Hypertension or high blood pressure is the force with which the blood pushing against the artery wall is too high. Any blood pressure above a mark of 140/90 is called blood pressure and above 180/120 is called severe. The significant rise in obesity is found to have a direct correlation to risk of high blood pressure. Obesity and hypertension together can give rise to an array of health issues and challenges there by affecting health, quality of life and life expectancy. Apart from just weight and obesity the fat distribution is also an important factor that plays a major role. Abdominal Obesity or central obesity around the waist circumference is the influencing factor for developing hypertension.

Hypertension and Obesity have a major impact on both the following systems.

• 1. Cardiovascular Diseases: When a person is over-weight or obese, the body requires pumping more effort thereby working harder to pump blood through the body. This puts more strain on the arteries and when this strain is resisted it causes the blood pressure to rise. Thus, obesity and hypertension together are one of the top reasons forcardiovascular diseases.
• 2. Kidney Dysfunction: When a person is overweight or obese and has high blood pressure, this excess pressure damages the vessels in the kidneys by thickening them thereby affecting the blood flow. This affects the kidneys main function of removing the waste and fluids.

Obesity, Hypertension and Obstructive Sleep Apnoea

Snoring is the most common sign of Obstructive Sleep Apnoea (OSA). In people who are overweight or obese snoring and eventually sleep apnoea is one of the most common co-occurring problem. In obese people the fat deposits in the chest and waist circumference or central obesity causes the lungs to get compressed thereby restricting the airflow thereby dropping the oxygen saturation. People who have chronic sleep apnoea experience sudden drop in their oxygen levels thereby increasing the blood flow and putting a pressure on the blood vessels which increases the blood pressure. This kind of a situation can be a silent killer as they could lead to serious complications like stroke or heart attack.

Is there a solution that can treat all these problems?

Bariatric Surgery can be a treatment for all these health problems all in one go. Bariatric surgery brings about a significant and long-term change in the weight and also brings about a significant drop in the blood pressure levels. As the person starts losing weight, the pressure on the heart to work hard and to pump more blood reduces, thereby reducing the strain on the arteries which in turn reduces the blood pressure. Once there is reduction in the blood pressure, the pressure on the small vessels going to the kidneys will reduce and will enhance the functioning of the kidneys.

Similarly, with the significant reduction in weight, waist circumference and reduction of fat deposits in the neck and chest region would open up the lungs that are compressed, improve the oxygen saturation and reduce the blood pressure caused due to the drop in oxygen saturation.

Thus one treatment can break the vicious cycle, improve health and quality of life.

Currently India has the third highest number of obese patients in the world after USA and China. Also, India has the second highest number of patients with diabetes after China. With this staggering growth in the number of obese as well as diabetics in the India both these health problems have become a major and ever lasting impact on the economy and health status.

Is there a correlation between Obesity and Diabetes?

It is estimated that about 60-90% patients with Type II Diabetes are also obese with a BMI more than 30kg/m2 in India. In Indians the fat percentage is much higher than the muscle mass. With more of central or visceral obesity ie, around the waist and abdomen patients with a BMI of as low as 23kg/m2 Indiansare also prone to developing diabetes. It is this high fat percentage and low muscle mass in the body that makes the person more prone to developing hyperinsulinemia thereby increasing their risk for type II Diabetes and also progressively leading to failure of the pancreatic cells. In obese patients these free fat cells around the muscles, abdomen and liver lead to a cytokine storm thereby leading to insulin-resistance and excess inflammation.

How can it be treated?

Lifelong and sustained weight loss through lifestyle modifications is the appropriate treatment for obesity and diabetes. But in patients who are overweight or obese (BMI >28kg/m2) with diabetes, the metabolism of the person is affected in such a way that following a diet and exercising and maintaining that weight becomes impossible. In such patients a treatment that will only help with the weight loss but also treat their diabetes is the most appropriate form of treatment.

So then, is there a cure?

Bariatric Surgery

Metabolic or Bariatric surgery for Type II Diabetes is now a treatment approved by the American Diabetes Association (ADA) as a scientific treatment for remission or cure of Type II Diabetes.

Who can undergo this surgery?

In Indians and Asians since the fat percentage is much higher than their western counterparts, anyone who is above a BMI of more than 28kg/m2 along with Type II Diabetes is an ideal patient to undergo bariatric and metabolic surgery. In patients with Obesity and Diabetes it is a dual burden.

How does surgery work?

Almost all patients who undergo bariatric surgery show a significant improvement in their diabetic status. The dual benefit of bariatric surgery is such that it induces weight loss thereby treating obesity but along with that there is a significant change in hormones and metabolism of the blood glucose which is independent of the weight loss.

Surgery has shown to improve diabetic status in almost 90% patients by reducing their blood sugar levels, reducing the medicine dose that they required as well as improving the health problems arising out of diabetes. In 78% of the patients there is improvement in blood sugar levels along with elimination of all anti diabetic medications.

In a study titled ‘Gastric Bypass vs. Medical/Lifestyle Care for Type 2 Diabetes in South Asians’ Dr Shashank Shah was the first surgeon to be awarded the Vivian Fonseca Award by the American Diabetes Association for surgical treatment of Type II Diabetes. In the study two group of patients, one undergoing surgical treatment and the other on medical and lifestyle management alone were compared way back in 2006 and it was found the efficacy of bariatric surgery much more as patients with uncontrolled diabetes who underwent surgery achieved total disease remission compared to the medical arm which continued to be on medicines.

India currently has the third highest number of obese people in the world after USA and China. With this significant rise in obesity there are other health problems that co-occur with it. One of the most common health problems linked to obesity is infertility. Fertility is seen to be significantly affected by a person weight and multiple studies and research have found a direct co-relation. Obesity is known to affect fertility not just in females but in males as well including affecting the sexual health as well.

In Females :

1. Excess fat deposition in the abdominal region increases the risk of insulin resistance. Egg formation in females is affected significantly by insulin resistance. Insulin also affects the sex hormones and increases male hormones and reduces the female hormones. This increase in male hormones in females also gives rise to male characteristics such as excess facial hair growth, hoarseness or change in voice and acne development.
2. Obesity can significantly increase the chances of miscarriage due to poor quality of egg and hormonal imbalance could prevent the pregnancy from sustaining.
3. Obesity can also lead to complicated pregnancies. With the increase in weight at each trimester of pregnancy the female may develop high blood pressure, gestational diabetes, the baby’s head maybe enlarged (also called macrosomia) thereby making it a high-risk pregnancy and chances of normal delivery become almost impossible.

In Males :

1. Obese males can have a significant reduction in the sperm count or no sperm formation at all when compared to normal weight adults thus affecting conception.
2. With increase in weight there is a significant reduction in the male hormones which get converted into female hormones thereby affecting the sperm formation. Males tend to develop female characteristics like change in voice, breast development (gynaecomastia), acne and indrawn or buried penis.
3. Also, due to the excess fat deposition there can be an increase in the temperature around scrotum thus affecting the sperm count, sperm concentration and the sperm’s ability to swim.

Multiple research and studies have shown that it is safer to conceive after bariatric surgery than to conceive when you are overweight or obese.

The following points were noticed regarding Obesity and Infertility after Bariatric Surgery :

1. Significant improvement in Fertility
2. Need for fertility treatment was very low
3. Normalization of hormones, decrease in excess hair growth in females (hirsutism), regularization of menstrual cycle
4. Resolution of PCOD
5. Increase in chance of healthy and normal conception
6. Improvement in sperm count
7. Improvement in sexual libido in both males and females
8. A significant reduction in maternal complications like diabetes, high blood pressure and foetal complications like macrosomia.
9. The baby is also protected from getting all these health complications

Thus Bariatric Surgery is a very important tool in not just improving fertility but also maintaining good sexual health and improving family and quality of life.

At LOC healthcare LLP Dr Shashank Shah has been performing Bariatric Surgeries for the last 17 years and he must have operated on over 1500 young girls who had healthy and normal babies post surgery.