operated on, while the other half received conventional obesity treatments, such as dietary regimes.

After two years, the individuals who had undergone surgery had lost 15kg, while those treated conventionally had lost 8.9kg. After eight years, those in the surgical group had on average lost 16kg while those placed on diets had gained 12kg.

The reasons: Firstly, if you are mildly obese, you only need to lose a few kg to become healthy. If you are severely obese, however, you need to lose 20 kg, 30 kg or even a 100 kg, which is much more difficult, if not impossible, to achieve. Secondly, morbid obesity is likely to be genetically predisposed, says Dr Baladas.

“In everybody, once calorie intake is reduced, their metabolism slows down so that they burn less fat. In severely and morbidly obese persons however, the degree, severity and duration of the drop is so much more. Basically your genes are saying you have to weigh this much and if your weight drops below that, they cause you to become inactive and insatiably hungry. Surgery, however, has been shown to be the only means that can overcome this genetic predisposition.”

Morbid obesity is defined as a BMI of over 37 while severe obesity is defined as a BMI of over 32. Adds Dr Baladas, “The majority of those with BMI over 35, in my personal experience, eat the same as the normal person, or even less.”

A Life-changing Operation

“My patients are always extremely happy and grateful after the operation,” says Dr Baladas.

This is because the operation usually changes their physical health, self image and social life for the better.

Obesity often engenders complications such as diabetes, high blood pressure, high cholesterol, heart diseases, strokes, snoring, sleep apnea, severe fatty liver, low testosterone level, poor libido, low sperm count, polycystic ovarian disease and male and female infertility.

Indeed three out of the four major cardiovascular risks - diabetes, high blood pressure and high cholesterol- are associated with obesity.

In addition, the morbidly obese usually suffer from severe knee problems as well as low self esteem and isolation. They often have a small circle of friends.

These problems often fall away after the operation.

Says Dr Baladas, “They become more active, they are healthy and they have more friends. They no longer have a problem with mobility or employment.”

They also become more fertile. Often, just a three-point drop in BMI can increase fertility tenfold and a six-point drop can see fertility soaring a hundred times.

But not everyone can opt for the operation. To qualify for lapbanding, you must be aged between 18 and 65, have a BMI of above 32 and be very motivated in wanting to proceed with the operation.

Says Dr Baladas, “You must consider whether you have tried to lose weight by other means.”

A Lifelong Commitment

Before you jump on the idea of lapbanding to lose those love handles, bear in mind that lapbanding is for life.

A lapband is inserted for life because most individuals would regain their weight once the lapband is taken off. States Dr Baladas, “It is almost a guarantee that if you take off the band, you will go back to the same weight.”

Typically, about one out of every 1,000 individuals will request a reversal of the operation after they have lost weight– that is, have the lapband taken off.

Lapbanding also entails a lifelong commitment to a certain lifestyle.

You will be advised to exercise three times a week, in order for you to achieve the ideal weight for your height.

You may also find that certain food will no longer sit right on your stomach anymore. Common problem foods are beef, bread and pasta.

Lapband also requires certain dietary rules to be followed. They are:

Rules of eating with lapbanding: 1. You have to eat three times a day. 2. You should eat slowly, chewing food till it is fine. Eating too fast or too much will cause you to throw up. It will take you 20 minutes to eat a normal meal. 3. You should preferably eat solid food. Soups or porridges tend to just glide through the small pouch, defeating the purpose of lapbanding. 4. You shouldn’t wash down meals with water for the same reason. 5. You cannot have sweet drinks and must reduce your intake of alcohol. 6. You have to take vitamin supplements.

Also you may suffer from vitamin B deficiency because most people with a lapband choose not to eat red meat and green leafy vegetables, which are the usual sources of vitamin B.

Singapore: A Leader In Lapbanding

Singapore leads the region in lapbanding.

Since the surgery was first conducted in the republic five years ago, Singapore has gone on to notch up the largest number of lapband surgeries in East Asia.

Raffles Hospital leads all other medical centres in this surgery because of Dr Baladas’ credentials in this. Lasting one to two hours, the operation will cost between S$15,000 and S$21,000 at Raffles Hospital.

According to Dr Baladas, there is enormous potential demand for lapbanding in the region. South East Asia teems with millions of obese people who are as yet unaware of this procedure. In the region, Singapore, Malaysia and Brunei are the countries with the most number of obese citizens.

The success of the procedure depends on many factors. The most important is the patients’ motivation and diligence in persevering with follow-ups. Patients who do not turn up for months for the adjustment of their lapband will not lose weight very quickly. The next factor is the patient’s ability to exercise after banding. Those with severe knee problems are unable to exercise and tend to lose weight more slowly, though they eventually get there. Another relevant factor is the accuracy of band placement and this is where surgeon experience counts.

What You Have To Live With, Post-op

To protect your stitches after your operation, you will be put on a special diet for three weeks: liquid food only for the first week, baby food for the second and a soft diet for the third.

You will also have to have your band adjusted in the months that follow.

About once a month, you will go in for a consultation to see if you are losing as much weight as you should. Depending on your weight loss, you may have your band tightened or loosened through the injection of a salient solution. Adjustment is an easy procedure done in the doctor’s office.

Your target would be a weight loss of about 3kg to 4kg a month.

The Big Lover Of Good Food And Wine Is No Longer So Big

Italian Paolo Alabiso has always loved food and wine. And as executive chef, the chief perk of his job is enjoying an abundance of both.

Then one day the executive chef discovered to his dismay that he weighed 121 kg.

Standing at 1.75m, his Body Mass Index (BMI) was 42, which puts him in the morbidly obese category.

Says Paolo, “My weight gain started when I went to work as an executive chef on a cruise ship. Onboard a ship, the hours are long. I worked from 11am to midnight, which is stressful. And when I get stressed, I eat. Also to control the quality of the food that we served, I had to taste everything. Plus I am an executive chef. I deal with food all the time.”

The price he paid for all the eating: excess weight that took a physical toll.

“Weight affects many things in your life. I was struggling even to climb a few steps. It was how I looked, how painful it was to walk - even to make love was a challenge. And my friends make jokes about my weight.”

He tried to lose weight by working out at a gym but found the going tough. “With the weight, you really don’t feel like working out. On top of it, it was quite painful to work out; I got pains at my ankles and knees.”

Then in March 2005, while watching television, he caught the news about soccer great Diego Maradona undergoing a gastric by-pass operation for his weight problem.

Paolo got in touch with a hospital in Germany that advised him that lapbanding would be more suitable for him because his obesity was not that bad. Paolo also looked into the possibility of doing the operation in Thailand. However, the clinic he contacted was closed for refurbishing. It referred him to Raffles Hospital.

While he was working in Singapore previously, Paolo had been treated at the hospital for a hand injury.

Says Paolo, “I know it is a good hospital - one of the best in Asia.”

His subsequent consultation with Dr HG Baladas further reassured him.

“First, he was thorough in his explanation, and did not push me to do the operation. Secondly, he carefully explained the operation and the change in lifestyle that will be required of me. I would have to make some drastic changes in my life. But I thought, I had been enjoying good food and a great lifestyle for 40 years, and now it’s time to cut down on it.”

Paolo went under the knife on 17 September 2005.

Says Paolo, “The surgery was easy. I was discharged after one day. But the first day after the operation, I was so shocked because the doctor said that for one month, I would be on liquid food. I was scared. I went: “What have I done?””

But after that early shock, it was smooth sailing. His fat melted off his body as he dropped 5 kg every month.

“I was very motivated because I could see the weight falling off.”

He was also feeling better. “The biggest change is that I now feel good – both physically and mentally. Whereas before I was feeling lethargic, now I am very energetic. I am more willing to walk and do physical things.”

Just five months after the operation, Paolo has lost 30 kg. He now weighs in at 91kg, for a BMI of 29.7. Paolo is no longer obese.

Paolo has no regrets at all about doing the operation. “I made my decision for health and quality of life. And my health and quality of life has definitely improved.” In all, it was a life-changing operation. “At 40, I was heading for a heart attack. At the back of my mind, I was thinking that my father has already had two heart attacks. But now I don’t obsess about food, and I am trying out new things in life and exploring new experiences. And I am eager to go back to the gym.”

One of the things Paolo enjoys now is overhauling his wardrobe - all his old clothes no longer fit. He now buys his jeans in size 33 while those hanging in his wardrobe are in size 41.

His friends and family are amazed at the results. And he is getting more attention from women. Smiles Paolo, “Girls look at me more now.”

Best of all, Paolo says he doesn’t feel a sense of deprivation when it comes to food or drinks.

“You still do whatever you want. I still drink but only two drinks. And I still have good food but I no longer eat for three or four hours. With lapbanding, you can’t eat both the beef and the lamb at one meal. So I say, “Today I eat lamb and tomorrow I’ll eat beef.” You enjoy quality, not quantity. And you do feel full. A sense of being full is all in the mind. And your mind is saying you are satisfied.”

Paolo has set his mind on lowering his weight to 80 kg – a target that Dr Baladas says is highly achievable.

In all, the operation cost Paolo €7,500 – money that Paolo says is very well spent.

“I would recommend the surgery to anyone. It is a big savings compared to Germany which would have charged me €11,000.”

Lisa Maree Spiteri had battled weight problems most of her life but it was a family crisis that finally made her decide to go for lapbanding surgery.

Over the years, the accounts executive had gained weight because of poor eating habits, the stresses of work and a lack of exercise. Weight problem also tends to run in her family.

At age 37, she weighed 137kg, with a Body Mass Index (BMI) of 54.

While professionally Lisa had never had to combat discrimination – at one point she held down a high-flying job as a director at a large Swiss bank in Singapore – the story was different when it came to social dealings.

Recalls Lisa, “The worst part of my weight problem came from people who judged me because of my weight, mainly the public. I came across many forms of discrimination while I lived in Singapore, more there than anywhere else I have lived and worked in.”

Lisa tried hard to lose the excess weight but while dieting and exercise would take the kilos off for a while, the weight would always return.

Then the Australian came to Singapore and discovered that Dr HG Baladas was carrying out lapband surgery at Alexandra Hospital (he would later shift his practice to Raffles Hospital). However what provided the final push was the devastating news that her father had just been diagnosed with terminal cancer. “That made me want to get my weight off in order to be able to help my family. I just wanted to get it done and get on with my life.”

Lisa was to discover that the operation would not only let her get on with life, it would, in her own words, “give me back a life that I had never really had.”

After the operation, the weight simply fell off her. One year after the operation, her weighing scale registered a loss of 40 kg. The next year, she lost another 40kg.

Today, five years after the operation, she weighs 65 kg and has a BMI of 22, which puts her at the ideal weight for her height.

And she has been maintaining this weight: in the last three years, her weight has ranged between 55 kg and 65 kg.

While friends and family were proud of her achievement, others could hardly believe their eyes at her transformation.

The transformation in Lisa went beyond sporting a slimmer figure though.

Declares Lisa, “I’m a new woman now. I feel and look a hundred percent better. I have a lot more energy for everything. I just feel good about myself these days.”

While Lisa never had any problems making friends, now she gets chatted up by men a lot more often. She also believes the operation added 20 years to her life.

The operation was billed at $8,000 of which Lisa paid only $4,000 as her company picked up the rest of the tab. And it was worth every penny, says Lisa.

“I would do it again if I had to.”

In fact, Lisa is so positive about her experience, she has counselled many others who were thinking of having the operation. “Over 15 people have had the procedure once they have spoken to me and seen my results.”

Today, Lisa, 42, is determined to stay thin. “I eat very healthy these days.” She has grown used to smaller portions and now eats a much more balanced diet. In addition, she does a lot of walking.