कोरोना हा सहव्याधी रुग्णांसाठी जसा जीवघेणा आहे, तसाच तो स्थूल लोकांसाठीसुद्धा धोकादायक आहे. लठ्ठपणा या आजाराचे शिकार असलेल्या लोकांना कोविडमुळे श्वसनात अनेक अडचणी येतात आणि त्यामुळे त्यांच्या जीवाला धोका निर्माण होतो. त्यामुळे आता स्थूलपणाला कात्री लावण्यासाठी लोकं बॅरिएट्रीक सर्जरीकडे वळत आहेत.

स्थूलव्यक्ती मरता-मरता बचावले

वाढत्या स्थूलतेकडे दुर्लक्ष करणार्‍या माणसांनी आता अंगावर वाढलेली अतिरिक्त चरबी घटवण्याकडे कटाक्षाने लक्ष देण्यास सुरुवात केलीय. कोव्हिडची बाधा झाल्यानंतर थोडक्यात बचावलेले रुग्ण आता कटाक्षाने वजन नियंत्रित राखण्यात तसेच बॅरिएट्रीक शस्त्रक्रिया करण्याकडे लक्ष देत आहेत. यापैकी बॅरिएट्रीक शस्त्रक्रिया करणा-या रुग्णांचे प्रमाण लक्षणीय असल्याचे मत लीलावती रुग्णालयाचे बॅरिएट्रीक सर्जन डॉक्टर शशांक शाह यांनी व्यक्त केले. या शस्त्रक्रियांना आता इन्शुअरन्सचाही आधार मिळू लागल्याने रुग्णांचा आर्थिक भारही हलका झाला आहे. त्यामुळे या शस्त्रक्रिया वाढू लागल्या आहेत. चुकीच्या जीवनशैलीमुळे आता सर्व वयोमानात स्थूलता दिसून येत आहे. मुळात स्थूलता हा आजार असल्याबाबत आजही जनसामान्यांमध्ये संमिश्र प्रतिक्रिया आहेत. ज्या रुग्णांनी औषधोपचार घेतले त्यांनाही कित्येकदा पुन्हा स्थूलतेचा सामना करावा लागला. परंतु कोव्हिडकाळात हे रुग्ण मरता -मरता बचावले, असेही डॉक्टर शाह म्हणाले.

डॉ. शहांनी सांगितला अनुभव

स्थूल रुग्णांना उपचारांना प्रतिसाद देताना असंख्य अडचणी निर्माण झाल्या. परिणामी, मृत्यू पावलेल्या रुग्णांमध्ये स्थूलतेचे प्रमाण जास्त असल्याचा निष्कर्ष डॉक्टरांनी मांडला. याबाबतचा अनुभव मांडताना बॅरीएट्रीक सर्जन डॉक्टर शशांक शाह यांनी सख्या दोन भावांचे उदाहरण देखील दिले.यापैकी ज्या भावाने वजन नियंत्रित न राहिल्याने बॅरिएट्रीक शस्रक्रियेकडे कानाडोळा केला,त्याला कोविड झाल्यानंतर कित्येक दिवस अतिदक्षता विभागात उपचार घ्यावे लागले. मरणातून वाचल्यानंतर त्याने दीड महिन्यानंतर त्वरित बॅरिएट्रीक शस्रक्रिया केली, अशी माहिती शाह यांनी दिली. मात्र ज्या भावाने कोविडची बाधा होण्याअगोदरच बॅरिएट्रीक शस्रक्रिया केलेली त्याच्या उपचारांत अडचणी आल्या नाहीत, तो या जीवघेण्या आजारातून सुखरुप बाहेर आला, असं शाह पुढे म्हणाले.

बॅरिएट्रिक शस्त्रक्रियेविषयी

• बॅरिएट्रिक शस्त्रक्रियांना चयापचय शस्त्रक्रिया म्हणून देखील ओळखले जाते, कारण ते मूळ कारणांवर कार्य करतात आणि चयापचय गतिमान करतात. हे बदललेल्या आतड्यांसंबंधी मार्गाद्वारे आणि आतड्यांच्या वेगवेगळ्या भागांना उत्तेजन देऊन होते. या उत्तेजनामुळे हार्मोन्सचा स्राव होतो ज्यामुळे भूक कमी होते, तृप्तता सुधारते आणि वजन कमी होते.
• या प्रक्रिया मधुमेह, रक्तदाब, सांधेदुखी, स्लीप एपनिया इत्यादी स्थूलपणाशी संबंधित सर्व आजारांना उलट करण्यासाठी ओळखल्या जातात आणि कॉमोरबिडीटी कमी करून आयुष्य वाढवण्यासाठी ओळखल्या जातात.

स्थूलतेच्या शस्त्रक्रियेसाठी कसा मिळतो इन्शुअरन्स

• हृदय विकार, मधुमेह आणि झोपेची समस्या असलेल्या रुग्णांना स्थूलतेचा आजार असल्यास इन्शुअरन्स कंपन्यांकडून बॅरिएट्रीक शस्त्रक्रियेसाठी आर्थिक उपाययोजना केल्या जातात.
• खासगी रुग्णालयात बॅरिएट्रीक शस्त्रक्रियांचा खर्च हा २ ते ५ लाखांपर्यंत जातो. तर सरकारी रुग्णालयांत या शस्त्रक्रियेसाठी मोठी किंमत मोजावी लागत नाही.

Obesity and diets are thought to be interlinked. Different types of diets exist, each one claiming benefits over the other, often confusing the reader about which is the best diet for him or for her. We attempt to offer a comprehensive summary about how you can choose the best diet for yourself. Diets have a better role in prevention of obesity as well as maintenance of weight loss, however dietary therapy alone for weight loss has not offered the best results for long term “weight loss maintenance”.
Rachel Freire has published a great summary in his review article published in ‘Nutrition’ Journal which included a study of different types of diets like intermittent fasting, keto diet, calorie restricted diet, Very low calorie diet, low carbohydrate diet (most commonly adopted diets) , and concluded as follows:

1. The creation of new diets will continue to follow popular trends. However, the belief that these diets promote weight loss has emerged more from personal impressions and reports published in books, rather than from rigorously controlled research.
2. Over several decades, efforts have been concentrated on clinical trials to determine the best diet for the treatment of obesity. Unfortunately, the evidence remains inconclusive and contested, and the trials present important limitations.
3. In the “short term” diet promote different degrees of success, but in the “long term”, the small difference does not instill confidence for prescribing one diet over another.https://pubmed.ncbi.nlm.nih.gov/31525701/

Despite the above conclusion, people do experience different types of response or success in losing weight.However, the response remains unpredictable and grossly variable among people .This clearly suggests that there are some factors in the human body which modulate or govern the response to a therapy .These could be the genetic tendency, epigenetic expression ,intestinal bacteria/gut microbiota ,environmental and socio economic factors ,sleep cycle , stress, associated medical conditions , nutritional status ,etc., which have an impact on the body’s tendency to store a certain percentage of fat also known as ‘the set point of obesity’ in that individual. Eventually, the hormonal response generated in the body by all the factors mentioned above may induce an imbalance in the metabolism resulting in the disease of obesity in an individual. Hence the treatment of the disease of obesity should be based on evidence based scientific protocol just like the treatment of any other chronic disease e.g., Hypertension, cancers, etc.

Unfortunately, patients with obesity are blamed for unhealthy eating habits and /or lifestyle. This is more commonly seen as a bias especially when viewed by a normal weight or a lean individual or clinician or any therapist. This is simply because of a tendency to compare one’s own habits and response and an attempt to apply the same to others. I would like to state here that many scientific organizations in the world like AMA,American Medical Association, OSSI,Obesity Surgery Society of India declared “Obesity as a disease’’and‘not just a lifestyle disorder’.Even bariatric surgery started being called metabolic surgery after better understanding of the altered metabolism in people with obesity. Bariatric surgery got included in the insurance cover, which clearly explains that obesity is accepted as a disease.

I would like to discuss some important and common myths about Obesity.

Myth 1 : OBESITY IS CAUSED ONLY BECAUSE OF WRONG DIETS
We often see people who eat freely and still maintain their weight and also those who try to eat less but still remain in the category of overweight or obesity. Some are thought to be blessed with a metabolism to remain thin or normal weight ever.At the same time those who are not blessed with such metabolism are blamed. Prof. Lee Kaplan et al published the explanation for this after a multigenerational multicentered study known as “MARS”. I strongly recommend all those who feel that” those who cannot lose weight do not have willpower “to read the Myth published in “MARS”. https://jnjinstitute.com/en-

The study clearly states a myth which even doctors and clinicians find difficult to believe. The MARS study clearly concluded that “weight cannot be reliably controlled by voluntarily adjusting energy balance through diet and exercise “. The converse is also true for very lean and thin who try to gain weight by increasing calories and still don’t succeed .

Myth 2 : ANY GRADE OF OBESITY CAN BE TREATED WITH DIET INTERVENTION AND EXERCISE.

As mentioned earlier, obesity is a disease and needs to be treated like all other diseases. Treatment of any disease is based on grade, severity, and stage of the disease. Forexample, the treatment for cancer varies depending on the type and grade of disease and it is well known that the best results are seen only in those who are diagnosed early and treated in time as per the best available evidence-based therapy of that cancer. Needless to say that the same thing holds true for the treatment of obesity at various stages.

Evidence based/BMI (Body Mass Index) based algorithm for obesity.
Note : Even though BMI has its limitations , the algorithm can be generally applicable to all , with some exceptions.

The algorithm shows that diet and exercise are present in all the approaches for the treatment of obesity but this algorithm also indicates that diet and lifestyle change cannot be a single line of treatment when you cross a certain grade of obesity and it should always be accompanied by other complimentary therapies.

In conclusion, diet for weight loss can be adopted a jumpstart. Caution is required for each diet and hence it should be the diet supervised by a qualified nutritionist. Maintenance of weight loss may require supervision from qualified obesity experts. Failure of therapy should not be considered as failure on part of the patient. Start a dietary change which has “no expiry date”.

Diets most often fail to work in patients with morbid obesity. Metabolic and bariatric surgery is the only proven long-term treatment for morbid obesity till further research would invent medications which can mimic the metabolic and hormonal change after bariatric surgery.

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.