OBECON

Obesity Treatment

What is Obesity?

Obesity is a complex, relapsing, multifactorial and neurobehavioral disease which involves an excessive amount of body fat which results in change in metabolic, biomechanical and psychology adversely and abnormally.Obesity is not just a cosmetic consideration but a medical condition that creates a risk of various chronic illnesses and health problems, including diabetes, high blood pressure, joint pains, infertility, sexual dysfunction, cardiovascular diseases, sleep apnea and certain types of cancer in a few cases. The many non-fatal but debilitating conditions that affect the obese. These are responsible for a much reduced quality of life in overweight patients

Diagnosis of obesity

BMI can be considered to provide the most useful, albeit crude, population-level measure of obesity. BMI is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in metres (kg/m2). (Check your BMI in provided calculator). An Asian individual having Body Mass Index (BMI) of 27.5+ or higher is diagnosed as Obese.

Causes of obesity

Obesity overall results from a combination of various causes and various contributing factors. It is a disease or a medical disorder considered to be the effect of genetic, metabolic and hormonal influences on body weight. Obesity is caused by a combination of inherited many factors including diet, exercise or physical activity, lifestyle and even social conditions.

Below is detailed list with description about the causes of obesity:

1. Genetic

The genes inherited from parents may affect the amount of body fat in children, and where that fat is distributed in them. Genetics may play an important role in efficiency of the body to convert food into energy, how your body would regulate appetite and how your body would burn calories during exercise. Some families tend to have a tendency of obesity. It is not necessarily because of the genes. But, the members in the family may also have common habits of eating and activity contributing to obesity.

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2. Diet

Diet is one of the major contributing factors under lifestyle as a cause of Obesity. Unhealthy diets such as a diet with calories that does not include fruits and vegetables, junk food, oversized portions of food serving and drinking liquids with high-calorie beverages such as alcohol and sugary soft drinks, all contributes to weight gain. Also, some people don’t have healthier foods since they can't cook and the sources they get the food from do not provide healthier food

3. Inactivity

Inactivity is another of the major contributing factors under lifestyle as a cause of Obesity. Watching television and looking at desktop computer or tablet and even mobile phone screens is a sedentary activity. Doing this for long hours in a day without having exercise amounts to inactivity which results into no burning of calories taken in, and subsequently contributes to weight gain. Also, many people don’t have a safe space for walking or exercise or they spend excessive time with friends and people who have obesity and remain poorly active which causes obesity .

4. Medical problems causing inactivity

Medical problems, such as Prader-Willi syndrome, Cushing syndrome and Arthritis can lead to inactivity, resulting in weight gain.

5. Medication

Medications such as diabetes medications, anti-seizure medications, antidepressants, antipsychotic medications, beta-blockers, and steroids can lead to weight gain if proper diet or activity is not done.

6. Age

Due to the aging process, hormonal changes occur in the body and then a less active lifestyle increase the risk of obesity. Muscle mass in the body tends to decrease with age, which causes decrease in metabolism and calories needs. However, if calorie intake is not reduced it results in weight gain.

7. Pregnancy

Weight gained by women during the pregnancy can lead them to obesity if not controlled after the baby is born, especially when breast-feeding is not provided to the baby.

8. Smoking

Many people intake food to cope up with smoking withdrawal leading to obesity

9. Sleep

Imbalance of sleep that is taking less or more sleep can cause changes in the hormones that increase appetite for carbohydrates, resulting in weight gain.

10. Stress.

In stressful situations people tend to have more high-calorie food causing obesity.

11. Yo-yo Dieting

Weight gain can also happen due to the phenomenon of yo-you dieting where, after any attempts to lose weight by dieting, the body starts regaining the lost wait by slowing down metabolism and tending to have more diet.

12. Microbiome

Gut bacteria Microbiome is affected by food intake and may cause weight gain or difficulty in losing weight.

How to treat Obesity?

It is best to consult with the bariatric doctor about weight management and to discuss your weight loss or obesity treatment options. Even small weight loss can improve or prevent the health problems associated with obesity. Hormones in the body play a significant role in weight management and it can be controlled through diet and exercise to a certain extent and further with the help of a bariatric doctor through medical options for treating obesity.

Treatment 25-27 27-30 30-35 35-40 40-45 50
Diet Exercise Behavior Modification
Medicine
Surgery *

Above is a chart to understand how and when to consider a treatment option which are listed below depending on the BMI Calculation:

Obesity Treatment

Intragastric Balloon in Pune and Mumbai

Intragastric Balloon

An intragastric balloon is a newer kind of weight-loss procedure. A saline-filled silicone balloon is placed in your stomach, which helps you lose weight...

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Sleeve Gastrectomy in Pune and Mumbai

Sleeve Gastrectomy

Sleeve Gastrectomy, also known as gastric sleeve surgery, restricts the amount of food you can eat by reducing the size of the stomach.

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Single Incision Sleeve Gastrectomy in Pune and Mumbai

Single Inciscion Sleeve Gastrectomy

The Single Incision Laparoscopic Sleeve (SILS) is rapidly becoming a popular laparoscopic weight loss surgery in INDIA. There are not a lot of doctors that can perform ...

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Roux-en-Y Gastric Bypass

Roux-en Y Gastric Bypass Surgery

Roux-en-Y Gastric Bypass (RYGB) pronounced “roo-en-why” is the most commonly performed weight-loss procedure.

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Banded Roux-en-Y Gastric Bypass in Pune and Mumbai

Banded Roux-en Y Gastric Bypass Surgery

Roux-en-Y Gastric Bypass (RYGB) pronounced “roo-en-why” is the most commonly performed weight-loss ...

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Mini Gastric Bypass in Pune and Mumbai

Mini Gastric Bypass

The Mini-Gastric Bypass or single anastomosis gastric bypass, is an effective and well-established procedure which combines some of ...

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Sleeve Gastrectomy Deuodeno-Ileostomy

Sleeve Gastrectomy Deuodeno-Ileostomy

Laparoscopic sleeve gastrectomy with duodeno-ilieostomy surgery is a surgical procedure in which a sleeve of stomach is ...

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Sleeve Gastrectomy Deuodeno-Jejunostomy

Sleeve Gastrectomy with Duodeno-Jejunostomy

This procedure involves creating a sleeve that is surgically removing two-thirds of the stomach portion and then also by...

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Duodenal Switch

Duodenal Switch

The Biliopancreatic Diversion with Duodenal Switch goes by many names. Some refer to it by the initials BPD-DS many call it the “Duodenal Switch” or just “The Switch.”

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FAQ'S

"Bariatric surgery is a procedure on the stomach and/or intestine to change the metabolism, reduce excess cravings, and convert the fat stores into energy. It is known to induce weight loss by hormonal mechanisms and also to reverse all obesity-related health problems. All bariatric surgeries are laparoscopic, key-hole, and almost day-care procedures. There are two types of procedures, one mainly on the stomach and the other on the stomach and intestine. A procedure only on the stomach is called a Sleeve Gastrectomy in which the curvature of the stomach is removed. The curvature secretes certain hormones that are responsible for obesity. The other type of procedure is called a Bypass where the stomach is converted into a small pouch which is then connected to the intestine so that fat is not absorbed and hormonal changes occur which reverse diabetes is induced which works on the center of hunger in the brain and induce weight loss. "

Bariatric Surgery is a life-saving surgery and not a cosmetic surgery as it generally is regarded. a gastrointestinal surgery to improve, prevent and/or treat obesity and its co-morbidities which may be life-threatening. This surgery which is done by laparoscopy does not involve the removal of fat from the body and the weight loss after surgery is gradual. Bariatric surgery is known to be the most effective and long-lasting treatment for morbid obesity and many related conditions, but now mounting evidence suggests it may be among the most effective treatments for metabolic diseases and conditions including type-2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease, and obstructive sleep apnea.

Multiple factors decide how much weight one loses after surgery. On average a patient can lose up to 80% of excess body weight but some patients can lose even up to 100% excess weight and come to their ideal weight. The general deciding factors are age, height, BMI, co-morbidities, past weight loss attempts, duration of obesity, and genetics. If someone's weight has always been higher than their ideal weight through the growing years the person may not reach an ideal weight but will lose significant weight and be free of health problems and weight loss will be appreciable.

Rarely are there any factors that can disqualify one from undergoing bariatric surgery. The fitness of the patient to undergo surgery as per the requirements of the anesthetist, physician and surgeon could be the ultimate deciding factor. Earlier psychiatric history, drug, and alcohol abuse were once considered contraindicated to surgery but today with research even those are not considered contraindications to surgery. Any person with a weight of more than an excess of 20 kgs and co-occurring health problems and failure of various weight loss attempts qualify for bariatric surgery

There are multiple types of bariatric surgeries and there are reversible surgeries as well. But to date, no patient has wished for a reversal because no patient would want the weight and co-morbidities and health problems to come back. Unless in a case of cancer in the last 50 years of bariatric surgery no patient has required reversal.

Published research does suggest that bariatric surgery reverses or improves depression. However, life after bariatric surgery is like a new journey. It needs to be supported by friends, relatives, associates, etc. Some other reasons for the impact on depression are the late decisions to opt for surgery. It feels sad to see patients above the weight of 160kg or BMI 50 kg still waiting to decide for surgery. Such people need longer time to lose weight. These people have larger skin areas due to severe and super obesity which generates a need for aesthetic correction of the skin. Lack of support for cosmetic corrections can interfere with the overall quality of life even though the patient enjoys all other benefits and feels happy. The best treatment of depression after surgery is offered through a regular follow-up, attending support group meetings, and agreeing to each additional therapy required for a better quality of life, may it be a cosmetic correction.

"Patients with T2DM hormones secreted by the stomach and intestine are altered thus insulin secreted by the pancreas becomes ineffective. Fat in the body suppresses the action of insulin causing insulin resistance. Metabolic Surgery corrects this hormonal imbalance and stimulates certain hormones like GLP1, making the pancreas work better, reducing insulin resistance; and improving insulin secretion and effect of insulin, thereby reversing T2DM. Patients with T2DM whose blood sugar is uncontrolled despite medications, prominent central obesity, high blood pressure, cholesterol, and snoring, causing damage like neuropathy (nerves), nephropathy (kidneys), retinopathy (eyes), sexual dysfunction, or heart disease. If these patients have a certain percentage of excess fat, such patients can undergo Metabolic Surgery. According to the guidelines of the American Diabetes Association, if these patients have a Body Mass Index >= 30, uncontrolled diabetes despite medications, Metabolic Surgery is beneficial for normalizing blood sugar levels. "

There are no simple steps for losing weight. Obesity is a disease and needs a scientific approach. Based on individual metabolism, and grade, and severity of obesity, the treatment plan can be defined. Bariatric centers of excellence which offer all modalities of treatment with different specialists can offer the necessary treatment options.

Obese people with severe obesity or with obesity-associated conditions like joint pains, breathlessness, infertility, diabetes, heart disease, kidney disease, respiratory discomfort, etc are the ones who are advised bariatric surgery. Those Asians or Indians with a Body Mass Index of more than 32.5 are defined as ones with morbid obesity. The most commonly offered procedures in India are sleeve gastrectomy or gastric bypass. These procedures induce up to 80 percent excess weight loss. These procedures get the patient to a healthier BMI and rarely to a skinny stage. Only with certain strong malabsorption procedures or with certain complications, the person can lose excess weight to be thin. These persons should seek advice from an experienced bariatric surgeon known for revision of bariatric procedures.

The diseases a person gets from obesity are many. To name the top 5 are diabetes, severe joint pains limiting movement, sexual dysfunction, breathlessness, and PCOS in young girls. These 5 are found to be the main triggers why these opt for bariatric surgery when every other treatment has failed.

Diet has an important role in weight management. However, only dietary intervention may not be sufficient. Body induces physiological changes after diet-induced weight loss and thereby gives rise to an increase in hunger hormone and slowing of metabolism, resulting in weight regain or relapse. Bariatric surgery is known to improve metabolism and reverse the physiological changes to near normal. Certain newer medications are also effective but their effect remains moderate.

Obesity is a progressive disease and the comorbidities and risk to the longevity of life increase with each BMI increase. Timely intervention and severity-based choice of treatment can avoid the damages caused by obesity. The new Canadian Guidelines for obesity treatment are purely based on how severely is the person affected due to obesity and are not just based on the actual weight or BMI. It is a general perception to choose the treatment based on the visual scale of obesity and the guidelines point out this mistake. The aggressiveness or choice of medical or surgical weight loss treatments should be based on the impact of obesity on overall health and wellness. This is clearly described in the most popular Edmonton Obesity Score.

Apart from medical conditions, obese people face several health challenges like difficulty walking or performing daily activities. Maintaining Hygiene becomes a challenge, Psychological challenges like impact on confidence, self-esteem, social avoidance, anger, irritation can be some. These people find it difficult to maintain relationships and have a significant impact on a sexual relationship, affecting marital relationships. Such health problems can be just a few to list apart from health problems

BMI is reliable for those with severe or morbid obesity. However, there are some with lesser weight and BMI but a higher fat percentage. These are best evaluated by a DXA scan to know the body composition, bone, and muscle mass as well as regional fat mass. Such people may develop type 2 diabetes and have to be treated based on fat mass and not BMI. Another fallacy of BMI is seen when the muscle mass is very high as seen in bodybuilders. Generally, females are known to have higher fat mass as compared to males even at the same BMI.

Low-calorie diets or very-low-calorie diets or ready-made meal replacements can be ideal to initiate weight loss. These need to be started under medical supervision. These can be only the options of initial boost and are not wonder solutions for weight loss over a longer duration

Most often Type II diabetes becomes uncontrolled and remains so due to various hormonal actions and also because it is very difficult to control and follow a thorough diabetic diet for a lifetime. However, despite giving all medications and multiple attempts, there are patients whose blood sugar levels remain uncontrolled and very high, ultimately giving rise to various diabetes-related complications like non-healing wounds, kidney diseases, impact on the eyes, sexual dysfunction, etc. If medicines do not work for such patients then metabolic surgery is an option for Type II Diabetes, which is an evidence-based option published in various research papers and articles over the last decade. Any patient with Type II diabetes whose blood sugar levels are uncontrolled despite medications, who have prominent central obesity or fat in the belly, diseases like high blood pressure, cholesterol, and snoring along with damage to various organs like neuropathy (nerve damage), nephropathy (kidney damage), retinopathy (damage to the eyes), sexual dysfunction (defect in an erection) or heart disease. If these patients have a certain percentage of excess fat in their bodies, then such patients can undergo metabolic surgery. According to the guidelines of the American Diabetes Association if these patients have a BMI of more than 30 and if diabetes remains uncontrolled despite medications they can benefit from metabolic surgery for normalizing their blood sugar levels.

Obesity is a unique disease that can practically affect any system in the body. The effects of obesity can be varied based on the weight-related effects or hormonal effects. The weight-related effects are obvious like wear and tear of knee joints or the spine. Excess weight on the joints as well as the change in posture or center of gravity makes the joints weak and painful. Excess weight in the body also increases the load on the lungs and may induce breathlessness which can slowly give rise to sleep apnoea or disturbed sleep and snoring.

The hormonal effects of obesity are on different systems and can induce chronic diseases like diabetes, high blood pressure, and cholesterol and even may lead to affection of kidneys and / or heart.

Fat is also known as the largest endocrine organ in the body. Fat can convert the female hormone to male hormone in a female which is seen as excess hair growth (hirsutism) or infertility in a female. In males, hormones from the fat can reduce the testosterone levels and the person would have related symptoms like the development of male breasts, indrawing of sexual organs, reduced sexual libido, or even reduced sperm count or quality. Hence it is said that treating obesity is equivalent to preventing many diseases.

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