"Seventy-five per cent of Egyptians are overweight, while 35.7 per cent of this percentage are obese,” according to a 2017 study conducted by the World Health Organisation (WHO) and the Egyptian Central Agency for Public Mobilisation and Statistics.
The ongoing rise in obesity rates in Egypt and around the world has boosted the popularity of weight-loss businesses. Doctors in Egypt and worldwide are promoting pharmaceutical options and surgical interventions as breakthroughs in the obesity fight. Yet, the question remains which of these developments is likely to be most effective in combating obesity.
“Despite the remarkable progress in surgical procedures, some of these advances have not been properly promoted,” Fahim Bassiouni, a professor of general and laparoscopic surgery at the Qasr Al-Aini Faculty of Medicine in Cairo, explains. “Unfortunately, some surgeons rely on deceptive information to mislead patients about the surgical methods used in bariatric [anti-obesity] surgery.”
“For example, some surgeons promote using robots to perform ‘gastric sleeve’ operations, in which a portion of the stomach is removed to reduce the feeling of hunger, thus helping the patient to lose weight. The remaining portion of the stomach is stapled and cauterised to seal it off. But because the robots used in Egypt lack a tool for stapling the stomach, they are only used to make a few extra stitches that are not part of the gastric sleeve procedure,” Bassiouni said.
“Some doctors promote their work by saying that they use a robot during gastric bypass surgery and add approximately LE80,000 to the cost as a result. This is when the robot’s real role in the surgery is less than 20 per cent,” he said.
Dealing with patients who fear leakage as one of the possible complications of such surgery, some doctors advocate using a “smart stapler” to staple the stomach and reduce the risk of post-surgery leakage.
“The smart stapler is used to measure the size of the stomach and determine the appropriate part to use,” Bassiouni explained. “But it is a tool made for a poorly-skilled surgeon because a well-trained one does not need a stapler to determine what is suitable. Furthermore, it is rarely used in Egypt, benefiting only the companies that sell it.”
Islam Abdel-Rahman, a medical sales manager in Cairo, said that “due to my experience selling medical devices, I am familiar with the latest versions. But when I had gastric bypass surgery myself, my operation did not include stapling because the cost was prohibitively expensive.”
“I strongly recommend anyone considering having surgery for this purpose in Egypt to double-check that it is formally registered and documented by the US Food and Drug Administration, as some doctors may perform operations with dangerous Chinese-made staplers.”
“After having a gastric bypass operation five years ago that cost me LE50,000, my doctor told me that my brother could undergo the same procedure for LE20,000 less if we used equipment from his surgery,” said Marwa Al-Feki, who has managed to turn her fight against obesity into a successful career in fitness training.
According to Bassiouni, “besides using unnecessary and expensive equipment, some surgeons suggest an additional incorrect procedure, claiming it might prevent patients from regaining the lost weight. This is the case even though patients must follow a healthy lifestyle of eating and exercising to lose weight even after surgery.”
“For instance, some sleeve gastrectomy patients’ stomachs adapt to the surgery and expand again. As a result, some surgeons may advise a modified sleeve gastrectomy.”
“They place a ring around the remaining portion of the stomach after removing approximately 80 per cent of it in standard sleeve surgery to prevent the stomach from expanding again. In 50 per cent of cases, however, the ring penetrates the stomach and causes complications.”
“Many people proceed with surgery unaware that they could still easily regain weight afterwards, since many doctors do not inform their patients about that,” said Naeem Ali, the founder of a gastrectomy patient group.
“I founded a Facebook group three years ago to provide a realistic picture of bariatric surgery through the experiences of those who have undergone it.
“After I had a gastric bypass operation and lost roughly 30 kg of my weight, I regained all the lost weight as if I had not even undergone the surgery. I regretted doing it in the first place as a result.
“Many people are unaware that surgery is only a tool because losing weight requires exercise and a commitment to healthy eating habits as well. If I had known that from the start, I might have been able to avoid the risks and hefty expenses associated with surgery,” Ali said.
Another example of misleading operations is what is known as a “smart capsule”, a kind of tiny gastric balloon. Bassiouni explains that “one of the things that is popular on social media is the smart capsule, which can work on reducing weight by about 10 to 15 kg, while many patients who use it are overweight by about 30 kg.
“Moreover, the patient might swallow it whole while having reflux or a stomach infection without knowing it. As a result, the patient suffers discomfort and inflammation. After a couple of days or a week, the patient is forced to request its removal.
“But despite the false advertising used by some doctors, bariatric surgery remains a healthy alternative for obese people who suffer from life-threatening diseases and health problems or have their quality of life reduced,” Bassiouni said.
Mohamed Abdallah, a manufacturing manager in Cairo, recalls that “four years ago, I was taking medications to treat diabetes, high cholesterol, and uric acid. Then my blood pressure started to rise, so I underwent a gastric sleeve operation to avoid the health problems I was facing.
“However, surgery is not a guarantee of success; it must be accompanied by high-quality nutritional supplements to avoid dangerous side effects, a balanced diet, and regular exercise. The doctor, the hospital, and the nursing staff are also crucial elements of successful surgery.
“Internal body fat releases hormones that make a person feel either hungry or full,” said Bassiouni. When a patient undergoes bariatric surgery and loses a large amount of body fat, the ratio of hormones produced by the fat changes, and that causes the patient to feel less hungry than before surgery.
“Even 15 months after my sleeve gastrectomy surgery, I still maintained a lunch portion the size of an average cup of tea. Some of those who have had surgery complain about the small amount of food they can consume and how they miss the pleasure of eating. Yet, not being able to eat as much is a benefit for me because it enabled me to lose weight,” said Noha Zayed, a Cairo housewife.
Aside from surgery, research has investigated other approaches for dealing with obesity.
For example, research has found that children should not consume fast-absorbing monosaccharides, as children who eat a lot of sweets are more likely to develop obesity and a sugar addiction.
As a result, “eliminating this dangerous habit at a young age can spare them its consequences later in life,” explained Amr Matar, head of the Clinical Nutrition Unit at the Qasr Al-Aini Hospital in Cairo.
“According to another study, obesity is contagious. An experiment was conducted in which a person with a healthy weight was exposed to a large group of obese individuals who tended to consume lots of food. Despite having no genetic causes of obesity, the healthy individual became obese as well. As a result, obesity rates could be decreased by modifying the surrounding environment,” Matar said.
“It has been shown that 39 per cent of fat people suffer from depression, while the rate of non-obese depressed people is less than 17 per cent. A psychological imbalance can lead to obesity. Some psychiatric conditions contribute to obesity, including depression. Obesity in turn can lead to isolation, creating a closed circle,” said Heba Ali, a psychiatrist in Cairo.
An obese patient may resort to eating to replace negative feelings, such as tension, loneliness, or grief. Food serves as both a comforting companion and a psychological refuge. Such behaviour may result from an improper upbringing in which a child is rewarded through food.
After growing up, such children may use the same method to soothe themselves. “Psychological rehabilitation can treat this kind of behaviour through cognitive-behavioural therapy, which helps individuals to acquire new healthy habits, change their thinking patterns, and learn how to deal with feelings such as stress and sadness away from eating,” Ali said.
“Paying attention to the psychological side is unusual, but that’s where I ended up after having gastric bypass surgery and regaining weight. I realised that I needed to change my lifestyle, which meant changing my thinking patterns,” Al-Feki said.
“I underwent psychiatric therapy to overcome my food addiction and find the motivation to lose weight. Through surgery, the doctor muzzled my stomach but not my brain, which brought me back to eating.”
“In the light of these studies, pharmacological treatments have also been developed for obesity, and five medicines are authorised by the US Food and Drug Administration to be used under the supervision of a doctor,” Matar said.
“Among these are drugs prescribed for the treatment of diabetes that have been found to be effective at treating obesity. Other medications help to combat hunger by decreasing appetite, as well as others that raise the metabolic rate required by the body to achieve weight loss.”
Rawan Essam, a social media influencer in Cairo, said that “several doctors asked me to offer weight-loss medication to my followers. However, I declined because I was concerned that the medicine could adversely affect their health due to the variety of their health conditions.”
For her part, Magda Moussa, a Cairo housewife, said that “despite not succeeding in my many diet attempts, I do not want to undergo surgery and expose myself to additional risks. I am not enthusiastic about trying any newly developed drug either, as many of these may have hidden side effects that manifest themselves in the long run.
“The users of these drugs also gain weight again as soon as they stop using them. I am trying to stick to a healthy lifestyle, using the fear of surgery as a strong motivator even though my doctor has recommended bariatric surgery to avoid aggravating a medical condition in my spine,” Moussa concluded.
* A version of this article appears in print in the 2 March, 2023 edition of Al-Ahram Weekly