ABOUT OBESITY IN INDIA
Obesity now considered as a “Killer lifestyle” disease is an important cause of preventable death worldwide.
According to the World Health Organization (WHO), 1.2 billion people worldwide are obese of which 30 million Indians are obese, and most likely to double in next 5years. This is probably the most sedentary generation of people in the history of the world. In the Indian scenario, even with the growing awareness about health and fitness, more than 15 to 20% percent of the Indian populations are obese. There is an urgent need to create public awareness about the mechanisms of identification, prevention and treatment of severe obesity.
Obesity is a disease characterized by excessive body fat. People who are medically obese usually are affected by behavior, genetic and environmental factors that are difficult to control with dieting. Obesity increases the likelihood of certain diseases and other related health problems.
BODY MASS INDEX
Obesity is determined according to one’s BMI. BMI measures weight for height of a person.
Weight (in Kgs)
BMI = ——————————————————–
Height (in meters) X Height (in meters)
INTERPRETATION OF BMI
|Below 18.0||Under weight|
|30-33.0||Obesity (Obesity I)|
|35-40.0||Severe Obesity (Obesity II)|
|40-45||Morbid Obesity (Obesity III)|
|> 45||Super Morbid Obesity|
HEALTH RISKS ASSOCIATED WITH OBESITY
There are more than 30 medical conditions that are associated with obesity. Individuals who are obese are at risk of developing one or more of these serious medical conditions, causing poor health or, in severe cases, early death. In fact, more than 112,000 annual deaths in the U.S.A are attributable to obesity. The most prevalent obesity-related diseases include:
- High blood pressure
- High cholesterol, and Triglycerides, HDL
- Heart disease
- Gallbladder disease
- Gastro esophageal Reflux Disease (GERD)
- Osteoarthritis of knee joints
- Obstructive Sleep apnea and respiratory problems
WHAT CAUSES OBESITY ?
Obesity is due to an individual taking in more calories than they burn over an extended period of time. These “extra” calories are stored as fat. Although there are several factors that can lead to this energy imbalance in obese individuals, the main contributors are behavior, environment and genetics. Causes of Obesity
Although the causes of obesity are widespread, certain factors are targeted as major contributors to this epidemic. Causes associated with obesity include:
- Dietary patterns or (Behavioral)
- Heredity and family (Genetics)
- Lack of physical activity (Social)
- Socioeconomic status
SOCIAL EFFECTS OF OBESITY
Individuals affected by obesity often face obstacles far beyond health risks. Emotional suffering may be one of the most painful parts of obesity. Society often emphasizes the importance of physical appearance. As a result, people who are obese often face prejudice or discrimination in the job market, at school and in social situations.
Effects at Work Due to the negative stigma associated with obesity, obese employees are often viewed as less competent, lazy and lacking in self-discipline by their co-workers and employers. Often times, discriminatory attitudes can negatively impact salary, promotions and employment status for obese employees.Finding a job can also be a difficult task for an obese individual. Studies show that obese applicants are less likely to be hired than thinner applicants, despite having identical job qualifications.
Effects at School Educational settings also provide the possibility for discriminatory situations. Obese children face numerous obstacles, ranging from harassment, teasing and rejection from peers, to biased attitudes from teachers. At a young age, children are exposed to obesity’s negative stigma. Obese children are sometimes characterized as being unhappy, lazy, mean and not having many friends.
In Healthcare Settings Negative attitudes about obese patients also exist in the healthcare setting. Obese patients are often reluctant to seek medical care, may be more likely to delay important preventative healthcare services and more frequently cancel medical appointments. Delaying medical attention can lead to delayed discovery or treatment of co-morbid conditions, such as diabetes and cardiovascular disease, while becoming more physically damaging. The consequences of this discrimination can seriously impact an individual’s quality of life and only further intensify the negative stigma associated with obesity.
TREATMENT OF OBESITY
Obesity treatment strategies vary from person to person. Beginning treatment early is an essential part of success, and it is important to talk with your physician before beginning any weight-loss program.
. The various treatments of obesity in children and adolescents include:
- Dietary therapy
- Physical activity
- Behavior modification
- Medically managed Weight Loss Programme
- Pharmacological treatment
- Bariatric or Weight loss Surgery
SURGICAL TREATMENT BY LAPAROSCOPY
Surgical treatment of obesity is an option for those who are classified as morbidly obese. Morbid obesity is defined as a patient having a BMI of 40 or greater, or weighing more than 40 kilograms over their ideal body weight. In addition, a patient with a BMI of 35 or greater with one or more obesity-related diseases is also classified as morbidly obese.
There are a few different types of bariatric surgery or weight-loss surgery treatment options, such as Roux-En-Y Gastric Bypass, Banded Gastric Bypass, Gastric Sleeve resection and Adjustable Gastric Banding and Mini Gastric Bypass.
INDICATIONS OF BARIATRIC SURGERY:
One can consider bariatric surgery as an effective weight loss option if a person has any of the following conditions:
- BMI > 35 with co-morbid disease (hypertension, diabetes, heart disease, joint problems, reflux)
- BMI > 40 without co-morbid disease
3.BMI > 30 and have tried several weight loss methods over a period of one year
ELIGIBILTY FOR WEIGHT LOSS SURGERY
- Presence of serious sequelae of morbid obesity
- 30 kg overweight or a BMI> 33 kg/m2 for more than 5 years with at least one co-morbidity (ASIA PACIFIC GUIDELINES)
- BMI > 37 with or without co-morbidities
- .3.Failure of sustained weight loss on supervised dietary and conservative approaches (OR Multiple unsuccessful attempts at Weight loss with non-surgical methods)
- Absence of an endocrine cause
- Acceptable operative risk
- Compulsive eaters
- Educated, compliant patient. Demonstrate willingness to maintaining dietary guidelines and other follow-up care.
- Have support from family, spouse, or close friends.
- Surgery is not recommended for the mentally ill or impaired, patients known to abuse alcohol or drugs, or those with an eating disorder such as bulimia.
TYPES OF WEIGHT LOSS SURGERY:
1.LAPAROSCOPIC SLEEVE GASTRECTOMY
1.Laparoscopic Sleeve GastrectomY is a relatively new operation that can be done either as a standalone procedure for those who don’t have much weight to lose, for those who are older or higher risk, or as part of a staged operation. Approximately 85% of the stomach is removed, leaving a cylindrical or sleeve-shaped stomach. Unlike other forms of bariatric surgery, the outlet valve and the nerves to the stomach remain intact and, while the stomach is drastically reduced in size, its function is preserved.
The sleeve gastrectomy is not reversible.
With the sleeve gastrectomy, the new sleeve-shaped stomach is is about the size of a banana. Weight loss occurs because the reduced stomach volume only allows for the ingestion of a small amount of food, which increases the feeling of fullness.
The weight loss with the Sleeve Gastrectomy is in the range of 55% to 70% of the excess body weight.
The Sleeve Gastrectomy operation is done with 5 small incisions, and takes about an hour to do. Dr. Sreejoy Patnaik uses a small tube to size the Sleeve so that the diameter of the resulting stomach pouch is not too small or too large. He does a “leak test” in the operating room before he completes the operation. Having the Laparoscopic Sleeve Gastrectomy usually involves just 2 night stay in the hospital. You are able to return to work, resume heavy lifting and strenuous activity, in most cases, in about two weeks from the time of surgery. If you are able to do light duty at work, there is the possibility of going back to work sooner than two weeks.
- Decreased appetite
- Prolonged sense of fullness after small meals
- Decreases cravings for sweets
- Rapid initial weight loss
- Laparoscopic procedure is minimally invasive
- Permanent procedure
- Requires cutting and removing a portion of the stomach
- Requires patient discipline with diet to avoid nutritional deficiencies and malnutrition
No long-term data
2.LAPAROSCOPIC GASTRIC BYPASS
Laparoscopic Gastric bypass ( short limb ) is more effective in “sweets eaters” because dumping symptoms curtail the high dietary intake of sweets. If the intestinal anastomosis is made lower down, this procedure becomes a combined restrictive + malabsorbtive procedure. RISKS: Leaks and nutritional deficiencies due to malabsorbtion and diarrhea.
According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is completely stapled shut and divided from the stomach pouch. It is not completely removed. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, called the Roux limb, thus eliminating the duodenum and a small portion of the jejunum from the absorptive circuit. The omitted segment is connected into the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be adjusted to produce lower or higher levels of malabsorption.
- The duodenum being bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia.
- A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
- A condition known as “dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
- Metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones.
- All the above listed deficiencies can be easily managed through a proper diet and vitamin and calcium supplements. It is mandatory for patients undergoing gastric bypass to consume a multivitamin and calcium supplement daily.
RESULTS FROM GASTRIC BYPASS
- Weight loss after gastric bypass surgery is often dramatic. On average, patients lose 70- 80% of their extra weight. Right after surgery, most patients lose weight quickly and continue to lose for 18 to 24 months after the procedure.
- Recovery after Gastric Bypass
- LAPAROSCOPIC MINI GASTRIC BYPASS
The Mini Gastric Bypass (MGB) is a Short, Simple, Successful, Reversible Laparoscopic gastric bypass weight loss surgery. The operation usually takes only 30 min., hospital stay less than 24 hours. The Mini Gastric Bypass (MGB) is low risk, has excellent long term weight loss, minimal pain and can be easily reversed or revised.
It is powerful like the LRNY but unlike the LRNY it is easily revisable (~30-60 minutes.) The MGB cuts hunger by over half in contrast to the band which leaves patients hungry and vomiting when they eat healthy foods.
Today, because of developments in laparoscopic (“keyhole”) surgery, MGBP has started to come back into fashion and is being promoted as a quick and effective alternative to standard gastric bypass. The surgery is a simplified form of Roux-en-Y gastric bypass surgery (LRNY). A thorough review of the studies that specifically evaluated the effectiveness of MGBP shows that the procedure is shorter, easier, less expensive and has lower risk and equally successful outcomes as RNY.
MINIMALLY INVASIVE WEIGHT LOSS SURGICAL PROCEDURE.
- Performed laparoscopically (5 small, 1″ incisions)
- Usually takes less than one hour to perform
- Overnight hospital stay
- Easily reversible or revisable
- Excellent weight loss
- Low complication rate
- Return to normal activity within one week
THREE IMPORTANT AND DISTINCT WAYS THE MINI-GASTRIC BYPASS HELPS YOUR BODY TO SHED POUNDS.
1.Restrictive – A Small stomach pouch is created restricting the amount of food you can eat.
2.Malabsorptive – A portion of the small intestine is bypassed. Since the small intestine is responsible for absorbing the calories from the food you eat, bypassing a portion of the small intestine results in fewer calories being absorbed, thus creating additional weight loss.
3.Hormonal – The hormone ghrelin has been nicknamed the “Hunger Hormone” by researchers because of its significant effect on appetite. Gastric Bypass results in a fall in ghrelin levels resulting in a reduced appetite.