Diet and exercise may not be enough to get rid of Obesity
Obesity and overweight has been defined as a chronic disease of excessive fat deposit in the body. WHO (world health organization) listed obesity as a disease in 1979. Obesity especially morbid obesity is increasing worldwide and it is becoming significant health hazard. Prevalence of obesity has reached epidemic proportion in India-gender wise; it has gone up to 50% in women and 32.2% in men.
Causes of Obesity
Obesity is a complex disease .It is interplay of Genetics, Environmental and Psychology factors which predispose the individual for obesity. It starts in childhood and progresses through adolescence to adulthood. Lack of physical activities, luxurious lifestyle and remote operated gadgets play major role in the incidence of obesity. Psychological disorders like depression, eating disorders and body image disturbance are another set of factors which encourages obesity. Moreover Environmental factors are responsible for 85% of obesity. Obesity is best measured by body mass index (BMI) .i.e. weight in kg divided by height in meter sq. BMI = body weight (KG)/height (meter sq).
In Asian population visceral (abdominal) obesity is more than that of hips and limbs. In male, if the waist circumference is more than 90cm and in female, it is more than 88cm, they are at risk of obesity.
According to BMI Indian population has been classified as:-
|Normal||18.5 – 23|
|Overweight||23 – 25|
|Class 1||23 -25|
Obesity is a multi system disease. It is associated with Hypertension, diabetes, cardiac disease, hyper lipidemia, joint disease, Non- alcoholic cirrhosis of liver, infertility and types of cancer are the prominent ones besides innumerable minor complications.
Few Social problems of obesity are difficulty in movement, limited options in clothing and difficulty in personnel hygiene. Studies have shown that 10 kg extra weight gain, reduces the life expectancy by about 3 years. In morbidly obese person life expectancy is reduced by 9 years for female and 12 years for male.
Management of obesity
In fact it should be started in childhood by health education, lifestyle modification, good dietary habit and adequate physical activities. If these measures fail then some medicines can be tried under medical supervision of physicians and endocrinologist. This treatment option invariably fails to achieve long term weight loss impact. In fact they regain lost weight in short period of time and this is called YO-YO dieting effect.
In last 10 to 15 years surgical management of obesity has been established as only long term sustainable treatment and is known as bariatric surgery or metabolic surgery. With the advancement in laparoscopy, bariatric surgery has gained popularity. In this method of surgery, there is less blood loss, less post operative pain and speedy recovery. Bariatric surgery should be considered for individuals who have BMI of 40 kg/ meter sq or more and who have BMI of 35 kg /m sq with co- morbidity like diabetes and hyper tension. There are 3 types of procedures in bariatric surgery:-
- Restrictive type: Gastric banding- where patient can’t eat more and feel satisfied but it doesn’t give long term weight loss as, it is losing popularity.
- Combined, restrictive and malabsorptive procedure: called Roux en Y gastric bypass (RYGB) where small stomach pouch is made and long segment of small intestine is bypassed. Added advantage of this procedure is, it controls diabetes completely or decreases the requirement of insulin. This is a gold standard of treatment for morbid obesity.
- Malabsorptive procedure: this extreme one is for revision surgery called Biliopancrieatic diversion or with duodenal switch.
Recently two new procedures have gained popularity that is sleeve gastrectomy and mini gastric bypass. These procedures are less complicated and more effective in controlling obesity. Definitely these procedures are little expensive and not without risks but if you compare with the advantage, they will outweigh the expense and risk factor involved
We at Sarvodaya hospital are providing all surgical and non surgical treatment of obesity with dedicated team of bariatric surgeon, physician and dietician.
Dr. Prem Kumar
Laparoscopic & Bariatric surgeon
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