Obesity, commonly considered a cosmetic problem, has become one of the major public health problems in our country today — more than one third of Indians are overweight and roughly 1.15 billion people in developing countries have severe obesity (defined as being 35 kg or more overweight). Obesity has surpassed many diseases including Diabetes and Heart conditions and resulted in major cause of premature death and many other medical conditions, including cardiovascular conditions, hypertension, sleep apnea, degenerative joint diseases and many more.
WHAT IS SEVERE OBESITY?
Severe obesity, known also as “morbid obesity”, is defined as being approximately 35 kgor more above the ideal body weight. This condition is associated with the developmentof life‐threatening complications such as hypertension, diabetes and coronary arterydisease, to name a few.Numerous treatment approaches to this problem have been advocated, including lowcalorie diets, medication, behavioral modification and exercise therapy. However, theonly treatment proven to be effective in long‐term management of morbid obesity issurgical intervention.
WHAT CAUSES SEVERE OBESITY?
The cause of severe obesity is incompletely understood. There are probably many factors involved. In obese persons, the set point of stored energy is too high. This altered set point results in from a low metabolism with low energy expenditure,excessive caloric intake, or a combination of the above. Severe obesity is not a case of simple lack of self‐control by the patient.
WHAT ARE THE TREATMENT OPTIONS?
In 2004 the American Society for Bariatric Surgery, now the American Society for Metabolic and Bariatric Surgery (ASMBS), published a consensus statement that surgical treatment is the long lasting option of Morbid Obesity. However, all patients should know the other options available for moderate weight loss.
Regulating dietary intake is one of the most important components in the treatment of obesity. Caloric restriction can be achieved by low calorie diets and very low calorie diets. Low calorie diets restrict daily caloric intake by 500 to 1000 kcal per day, with a goal of inducing a 1‐ to 2‐lb weight reduction per week. Very low calorie diets provide 200 to 800 kcal per day and are used often when there is a need to achieve more rapid weight loss, although results do not differ significantly at 1 year. Success ultimately relies on reducing energy intake, despite considerable controversy regarding the optimum macronutrient composition (eg, low fat versus low carbohydrate) in a diet.
Behavior therapy aims to modify behavior with regard to energy consumption. Often, it is integral to a comprehensive weight loss program, involving self‐monitoring, stimulus control, cognitive behavior modification, goal setting, self‐esteem, assertiveness training, relaxation exercises, nutrition, stress management, and social support, among others.
Physical activity or exercise is important in the treatment of obesity and is a valuable tool in any weight‐reduction program. Exercise alone, however, produces only small weight losses, with its greatest role apparent in long‐term weight loss maintenance.
Medically managed weight loss
Medically managed weight‐loss programs provide treatment in a clinical setting with alicensed healthcare professional, such as a medical doctor, nurse, registered dietitianand/or psychologist. These programs typically offer services such as prescription ofweight‐loss medications, nutrition education, physical activity instruction and behavioraltherapy. Although medications are available to induce weight loss, there does notappear to be a role for long‐term medical therapy in the management of morbidobesity. Medications that reduce appetite can result in 5‐10 kg. weight reduction.However, weight gain is rapid once medication is withdrawn.
Surgery for weight loss
Laparoscopic Sleeve gastrectomy (LSG) is gradually becoming the new gold standard for Bariatric surgery. It is the restrictive part of the more extensive mixed restrictive and malabsorptive operation, gastric bypass and duodenal switch (GB/DS). It generates weight loss by restricting the amount of food that can be eaten without any bypass of the intestines or malabsorption. With this procedure, the surgeon removes approximately 85 percent of the stomach laparoscopically so that the stomach takes the shape of a tube or "sleeve."
Other options are Gastric Bypass, Gastric Plication, Intra Gastric Balloon treatment.