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OBESITY

Overview

Obesity is defined by body mass index (BMI). It is a medical condition in which the excess body fat accumulates to the extent that it can have negative effect on health, leading to a reduced life expectancy and several health problems. However, weight loss surgery is recommended if you cannot lose weight and are keeping it off by maintaining a healthy diet, and lifestyle. Doctors often use BMI and other health conditions like Type 2 diabetes and high blood pressure to determine who are the patients who are likely to benefit from weight loss surgery. The patients who are the right candidates for surgery are those with a BMI>32.5 kg/m2; those who are suffering from co-morbidities like diabetes; or patients with BMI>37.5kg/m2 (with or without associated co-morbidities).

HOW IS BMI CALCULATED ?

BMI is calculated by using following formula:

BMI = Weight (in kilograms) / Height (m) X Height (m)

BMI Range-kg/m2

Category

<18.5

Underweight

18.5 - 23.5

Normal

23.5 - 27.5

Overweight

27.5 - 37.5

Obese

>37.5

Morbidly Obese

>50

Super Obese

>60

Super Super Obese

 

CAUSES OF OBESITY

Genetics: Genetics are responsible for affecting hormones in fat regulation. A person is more likely to be obese if one or both parents are obese. 

Lack of Caloric Balance: If you are eating more calories than your body is using, there is a possibility that the extra calories get stored and you can gain weight.  

An Inactive Lifestyle: Lack of physical exercise and involvement in leisure activites like television and computers as well as mechanization of jobs is also developing obesity.

Our environment: Easily available processed and unhealthy foods, and oversized food portions increases the chances of obesity.

Medications: Few medications associated with weight gain include antidepressants,anticonvulsants, diabetes medications, steroids, and some high blood pressure medications and antihistamines. 

Psychological factors: Factors like emotional stress, anger, sadness can also lead to weight gain, as people tend to eat more during such conditions.

Diseases: Conditions like hypothyroidism, insulin resistance, polycystic ovary syndrome, and Cushing's syndrome also contribute to obesity.

MORBID OBESITY

Those people who are morbidly obese are at a greater risk of illnesses like diabetes, high blood pressure, sleep apnea, gastroesophageal reflux disease (GERD), gallstones, osteoarthritis, heart disease, infertility and cancer. Morbid obesity is a state of severe obesity and is defined by the following condition:

  • If a person has a BMI above 37.5 with or without associated illness or BMI above 32.5 with diseases like diabetes, hypertension are considered to be morbidly obese. 

COMMON OBESITY RELATED CONDITIONS

  • Type 2 diabetes
  • High blood pressure
  • Heart disease
  • Joint pains/ Osteoarthritis
  • Stroke
  • Gastroesophageal reflux disease
  • Gallstone disease
  • Increased chances of developing cancer of breast, prostate ,colon, uterus and ovaries.
  • Sleeping disorders like Obstructive sleep apnea
  • Infertility/Polycystic ovarian disease (PCOD)
  • Depression/Anxiety/low self esteem

TREATMENT OPTIONS

The various treatment options available for obesity are as follows:

Diet and Exercise: If BMI > 23.5, certain lifestyle modifications, changes in diet, increase in physical activities, and practicing healthy eating habits can reduce obesity. 

Weight loss drugs: If BMI > 27.5 with co-morbidities or > 30 with or without co-morbidities, pharmacotherapy with weight loss drugs is reecommended. Close medical monitoring is required while taking a prescribed weight-loss medications. 

Surgery: If BMI > 32.5 with co-morbidities or > 37.5 with or without co-morbidities, bariatric surgery is the right choice of treatment. Weight loss surgery for obesity may be considered if other methods to lose weight have not worked. 

DIABETES AND OBESITY (DIABESITY: DUAL EPIDEMIC OF MODERN ERA)

Indians are genetically susceptible to weight accumulation, especially around the waist. An obese individual is much more susceptible to diseases like diabetes, hypertension, osteoarthritis and obstructive sleep apnoea. Studies have shown that:

  • In MALES, Compared with a healthy weight man, an obese man is 5 times more likely to develop type 2 diabetes.
  • In FEMALES, An obese woman, compared with a healthy weight woman, is almost 13 times more likely to develop type 2 diabetes.

The traditional approach to treat TYPE 2 DM (Diabetes Mellitus) has been step wise introduction of lifestyle changes with or without oral medications, saving the insulin therapy for last. Treatment should focus equally on remission of both diabetes and obesity and needs to be widely understood. In the light of escalating global diabetes crisis, the need of the hour is to identify interventions that provide a long term metabolic outcome (obesity and associated diseases remission). There are several methods for treating obesity, such as lifestyle changes encompassing behaviour modification, physical activity, diet modification and medical management. It has been seen that the sustained weight loss is achieved by only 10% of the population.

Bariatric surgery (Obesity surgery) is the most effective long-term treatment for obesity with the greatest chances for amelioration and even resolution of obesity-associated diseases. In the given scenario of increasing morbidity and mortality due to Type II Diabetes Mellitus and obesity, bariatric surgeries emerged as a promising treatment. It provides exceptional sustained weight loss and remission of type II diabetes in addition to improvement in other co-morbidities and quality of life.

TYPES OF BARIATRIC AND METABOLIC SURGERY

Bariatric surgery is considered to be the most effective treatment for obesity. The bariatric surgical procedures causes weight loss by restricting the amount of food, causing mal-absorption of nutrients, or a combination of gastric restriction and mal-absorption. Most weight loss surgeries are performed using minimal invasive techniques (laparoscopic surgery).

The choice of the surgical procedure depends on the treating surgeon and the team after evaluation and counselling. Common Bariatric surgery options which are available are:

  • Gastric Bypass
  • Sleeve Gastrectomy
  • Minigastric bypass
  • Gastric bands
  • Others
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