Obesity is a very common phenomenon known for decades & accepted as a simple problem of Over-eating. Every common person claims to treat by the indigenous way with little temporary success.
Facts of Obesity
- Genetic diseases also cause overeating.
Sweet Chubby babies used to get the best child awards for many years. Childhood Chubbiness will be resolved by activities, but in a society of overwhelming protection by the parents especially precious children obesity is accepted as a sign of Good care. Obese people are in General very pleasant & sweet, but later develop Psycho-Social issues invariably due to physical appearance and limitations. - Obesity affects all ages & sex.
- Globally obesity has doubled.
Around 1.9 billion adults above 18 years in age are overweight whereby 600 million are obese and 42 million out of those 600 million obese patients are children. - Obesity is preventable and also reversible issue declared as a Disease by WHO.
- Patients in the Overweight & Obesity categories are at higher risk than Underweight patients.
What is Obesity?
- Obesity in a simpler outlook is an abnormal or excessive fat accumulation that impairs health. But this abnormal fat starts working as a Large Endocrine organ producing some hormones.
- Fat should ideally be 20% of body weight.
- Consuming more calories than to burn, can lead to accumulation or storage of either carbohydrate which is converted to fats in the body or whilst consuming fats along with carbohydrates.
- This occurs more in an urban setting, as the urban setting provides them with a sedentary lifestyle rather than an active lifestyle in the name of convenience.
In Simpler way Obesity can look like a Central- Male /Peripheral-Feminine type.
Grading of Obesity:
BMI .50 = Super Obesity.
If a person has a BMI of 40, it means he is already above 80% of overweight
Effects of Obesity
Obesity can lead to metabolic syndrome (MS) or Syndrome X,
- Central obesity
- High serum triglycerides
- Low high-density lipoprotein cholesterol (HDL-C)
- Elevated blood pressure
- Elevated fasting blood sugar
- Underlying insulin resistance
MS is higher after the age of 40yrs with an incidence of 40%, but it is 25-40% below the age of 40.
Urban has 57%pf Urban people are at risk for SyndromeX with an incidence of 64.2% for females and Indians are at 68.8% risk.
Effective Management
- In patients with morbid obesity associated with comorbidities, Bariatric surgery is the only available therapeutic modality associated with clinically significant and relatively sustained weight loss.
- Bariatric/Obesity surgery, substantially cures/significantly reduces the morbidities associated with severe obesity.
- Surgery can be offered to all ages 16-65 yrs as per fitness.
Bariatric Surgery can be an Endoscopic Approach wherein an inflatable & Deflatable balloon is placed in the Stomach, so that person feels mechanically full & reduces the desire to eat. This Balloon can be left for 06-12 months.
Together with LifeStyle management, Dietary advice & staged Exercise programs one can lose weight so that OPEN / Laparoscopic Definitive procedures can be done to achieve sustained weight loss.
Endoscopic — Balloon.
Definitive Bariatric Procedures are varied Techniques based on the principle of Reducing the Stomach Capacity, Modifying the internal Hormonal Environment including Insulin & adding Malabsorption procedures.
Few of Definitive Procedures are:
- Sleeve Gastrectomy.
It is a procedure where the stomach is reduced to the size 3 ounces by removing a part of the stomach and is quite effective. Usually Done by Laparoscopic/Robotic technique/open procedure.2. Gastric Plication is a procedure of Sleeve Gastrectomy, where stomach is plicated like a curtain & made smaller by laparoscopic/Endoscopic way.
3. Gastric By-pass ( Roux –Y) procedures
It is done by reducing the stomach capacity & also bypassing the intestine so that the malabsorption component is added for better efficacy.MGB-Mini Gastric Bypass is a simpler procedure of Bypass .especially for sweet eaters
4. More Complicit Procedures involve intestinal bypasses. Many Morbid/Super Obese people may require more than one procedure.
Is Surgery Free of Complications?
Surgery has its own Complications especially related to anastomoses, BUT success rate is excellent in controlling and maintaining weight, the appearance of a person cosmetically, feeling of well being, control or Potential cure of Diabetes, Cholesterol related, cardiac & all other morbidities.
SUCCESS:
The Success of Weight reduction depends also on person compliance.
Article by:
Dr. Anantha Kumar Chinnaswamy
Consultant General & Endo/Laparoscopic Surgeon
Sri Kota Specialist Medical Centre
