What is Obesity?

The Asian people including Indians must be extra careful about their weight because they are more prone to diseases like diabetes, high blood pressure and high cholesterol at a lower BMI than their western counterparts. Obesity, defined as a body mass index or BMI above 27.5(or 30 globally), is a leading preventable cause of death worldwide, with increasing prevalence in adults and children, it is viewed as one of the most serious public health problems of the 21st century. Obesity is stigmatized in much of the modern world , though it was widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts of the world.  In 2013, the American Medical Association classified obesity as a disease. More than 30 co-morbid conditions are associated with morbid obesity, the most serious of which are hypertension, diabetes, heart disease, stroke, obstructive sleep apnea, degenerative joint disease, depression and low self esteem. Obesity shortens life expectancy , with increasing body mass index (BMI) resulting in proportionally shorter lifespan .

The main treatment for obesity consists of calorie restriction and physical exercise. Diet programs may produce weight loss over the short term, but maintaining this weight loss is frequently difficult and often requires making exercise and a lower food energy diet a permanent part of a person's lifestyle. Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2–20% . Surgery is now accepted as the best and most effective treatment for morbid obesity. .

Am I a Candidate for surgery?

Eligible patients often have a BMI ( weight in kgs/height in meters2) of 37.5 or more. Surgery is also an option for those with a BMI of 32 or greater who suffers from progressive life threatening obesity related health problems.

What are the various surgical options and how will I know which one is best for me?

Bariatric or Weight-loss surgery should not be confused with cosmetic surgery. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery). It mainly acts by causing decreasing food absorption, restriction of food intake, or a combination of the two. Bariatric surgery is not only successful for weight loss, but also for preventing, improving or resolving type 2 diabetes, hypertension and other co morbidities like sleep apnoea, acid reflux, joint pain along with improved mobility, improved mood and self esteem. Your surgeon will determine what best suits you after your initial assessment.

What are the routine tests before surgery?

Certain basic tests are done prior to surgery: a complete blood count (CBC), urinalysis, a chemistry panel, ECG, Chest X ray and Ultrasound. Other tests, such as pulmonary function testing, echocardiogram, GI evaluation, cardiology evaluation or psychiatric evaluation, may be requested when indicated.

How long do I have to stay in the hospital?

This depends on patient factors and type of surgery performed which usually requires 5-6 small holes in your tummy. The laparoscopic adjustable gastric band is done on an outpatient basis with a possible overnight stay. Usually there is 2-3 days of stay for sleeve gastrectomy and 3-5 days of stay for a laparoscopic gastric bypass.

How long will I be off of solid foods after surgery?

We recommend a period of four weeks or more without solid foods after surgery. A liquid diet, followed by semi-solid foods or pureed foods, may be recommended for a period of time until adequate healing has occurred. Your surgeon will provide you with specific dietary guidelines for the best post-surgical outcome.

How soon will I be able to walk?

Once the effect of anaesthesia wears off, doctor will require you to get up and move about. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks the next day and thereafter. On leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.

Can weight loss surgery prolong my life?

There is good evidence that if you have Type 2 diabetes (or other serious obesity-related health conditions), are at least 100 pounds over ideal body weight, and are able to comply with lifestyle changes (daily exercise and low-fat diet), then weight loss surgery may significantly prolong your life.

Can I get pregnant after weight loss surgery?

It is strongly recommended that women wait at least one year after the surgery before a pregnancy. Approximately 12-18 months post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus.

Are there any risks involved?

Weight loss surgery like any other surgery has certain risks like infection/leak, development of blood clots and vitamin deficiency etc which can prolong hospital stay.

Weight loss surgery requires personal responsibility, life style changes, long term follow up and nutritional supplements. If you would like to learn more about weight loss surgery and what it could mean for you, a member of your family, or a friend, please discuss the options further with us at Weight Loss Clinic, MAX HEALTHCARE Gurgaon.

Dr Anshuman Kaushal, Senior Consultant, Laparoscopic G I and Weight Loss Surgeon
MS, Fellow National Board of Examination (MAMC, New Delhi)
Fellow of International College of Laparoscopic Surgeons, FMAS, FIAGES