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.

Homemade Vegetable Soup Recipe

Soup is one of the easiest and wholesome thick liquid option to those who want to lose weight.Soups can be a good hydration option as it helps to increase your liquid intake throughout the day. It gives you satiety due to the fibres from vegetables / lentils / pulses / etc.

It is a healthier option of one pot meal which includes all essential components like Protein+fiber+antioxidants +vitamins+ minerals.

It Enhances Nutritious value of your meal while maintaining your portion size and calorie count.

It is one of the tasty forms of protein, fibre and low calorie option.

Which soup you should not take if you are aiming for healthy weight loss?

Thinking to lose weight initiates us to focus on every food choice we make nutritiously.

In case of soups, not all soups are the same. In today’s busy lifestyle, one who wishes to lose weight through healthy diet options are prone to select the easiest preparing ready to make food choices.

Packed/canned soups or few soups at the restaurants are loaded with hidden fat and sugar sources in the form of preservatives. The ingredients used are not of fresh quality, leaving the major content of the soup to be starchy, sugar and sodium.

The vegetable content of any instant soup is almost negligible besides containing depleted nutrients.

Just having soup for being healthy is not correct. One has to understand contents, which are not ideal for weight loss and prepare/consume soup accordingly and then only it can be considered healthy.

Checking food labels for the for better food choices in important.

Making soup at home without preservatives and low fat ingredients will help to enhance the value of it. Using
substitutes like fat-free or low-fat milk instead of heavy cream, almond milk, soya milk, blanched vegetable
over canned ones. You can use chicken broth to thicken the soup with pureed vegetables, lentils, beans or
tofu. Simple ingredients like ginger, garlic, cloves and herbs, nutmeg, spices enhances the natural flavours and
promote better absorption of nutrients. Sometimes vegetable soup simply isn’t an option for some people. For
improving the thickness and increasing the satiety level one can add fibre to soups in the form of simple
changes like of oats flour instead of corn flour, soybean flour, unsweetened SMP, etc. Instead of munching on
unhealthy snacks, switching to broth based soups will give you sense of fullness or better satiety.

Avoid using the following ingredients while preparing soups :

• Sugar, Sausages, sodium in high amount
• cornbread, cheese, croutons
• Heavy Cream
• Corn flour / refined flour
• White Rice.
• Cheese sauce / mayonnaise.
• Coconut milk.
• Canned Veggies / Hummus.
• Monosodium glutamate ( MSG ) i.e. Aginomoto.

It’s not just soup, but it’s the complete diet and lifestyle changes that help you lose weight. Tailor-made
diets by the experts are necessary for better results and weight loss.