After the news that 67 people in Europe were infected with botulism after undergoing weight loss procedures using botulinum toxin in Turkey, it became clear how safe these procedures are. For the past decade or so, Turkey has become the destination for cheap surgeries and implants, and it’s not always as cheap as they make it out to be. No case of botulism has yet been registered in Spain, but all hospitals are on guard should it happen.
The cause of botulism is iatrogenic, meaning it occurs as a result of medical intervention, but the origin is unknown, meaning whether it was caused by medical error or by toxin contamination.
First of all, the usefulness of botulinum toxin for weight loss has not been described beyond clinical studies. It is used without any scientific evidence and assuming risks that are a priori unknown. Using the toxin by intragastric injection attempts to relax the muscular walls of the stomach, slowing down gastric emptying and making the person feel more full, which would result in weight loss from eating less. All of this is theory as I insist there are no studies to back this up. If this method works, it should be repeated every five to six months as the toxin gradually loses its potency, which would mean regular surgery.
Patients who had undergone bariatric surgery in Turkey came to my practice and they didn’t even know what technique they had used, nor did they have a report, let alone post-operative guidelines. Basically, they’d had surgery, rested for two days, and got back on a plane, with all the risks that entails. I don’t doubt that there are clinics that do it right, but my experience is this: patients who don’t know exactly what to do after the procedure, with no postoperative controls, no dietary guidelines, or even minimal medical control.
Bariatric surgery is considered when diet modification has failed and a body mass index (BMI) of at least 35 kg/m², regardless of the presence, absence, or severity of comorbidities. And it is also taken into account in the case of metabolic diseases and a BMI between 30 and 34.9 kg/m² (SECO Spanish Society of Bariatric Surgery).
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In addition, the psychological state of the patient must be assessed, whether he suffers from eating disorders or uses toxic substances. It is therefore desirable that a multidisciplinary team composed of surgeons, nutritionists and psychologists or psychiatrists assess the suitability of the candidate. In addition, postoperative follow-up care should be carried out.
Why am I telling all this?
How much all of this, because while bariatric surgeries are necessary and successful in most cases, I believe there is one part that is not given as much information or is not considered when deciding to enter an operating room .
Regardless of how well the surgery is performed, the person undergoing it will need to make lifelong changes in diet, physical activity, and care. This isn’t about surgery and that’s it. In addition, we must consider the risks involved with every step through the operating room.
Dietary changes begin before the procedure in most cases, with a liquid diet usually prescribed at least two weeks before the procedure to minimize risks in the operating room so the patient comes in lighter for surgery. In the post-operative phase, a liquid diet is also recommended, then, depending on tolerance, food is reintroduced, up to a complete solid diet. If the digestive system is affected, it can lead to vomiting, diarrhea, difficulty swallowing, dumping syndrome (rapid emptying of the stomach after the meal when it comes 10 minutes early and 2-3 hours late).
A control must be carried out at the nutritional level in order to avoid nutrient deficiencies and difficulties in the treatment of the regime. We not only advise you so that you stick to a healthy diet that suits your needs, your lifestyle, your social and economic context.
The physical change is very noticeable in such an operation, so psychological follow-up is recommended, the body changes very quickly, but the head needs to assimilate these changes by a professional. In general, there is a residue of excess skin on the body and physical changes that need to be managed and accepted. And of course, as with any procedure, we need to add revisions with surgery.
It’s a much more complex process than what’s being heard out there. It is important that when a decision is made, it is made with good advice and taking into account all the work and changes associated with it, because the same applies here: health is not just a question of kilos.
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