Obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat and/or body water. Both terms mean that a person’s weight is greater than what’s considered healthy for his or her height.
Obesity occurs over time when you eat more calories than you use. The balance between calories-in and calories-out differs for each person. Factors that might tip the balance include your genetic makeup, overeating, eating high-fat foods and not being physically active.
Obesity is an increasingly important health problem worldwide including the developing countries. In India, obesity is emerging as an important health problem particularly in urban areas, paradoxically co-existing with under nutrition. Almost 30-65% of adult urban Indians is either overweight or obese or has abdominal obesity. The rising prevalence overweight and obesity in India has a direct correlation with the increasing prevalence of obesity-related co-morbidities; hypertension, sleep apnoea, the metabolic syndrome, dyslipidemia, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD).
Being obese increases your risk of diabetes, heart disease, stroke, arthritis and some cancers. If you are obese, losing even 5 to 10 percent of your weight can delay or prevent some of these diseases.
Three simple measures of obesity are widely used in clinical practice; BMI (body mass index), WC (waist circumference) and waist-to-hip circumference ratio (WHR). The most widely used method to define thinness and fatness is BMI, a ratio of weight in kilograms divided by height in meters squared (kg/m2) it has been correlated to morbidity and mortality risk in various populations. Abdominal obesity is defined by easy-to-use parameters; WC and WHR. Though BMI, WC or WHR correlate well with each other, it is also believed that combined use of these parameters of generalized and abdominal obesity may be better in identifying people at risk of CVD and obesity-associated diseases than either of them alone.
Use the BMI calculator or tables to estimate your total body fat. The BMI score means the following:
|Internationa BMI Kg/m2||Indian BMI Kg/m2|
|Underweight||Below 18.5||Below 18.0|
|Normal||18.5 – 24.9||18.0-22.9|
|Overweight||25.0 – 29.9||23.0-24.9|
|Obesity||30.0 and Above||25 and Above|
If you’re very overweight and can’t lose weight with a healthy diet, exercise and medicines, surgery might be an option for you.
For people who are considered obese or those who are overweight and have two or more risk factors, the guidelines recommend weight loss. Even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing diseases associated with obesity. Patients, who are overweight, do not have a high waist measurement, and have less than 2 risk factors may need to prevent further weight gain rather than lose weight.
The Normal Digestive Process
Normally, as food moves along the digestive tract, digestive juices and enzymes digest and absorb calories and nutrients. After we chew and swallow our food, it moves down the esophagus to the stomach, where a strong acid continues the digestive process. The stomach can hold about 1L of food at one time. When the stomach contents move to the duodenum, the first segment of the small intestine, bile and pancreatic juice speed up digestion. Most of the iron and calcium in the food we eat is absorbed in the duodenum. The jejunum and ileum, the remaining two segments of the nearly 20 feet of small intestine, complete the absorption of almost all calories and nutrients. The food particles that cannot be digested in the small intestine are stored in the large intestine until eliminated.
Surgical Treatment of Obesity
Bariatric surgery has evolved over the last half century as a treatment option for patients suffering from morbid obesity. It involves modification of the digestive system by either decreasing the gastric volume (restriction) or altering the path of the food bolus causing an element of malabsorption. These alterations effect appropriate changes in eating behaviour and aid lifestyle modifications to help weight loss.
Current International Guidelines for Surgical Treatment of Obesity: BMI above 35 kg/m2 with co-morbidity, or BMI above 40 kg/m2 without co morbidity.
Guidelines for Surgical Treatment of Obesity for Asian Indians: BMI above 32.5kg/m2 with co-morbidity, and BMI above 37.5 kg/m2 without co-morbidity.
The Surgical Options for Weight Loss Surgery:
Restrictive Procedures: Adjustable gastric banding (LAGB) & sleeve gastrectomy,
Combined Procedures: Roux-en-Y Gastric Bypass (RYGBP),
Malabsorptive Procedures: Bilio-pancreatic diversions (BPD),
Experimental Procedures: ileal interposition and duodeno-jejunal bypass, various implantable pulse generators.
Each surgical procedure has its advantages and disadvantages as regards weight loss, resolution of surgical co-morbidities, peri-operative morbidity and mortality and long-term sequel. To select the option that is best for you, you and your surgeon will consider that operation’s benefits and risks along with many other factors, including BMI, eating behaviors, obesity-related health conditions, and previous operations.
Mechanism of Weight Loss and Control of Metabolic Diseases
Weight loss is caused by decreased intake of food as a result of reduced stomach capacity and decreased hunger. Additional benefit is there in terms of better control of chronic diseases like Diabetes, Hypertension, Snoring, sleep apnea etc.
Adjustable Gastric Band
AGB works primarily by decreasing food intake. Food intake is limited by placing a small bracelet-like band around the top of the stomach to produce a small pouch about the size of a thumb. Problems of feeling of food getting stuck, band going through stomach wall, need to remove band, weight gain despite the band inside. Gradually this procedure is going into disrepute.
Vertical Sleeve Gastrectomy
VSG historically had been performed only as the first stage of BPD-DS (see above) in patients who may be at high risk for complications from more extensive types of surgery. These patients’ high risk levels are due to body weight or medical conditions. However, more recent information indicates that some patients who undergo a VSG can actually lose significant weight with VSG alone and avoid a second procedure. It is not yet known how many patients who undergo VSG alone will need a second stage procedure. A VSG operation restricts food intake and does not lead to decreased absorption of food. However, most of the stomach is removed, which may decrease production of a hormone called ghrelin. A decreased amount of ghrelin may reduce hunger more than other purely restrictive operations, such as gastric band. This procedure is better than Banding and Bypass surgery because it has more sustained weight loss and minimum complication
Other Complex Obesity Surgery Procedures are:
Roux-en-Y Gastric Bypass
RYGB works by restricting food intake and by decreasing the absorption of food. Food intake is limited by a small pouch that is similar in size to the adjustable gastric band. In addition, absorption of food in the digestive tract is reduced by excluding most of the stomach, duodenum, and upper intestine from contact with food by routing food directly from the pouch into the small intestine.
Biliopancreatic Diversion With a Duodenal Switch
BPD-DS, usually referred to as a “duodenal switch,” is a complex bariatric operation that principally includes 1) removing a large portion of the stomach to promote smaller meal sizes, 2) re-routing of food away from much of the small intestine to partially prevent absorption of food, and 3) re-routing of bile and other digestive juices which impair digestion.
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