There are three main types of bariatric surgery: gastric band, gastric sleeve and gastric bypass. Developed in the 1950s, laparoscopic sleeve gastrectomy (sleeve gastrectomy) involves removing part of the stomach so it becomes much smaller, and recipients feel fuller on less food. Arriving in China more than 20 years ago, it has become popular in the past decade. Gastric bypass surgery is a proven therapeutic option for the treatment of severe obesity and severe type 2 diabetes. It creates a small pouch in the stomach which is connected directly to the small intestine, so people absorb fewer calories from the food they eat. A gastric band is a reversible surgery where a band is placed around the stomach to make it smaller and produce a feeling of satiety.
“The logic was, if you make your stomach smaller, or if you bypass the intestine, you reduce the amount of food that somebody can eat, or the amount of food that somebody can absorb. You reduce the energy intake, therefore, people will lose weight,” Rubino said. Compared to a sleeve gastrectomy, a gastric bypass can induce more weight loss and better glycemic control, but it may lead to higher risk of post-operative complications and long-term malabsorption of nutrients.
Both sleeve gastrectomy and gastric bypass are well-accepted and safe surgical procedures. Normally, the surgery is done when diet and exercise have not worked or when the patient has serious health problems due to obesity.
According to statistics released by the “Annual Report 2019 of China Obesity Metabolic Surgery Database,” in 2008 there were only 117 cases of bariatric surgery nationwide, but by 2019 it had soared to 11,700, indicating a 100-fold increase over a decade.
In 2013, out of a total of 4,106 bariatric surgeries nationwide, only 777 were sleeve gastrectomies, while over 80 percent were gastric bypasses. By 2014, 2,200 sleeve gastrectomies were performed, and 2,920 gastric bypasses. Sleeve gastrectomy, a much more radical procedure, became more popular and by 2019 accounted for 86 percent of all bariatric surgeries performed in the Chinese mainland.
As chief physician of general surgery at the China-Japan Friendship Hospital in Beijing and head of its health management center for weight-loss diabetes surgery, Meng Hua is regarded as China’s top surgeon for bariatric surgery. His Douyin account has millions of followers.
Since 2012, Meng has performed over 4,000 bariatric surgeries. According to the “Annual Obesity Report 2019,” less than 55,000 bariatric surgeries were performed from 2012 to 2019.
In 2020, affected by the Covid-19 pandemic, Meng and his team resumed routine procedures in July, and by the end of 2020, they had performed around 500 bariatric surgeries. Meng told NewsChina that his hospital would likely perform more than 1,000 bariatric procedures in 2021.
“At present, no [other] hospital in the country can perform 1,000 bariatric surgeries a year. Most hospitals can perform at most dozens,” Meng said. On the first day of 2021, Meng performed seven procedures. NewsChina learned from the hospital that the surgery is so popular there is a five-month waitlist.
Even so, in Meng’s opinion, demand for bariatric surgery will grow. “Among the 330 million people in the US, 300,000 to 350,000 bariatric surgeries are conducted annually, accounting for 1 percent of the population. Thus in China, the number of bariatric surgeries can reach at least one million per year, 100 times more than we do now,” he said.
Li Guangwei, former director of Endocrinology at the China-Japan Friendship Hospital, said that the increasing trend of weight-loss metabolic surgery in China is “astonishing.”