Music has always been important to Navi, who started singing and composing at the age of 12. She knew from then on that this was the path she wanted to take in life. And for having more chances to reach her potential and express herself as an artist in music, she left home early, when being only 16 years old, moving to Bucharest. Not simple at all, not easy at all. In case of Navi, this "not easy at all" also had another meaning, as much as possible. In addition to the financial difficulties of a new beginning and the anxieties specific to a critical stage per se - adolescence -, Navi was carrying the weight of a few excessive kilograms. And these proved more and more difficult to wear as she became more and more body-conscious.

"I was a chubby, poor child with ugly teeth, coming from a provincial town (Oradea). Since the second grade, I began to realize that I was a chubby child - the other children were laughing at me, and from the adults, I received contradictory messages, which made me feel confused: first, they used to tell me <<what cheeks, what a chubby and cute child !>>, then I would hear them say that it’s not good that I’m like this, that I need to lose weight and eat less. So, there followed a long series of diets with a yo-yo effect (e.n. – this effect translates into an important metabolic and appetite disorder). Since that moment I’ve always eaten less than would’ve been normal, but despite all this, I didn’t lose weight, but at most I maintained it. If, on the other hand, I was eating normally, I was gaining weight at an accelerated rate," confesses Navi.

In the world of showbiz, a field where image matters so much, especially if you're a woman, you can feel the pressure created by other people's expectations of how you should look. In fact, there were a few instances where Navi felt she was being judged "by the packaging" rather than what she was doing musically. But, fortunately, those were isolated situations, and she didn’t take them to heart. However, Navi knew deep down that she needed to change something to truly feel good about being a music performer. "When I looked in the mirror, something was wrong: there was a discrepancy between that image and my image of myself as an artist. I didn't want things to stay like this, I decided to change my life and become the best version of me: a healthy, strong, and fulfilled woman in all respects", tells Navi.

"You don't know for sure that surgery is for you until you meet the right doctor"

Over time, Navi had tried just about everything to get rid of the excessive kilograms: diets, diet pills, or simply starving herself, sometimes supplemented with agonizing physical effort, because she had no energy and exercising seemed like a kind of punishment. She desperately needed to finally find a solution that would work for the long term. “I started thinking about Gastric Sleeve surgery in 2015 after seeing the effects on female colleagues in the industry. And in 2018, when the favorable context arose to do the surgery, I started from the idea that either I go to the best people to do the surgery, or I don't do it at all. I read all the biographies of the doctors on the Center of Excellence in Obesity Surgery page and I decided to start with Dr. Hutopila. After meeting this doctor, I knew he would be my doctor. Dr. Hutopila made me feel safe, to feel that I was in the best hands. In fact, you don't know for sure that surgery is for you until you meet the right doctor and ask him all the questions you need to know the answers to", says Navi. 

Being used to doing things methodically and because she had been waiting for several years to have the surgery, Navi showed up very prepared at the first meeting with Dr. Ionuț Hutopilă, bringing with her a notebook with many questions that she asked the doctor. She knew she needed to clear up all her confusion and enter the surgery room without any trace of doubt. 

"It’s very important that patient's expectations of what they will get through the surgery are realistic and consistent with the state of health from which they start on this path. Bariatric surgery was created to provide the patient with effective and constant help in weight control, to bring their weight back into the normal range. But it must be understood from the very beginning that our body doesn’t have a mathematical answer, but a biological one. This means that seven minus five can sometimes make not two, but one. So, even if weight loss after surgery or improvement/disappearance of obesity-related conditions follows the same positive pattern for all patients, we can’t expect them to be identical. Also, symptoms can have different nuances and intensities from patient to patient, and all of these are considered to be normal in the evolution after surgery because each body is unique. That is why it’s very important that the patient enters the surgery room with answers to all questions so that they find the information they’ve received in all the stages they’ll go through and they trust the doctor and the process", says the surgeon. 

Moreover, the first meeting with the surgeon has a decisive role not only for the patient, who can decide that they want that doctor to operate on them but also for the doctor, who determines whether the surgery is necessary and possible for the patient. "During this first meeting, general knowledge of the patient takes place, both from the point of view of the numbers - number of kilograms, height, body mass index - and associated ailments, as well as from the point of view of the lifestyle: diet style, physical activity, emotional state, so that we can determine together if they are a suitable candidate for bariatric surgical treatment. If, following the initial checkup, the conclusion is that the patient can benefit from the effects of bariatric surgery, we schedule and trigger the pre-operative investigation protocol, which has the role of an objective medical assessment. This stage is natural and implicitly mandatory, comprising several specific assessments, which will be performed as efficiently as possible, during a single day, starting in the morning and ending in the evening, with a discussion with the surgeon", explains Dr. Ionuț Hutopilă, Surgeon of Excellence in Obesity Surgery in the team coordinated by Prof. Dr. Catalin Copaescu.

A multidisciplinary team performs the pre-operative assessment 

The team that assesses the patient consists of doctors with different specialties, such as gastroenterology, cardiology, pulmonology, nutrition and diabetology, imaging, psychology, anesthesia and intensive care, and bariatric surgery. These checkups are based on a series of blood tests and some specific investigations (abdominal ultrasound, barite bowel movement, upper digestive endoscopy, spirometry, osteodensitometry). The role of this assessment is to identify the negative changes produced in the body as a result of obesity, with repercussions on other systems (digestive, cardiac, endocrine, respiratory, metabolic-glycemic, lipidic, etc.) and to improve them, if necessary, to prevent and reduce possible complications to a safe level for the surgery. 

"Through this pre-operative assessment, we look at several aspects because obesity has a strong impact on the whole body, with undesirable consequences. Because a person with obesity is a patient with a degree of risk, we expect that at the time of assessment, they will have at the onset or already have set in at least one of the conditions associated with obesity, even if it hasn’t been diagnosed at that time. That’s why all the required investigations and checkups are performed, through which we can identify those conditions that must be corrected before the surgery. The goal is to reach an effective treatment area, which creates the best operative and post-operative conditions for the patient so that the results are also the best", says the surgeon. 

Another important meeting in preparation for the bariatric surgery is the meeting with the psychologist. “It was a difficult and necessary discussion where we approached sensitive topics like fat shaming (e.n. – the guilt/shame of being fat). Together with Ms. Cosmina Peta, I elucidated the motivation behind my decision to have the surgery. It is important to have this surgery not out of fear or because you hate the way you look, but because you want to be more active, to be able to do more with your life. And I decided to have the surgery to bring me more joy and give me back my freedom of action", says Navi.
Informing the patient is also part of the preparation for the surgical intervention, which is extremely important, and this is performed by the entire team.

"If a patient is well prepared physically and mentally for bariatric surgery, one can get the best results. This means not only better weight loss and control of associated conditions but also fewer complications. The team's job is to prepare the patient and the timing of the surgery so well that there are as few surprises as possible during and after the surgery. Only in this way can we achieve a minimal risk of complications, worthy of a center of excellence. Being treated in a center of excellence means a guarantee of the best possible results", says Dr. Hutopila.

Major surgery, but with minimal disturbance

The idea of having most of one’s stomach removed can be daunting for many persons who desperately need to take control of their weight and who have been unsuccessful in doing so through conservative methods. The reality is, however, that bariatric surgery performed laparoscopically produces minimal discomfort – if it can be said this way – compared to its curative effects. "These surgeries are performed without completely sectioning the patient's abdomen, as it is the procedure in classic surgery, the only incisions between 5 mm and 12 mm in size are those in the skin, and then the spaces through which we reach the organs are performed with the help of some thin instruments with a conical tip (similar to the tip of a pencil) that only separate the muscle fibers without cutting them. Thus, patients, having their abdominal muscles intact, have the ability to move immediately after the minimally invasive surgery, and the day after the surgery, they are encouraged to get out of bed and walk the hospital corridors", explains the surgeon.

In fact, the entire medical process performed within the Center of Excellence in Obesity Surgery aims, beyond solving the basic problem, of obesity, to achieve this goal with minimal physical and mental trauma for the patient and with their return to their usual life as fast as possible. "The patient wakes up in the surgery room, only they don’t remember, because the medication used during the surgery also has a partial amnesic role, so the patient is protected psycho-emotionally. Afterward, it is very important that the patient feels as comfortable as possible, and for this, there is anti-algesic support - which is why they’re not limited by pain. That's why we take advantage of the fact that there are long corridors in the hospital and we encourage them to walk as many times as possible so that we can bring them to a state as close as possible to the pre-operative one. The role of these walks is to put the body's systems into action, to improve breathing, circulation, and muscle activity. Moreover, when we get out of bed, we don't just move our hands and feet, our intestines also move. Thus, the patient will be able to quickly resume their digestive activity, initially through oral hydration and then following the stages recommended by the nutritionist", says the doctor.

It was the same for Navi, who was encouraged to walk after the surgery: "<<If you make ten walks, your drain tubes will be removed faster>>, the doctor told me. After the surgery, I had no discomfort in the area of the incisions, nothing to bother me, absolutely nothing. It's hard to believe that I had absolutely no pain, but that’s how it is!”.

On the way to optimal weight    

Before the surgery, the doctor proposes to the patient a target weight that they would like to achieve and maintain. "Our goal will obviously be to get the patient to a normal weight at the end of the weight loss process. The way, speed at which the patient loses weight during the journey to a normal weight varies according to the stages through which they go post-operatively. Thus, the weight loss will be more pronounced during the first three months after the surgery, when the caloric intake is lower, and as they approach the target weight, the weight loss process will slow down with a slightly increased caloric intake, which will be appropriate to the weight and activity of a normal-weight person. Beyond that, patients will lose weight differently. Why? Because this is how it normally happens, they are unique, different in gender, age, and lifestyle - physical activity performed, choosing food and others", says Dr. Hutopila

Navi got rid of the extra 32 kilograms she had in a somewhat predictable schedule. "Seven-eight months after the surgery I reached my lowest weight (46 kg), after which I got stabilized at 50 kg - of course, with a slight variation of one kilogram, due to seasonal fluctuations (winter-summer) and other variables. This is my target or ideal weight from the point of view of health, as Dr. Hutopila told me. Fortunately, I've maintained this weight, even though I haven't always strictly followed the rules - I've also had busier, more stressful periods with less organized eating, but my metabolism knew how to do its job. Before the surgery, I would have gained weight immediately under these conditions", says the artist.

A restart and a new chance

Any treatment aims to reduce the impact of the disease on the person concerned from the point of view of what it means to carry out life: health, self-esteem, family, and profession. Obesity surgery, also called bariatric and metabolic surgery, does more than that, as it can treat those who suffer from obesity significantly and permanently. It has been scientifically proven that, by losing weight, not only does the quality and life expectancy improve significantly, but the complications caused by this suffering are also in remission until cured. 

The singer and composer Navi is one of the patients for whom the surgical treatment of obesity represented a restart, a new chance: "About ten days after discharge, I was back at work in the studio, and a month after the surgery, I resumed the concerts. Gastric Sleeve surgery helped me, first of all, to not get diabetes, considering that I have a family history. Since 2018 until now, my life has changed completely, and only for the better. I now have a healthy relationship with food and no need to starve myself. The starvation I used to resort to affected me on all levels: from my mental state and energy level to my relationship with others and my career. In my new life, I have more energy and I've discovered that I really enjoy working out. I made the decision to do the Gastric Sleeve surgery rationally and prudently, being fully aware of the cause, and now I can say that it was the best decision I made".
 
Scientific consultant: Dr. Ionut Hutopila, primary general surgeon, surgeon of Excellence in Obesity Surgery within Ponderas Academic Hospital