Incidence of obesity is on the rise globally. In India almost one out of 3 to 5 would have some degree of excess weight. The reasons are many and hence obesity is known as a multifactorial disease.

Genetics can contribute to obesity. Environmental factors such as preservatives, pesticides, etc. are the known endocrine disrupters. Environmental factors also have impact on epigenetics. Life style does play a role in aggravating the grade of obesity. Diet and life style change as a treatment of obesity has been attempted over many decades but could never give a long-lasting sustained success. The obvious reason being the body’s physiological response which gains the weight back. Hence, treating the root cause, that is the hormones of metabolism, is important for long-term control of weight.

Bariatric surgery was the only known and accepted treatment of obesity which could improve the hormones and metabolism. Bariatric surgery is known to reduce the hunger hormone Ghrelin and increase the GLP1 hormones. These hormones increase metabolism and help in weight loss. Researchers always attempted to create anti Ghrelin hormones but still it is not successful. The other attempt was to create a hormone which would work like GLP1 hormone. The newer medications or injections are the hormones like GLP! And hence are called hormone analogues/ GLP1 analogues. Like GLP1, there exist many hormones in the body like glucagon, GIP, amylin etc. which also have impact on hunger, appetite, and weight loss. Newer injections may have a single hormone or a combination of these.

Which drugs are known as weight loss medications /injections :

Injections like Liraglutide, Dulaglutide, Semaglutide , Tirzepatide etc are the newer medications for weight loss known as Victoza, Trulicity, Wegovy, Ozempic, saxenda, Mounjaro. There are some oral medications available like topiramate with phenteramine and bupropion with naltrexone.

How effective are these medications or injections?

These medications are effective and can give 5 to 15% weight loss based on various factors. It is necessary to follow a healthier and nutritious diet with these medications to minimise the side effects of these medications. The result of these remains variable and not the same for everyone. Majority of patients lose up to 5% weight.

What are the precautions before starting these medications and what are the side effects?

Patients may experience bloating, acidity, symptoms of reflux, some people may develop constipation or diarrhoea. Those with preexisting reflux, acidity or bowel disturbances should consult their doctor before starting these medications.

Incidence of thyroid cancer is reported with these medications, even though low. Those with thyroid disorders should consult their doctor and get thorough evaluation prior to initiation of therapy with these new medications. Those looking for conception/ pregnancy should avoid these medications or strictly use contraception while on these drugs.

Pancreatitis and gall stone disease are seen after the use of these weight loss injections. They should be best avoided in patients with history of gall stone disease, biliary diseases and those with history of pancreatitis.

A small number of patients have also reported changes in the mood, depression, anxiety, and suicidal thoughts after the use of these newer injections. Those with existing mood disorders or those on psychiatric medications should be screened prior to the use of these medications.

The drugs work by slowing the stomach movement, also known as delayed gastric emptying. A condition called gastroparesis has been reported which means the stomach start remaining paralysed and food remains in the stomach for longer period. This may give rise to bad breath, reflux and sometimes vomiting or reflux during sleep may be dangerous. Those with severe sleep apnoea should avoid heavy meal at bed time and should consult their doctors. The medications should be stopped two weeks prior to any surgery or anaesthesia for fear of vomiting and aspiration.

How long should one use these medications? Can someone stop these medications after achieving satisfactory weight loss?

It has been reported that if the medications are discontinued, there is increase in hunger, slowing of metabolism and rapid weight regain. Hence it appears that these medications have to be continued for life time, even though long- term side effects and safety is still yet to be known.

In simple language, these are just like a blood pressure or diabetes medications. The effect is seen till you consume those medications. Obesity being a chronic genetic, metabolic disease the treatment has to be continued ever.

Are these medications cost effective? Are they covered in insurance?

It appears that the medications cost around 20000 to 40000 Rs per month if you consider all the supplementary medications like statins, other medications, treatment of symptoms of side effects and protein and vitamin supplements. One may calculate the cost over a few years.

At present these are out patient treatments and hence not covered under insurance. Only bariatric surgery is covered under insurance and is known to be most cost effective as compared to these medications.

LOC or Laparo Obeso centre has been a comprehensive clinic and hospital offering the complete spectrum for weight loss since last 22 years. A team of well qualified experts at LOC Hospital offer all types of treatments including dietary modification, life style changes, endoscopic treatments like balloon, swallow balloon, bariatric surgery of all types so as to offer optimal weight loss to everyone.

If you’re dealing with both obesity and heartburn, you’re not alone. Many people notice that carrying extra weight can trigger acid reflux, also known as GERD (gastroesophageal reflux disease). GERD occurs when stomach acid flows back into the esophagus. It causes heartburn and a burning sensation in the chest. 

But how does excess weight make this problem worse?

Obesity and GERD are closely linked for several reasons. Let’s understand how they’re connected so you can manage both conditions more effectively. In this article we are going to explore the main ways extra weight affects acid reflux and how making a few simple changes can lead to significant improvements.

1. Extra Weight Increases Pressure on Your Stomach

When you put on extra weight, especially around your belly, it puts added pressure on your abdomen. This belly fat presses down on the stomach and nearby organs.

This extra pressure causes stomach acid to flow back up into the esophagus. Esophagus is the tube that connects your throat to your stomach. 

Normally, the lower esophageal sphincter (LES) works as a one-way valve that prevents stomach contents from rising. 

But because of this excess pressure, the LES weakens and relaxes, causing acid to leak into the esophagus, creating the burning sensation known as heartburn.

2. Visceral Fat Causes Inflammation

Visceral fat is a type of fat that wraps around organs like the stomach and liver. Unlike regular fat, visceral fat is active and releases chemicals called adipokines, such as interleukin-6 and tumor necrosis factor-alpha. 

These chemicals are inflammatory. And they interfere with the function of the lower esophageal sphincter (LES). When the LES becomes weaker, acid is more likely to flow back into the esophagus, increasing the risk of acid reflux.

Inflammation doesn’t only impact the LES; it can affect the entire digestive system, leading to more frequent episodes of acid reflux. This is why individuals with higher levels of visceral fat often experience more severe GERD symptoms.

3. Obesity Increases the Risk of Hiatal Hernia

A hiatal hernia occurs when part of the stomach pushes up through the diaphragm into the chest area. This disrupts the normal barrier between the stomach and esophagus, making it easier for acid to reflux into the esophagus.

Obesity raises the risk of developing a hiatal hernia because the extra weight pushes the stomach upward. 

This pressure can cause part of the stomach to slide through the diaphragm. When a hernia occurs, acid reflux becomes more likely and harder to control, worsening GERD symptoms.

4. More Frequent Lower Esophageal Sphincter (LES) Relaxations

Studies show that people with obesity experience more frequent transient lower esophageal sphincter relaxations (TLESRs). 

These are moments when the LES muscle relaxes, usually after eating, to release gas or relieve excess pressure in the stomach. 

However, if the LES relaxes too often, it allows stomach acid to slip into the esophagus.

Because individuals with obesity tend to eat larger meals, their stomachs stretch more, leading to even more TLESRs. This can create a cycle of acid reflux that’s difficult to break.

Research Behind the Link Between Obesity and GERD

Researchers have found that excess weight significantly increases the risk of GERD:

• People with obesity are nearly three times more likely to develop GERD compared to those of normal weight.
• A study in Scandinavia showed that overweight or obese individuals are six times more likely to experience GERD symptoms than those with a normal weight.

How Weight Loss Helps with GERD

Losing weight is one of the most effective ways to relieve GERD symptoms. 

Here’s how it helps:

Less Pressure on the Stomach: Losing weight, especially around the abdomen, reduces pressure in the stomach area. This helps the LES stay strong and prevents acid from pushing up into the esophagus. Since there is less pressure, acid reflux episodes lower down.

Reduced Inflammation and Improved LES Function: When the body sheds of visceral fat, the inflammation reduces and the esophageal muscles get strengthen. A stronger LES does its job better, keeping acid where it belongs.

Fewer LES Relaxations Smaller meals and less stomach stretching help reduce how often the LES relaxes, especially after meals. This means fewer times where acid can flow back up after eating.

Bariatric Surgery: An Effective Solution for GERD in People with Obesity

Bariatric surgery has proven to be one of the most effective solutions for those who haven’t found relief from GERD through weight loss and lifestyle changes alone. 

The procedure not only aids in significant weight loss but also reduces or even eliminates GERD by targeting the root causes related to obesity.

By addressing underlying issues like abdominal pressure, LES function, and inflammation, bariatric surgery offers long-term relief from acid reflux symptoms.

Dr Shashan Shah is one of the best and most experienced Bariatric Surgeon, with a proven track record in treating patients suffering from obesity-related GERD. 

He has helped many individuals reduce or completely resolve their GERD symptoms through advanced bariatric procedures.

With Dr. Shashank Shah’s expert care, you can regain control over your health and enjoy a GERD-free life.

If want to know how bariatric surgery can help you overcome GERD and achieve sustainable weight loss, reach out to us for a consultation. 

Urinary incontinence (UI) is a common condition in which people experience the involuntary loss of urine. It significantly affects the quality of life for many individuals. 

Recent studies show obesity as one of the biggest risk factor for developing urinary incontinence, mostly among women. 

we are going to explore the relationship between obesity and urinary incontinence, the mechanisms behind why it happens, and the potential solutions.

The Link Between Obesity and Urinary Incontinence

Research shows that obesity itself is a significant risk factor for developing urinary incontinence and for the condition worsening over time.

A systematic review of epidemiological studies has shown that each 5-unit increase in body mass index (BMI) is associated with a 20% to 70% increase in the risk of urinary incontinence symptoms. 

Specifically, the odds of developing urinary incontinence over a period of 5 to 10 years increase by approximately 30% to 60% for each 5-unit increase in BMI.

Types of Urinary Incontinence Affected

Obesity has a strong link to bladder leaks, especially with stress leaks. These leaks happen when activities like sneezing, coughing, or exercising put extra pressure on the bladder. 

Studies show that women with a BMI over 30 are much more likely to have stress leaks than women at a healthy weight. Obesity can also lead to urge leaks, where a sudden, strong urge to pee causes leaks before reaching the bathroom.

The connection between obesity and bladder control issues is complex, and while researchers are still studying exactly why it happens, there are some solid theories on how extra weight impacts bladder control. Here are the main ways that obesity may lead to bladder leaks:

• Extra Pressure on the Belly Area: When the weight is high, especially around the belly, is causes higher pressure inside the abdomen. Imagine it as squeezing an inflated balloon from all sides. This extra push puts stress on the bladder and can even make it harder for the muscles around the bladder (the pelvic floor muscles) to stay strong. When these muscles weaken, it can lead to leaks, especially when you do things like laugh, sneeze, or lift something heavy.

• Strain on the Pelvic Muscles Over Time: Similar to the toll that pregnancy can take on the body, excess weight can strain the pelvic muscles and other tissues around the bladder. Over time, this strain wears down the muscles and nerves that control bladder function. The pelvic muscles can be compared to a rubber band; when they are constantly stretched, they lose some of their natural “snap.” For some people, this strain means they’re more likely to have trouble holding in urine, as their pelvic support system becomes weaker from carrying extra pounds.

• Changes in Hormones: Hormones play a big role in bladder control, especially for women. Fat cells produce hormones, including estrogen, and having more fat tissue can mean more hormone changes. As estrogen levels fluctuate, it can affect the tone and function of the bladder and pelvic muscles. Estrogen, in particular, helps maintain muscle strength, so less estrogen can mean weaker muscles and poorer control.

Impact of Weight Loss on Urinary Incontinence

Several studies have shown that reducing weight loss can significantly improve urinary incontinence symptoms. Research indicates that even if someones looses 5% to 10% of total body weight it can substantial help reduce urinary incontinence episodes. 

Treatment Options

A primary strategy for treating urinary incontinence is through weight management.

Here are some methods to loss weight.

• Behavioral Weight Loss Programs: Structured programs focusing on diet and exercise can help individuals achieve significant weight loss.

• Surgical Interventions: For those with severe obesity, bariatric surgery is a great option that not only aids weight loss but also improves urinary symptoms.

• Pelvic Floor Exercises: Strengthening pelvic floor muscles through exercises such as Kegels can help improve bladder control.

How Bariatric Surgery Supports Morbidly Obese Patients with Urinary Incontinence

For those who are morbidly obese and experience severe UI, bariatric surgery is a proven option that offers sustained benefits. 

The substantial weight loss resulting from bariatric surgery can reduce the strain on the bladder and pelvic floor muscles, improving or even eliminating UI symptoms. 

Research underscores that many patients experience long-term UI relief following bariatric surgery, making it a viable solution for those unable to manage weight through traditional methods.

At the forefront of this field, Dr. Shashank Shah has made remarkable strides in assisting patients with UI related to obesity. His expertise in bariatric procedures has helped countless individuals achieve better health outcomes, not only by alleviating bladder control issues but also by enhancing overall well-being. 

For those seeking to address UI, Dr. Shashank Shah’s approach is grounded in a commitment to long-term, effective weight management solutions that bring comfort, confidence, and lasting relief.