Why can't I loose weight when I exercise and eat right?

Obesity is a complex chronic disease influenced by numerous underlying factors such as genetics, behavior, metabolic, and hormonal influences. It is not simply the result of eating too much and exercising too little. And it is not a choice. Only about 2% of people can lose weight and maintain weight loss through lifestyle changes such as diet and exercise. Research has shown that, by the time patients consider bariatric surgery, they have been unsuccessfully trying to lose weight through conventional methods for an average of 18 years. 

 

Read our blog that busts the myths about obesity here.

 

Do I qualify for bariatric surgery?

The following patients are considered candidates for bariatric surgery in South Africa:

• Patients with a Body Mass Index (BMI) of over 40.

• Patients with a BMI of over 35 with other co-morbid diseases associated with obesity.

• Patients with a BMI of over 30 with poorly controlled type 2 diabetes.

 

(These guidelines have been revised by metabolic societies in America and Europe in 2022, but the above are still considered the standard by bariatric teams and funders in South Africa.)

 

Is bariatric surgery safe?

When bariatric surgery is performed by an experienced surgeon on patients who have been properly assessed and prepared by a multi-disciplinary team, the surgery is safe and successful. The risks of surgery are very low compared to doing nothing at all. Furthermore, the risks of staying obese - with co-morbidities such as heart disease, diabetes, stroke, cholesterol, and sleep apnea - are far more dangerous. Listen to this podcast with Dr Cois Schutte for a detailed answer to this question.

 

Will my medical aid pay for bariatric surgery?

Bariatric surgery is not considered cosmetic surgery. Thanks to the hard work of several bariatric teams in South Africa, more medical aids are funding bariatric surgery - or at least partially. Funding is considered only if the surgeon is accredited by one of the two accrediting bodies in South Africa. On some plans, however, it remains an exclusion. Some medical aids contribute only a percentage of the total cost, and the patient will be responsible for the outstanding balance. We recommend contacting your medical aid to enquire about their specific terms and conditions relating to bariatric surgery.

The medical aids that are currently considering authorising payment for bariatric surgery claims, are:

• Discovery

• GEMS

• Polmed

• Bankmed 

• Barloword

• Sasolmed 

• Libcare 

• Anglo Vaal

• Netcare

• Remedi

 

What is bariatric surgery and how does it work?

Bariatric and metabolic surgery is first and foremost done for health considerations. It does induce weight loss, yes, but it also significantly improves other health problems related to obesity, such as sleep apnea, diabetes, high blood pressure, joint pains, heart disease, high cholesterol, asthma, and so forth. Due to the physiological nature of bariatric surgery, these co-morbidities are often resolved shortly after the surgical procedure before the patient has even started to lose any weight. Treating these co-morbidities of obesity is the main goal of bariatric surgery, and “weight loss surgery” is thus not an apt description.

 

How do I decide on a bariatric surgeon and a multi-disciplinary team?

Bariatric surgery has proven effective when surgeons work in a multi-disciplinary team, including physicians, dieticians, and psychologists. This team prepares the patient for surgery through a rigorous process that can take anything from three to six months, sometimes even longer.  

 

When searching for a bariatric team, consider the following:

• Look for a surgeon that is accredited to performing bariatric surgery (more information can be found here).

• An accredited surgeon will work as part of a multi-disciplinary team. Be skeptical about a surgeon working in isolation.

• It is highly unlikely that your pre-operation bariatric journey (from your first visit to the team, to undergoing the bariatric procedure) will be less than 6 weeks. Be skeptical of a surgeon that operates on you before you have completed the important pre-operative process (typically with a physician, dietitian, and psychologist).

• Look for a surgeon that performs a high number of bariatric procedures annually.

• Bariatric surgery is not a “one size fits all” solution. Be skeptical of a bariatric unit that only offers one type of procedure. The wrong procedure, or a procedure that is done without treating the disease (obesity) through a multi-disciplinary team, have proven much less effective in sustaining weight loss in the long term.

 

Read our guest blog post about the different bariatric procedures by Dr Thinus Smit here.

 

How do I know if my surgeon is part of an accredited bariatric surgery team?

There are currently two institutions in South Africa that oversee the accreditation of bariatric surgeons in South Africa: SAMMSS and SASSO. Whether you are referred to a surgeon by a friend or your GP - or find one via Google - make sure that the surgeon is accredited to perform bariatric surgery on South Africa by either one of these organisations.​

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There are four bariatric units in the public sector in South Africa. They are situated at Tygerberg Hospital in Bellville, Steve Biko Hospital in Pretoria, and George Mukhari Hospital in Ga-Rankuwa. Wits University has also recently become accredited.

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Do you have more questions?

Have a look at our forums, or send your questions to connect@reconstructcommunity.co.za.

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You can also find more FAQ's on the website of the South African Metabolic Medicine and Surgery Society (SAMMSS): www.sammss.org.