Article
on Obesity and obesity surgery
Dr Girish Bapat working as a bariatric
(obesity) surgeon at Jehangir Hospital. Dr Bapat has been working in England
for last 15 years brings with him vast experience in leading weight loss
programme and performing morbid obesity operations. Dr Bapat has presented his
research articles in various international meetings. He highlights the danger
of ever increasing problem of obesity and related illnesses such as diabetes,
high BP, cholesterol, infertility, early onset of arthritis etc. He recommends
various treatment options including surgery to deal with this problem. With his
background in England, Dr Bapat has started a weight loss surgery programme
with ‘multi- disciplinary team approach’ at Jehangir hospital, Pune.
What is obesity:
Obesity is a
medical condition
in which excess body fat has accumulated to the extent that
it may have an adverse effect on health, leading to reduced life expectancy and/or increased health
problems.
Why
obesity happens:
Here
is the simple explanation, your body needs energy to function and your energy
source is the food that you eat. A normal weight person successfully balances their
energy intake (food eaten) with their energy requirements (daily activity). In
other words, they burn up all the energy provided by the food they eat, and
stay slim. However, you began to get fatter when you started to eat more food
than you needed for your energy requirements. Over a long period of time the
excess has been stored as fat around your body. In theory, just 100 calories
eaten more than you need each day would lead to a weight gain of 5 kgs per
year. Do that for 10 years and you could gain over 45kgs!
Obesity is most commonly caused by a
combination of excessive food energy
intake, lack of physical activity, and genetic
susceptibility, although a few cases are caused primarily by genes,
endocrine disorders, medications or psychiatric illness.
Eating too many calories for our energy needs is a major candidate for the main
cause of the modern obesity epidemic. Overconsumption of trans-fats and refined
white flour carbohydrates, combined with low fiber intake also plays an
important role in the rise of obesity.
Obesity is defined by body mass index (BMI) and further evaluated
in terms of fat distribution via the waist–hip ratio and total cardiovascular
risk factors. BMI is closely related to both percentage body fat
and total body fat.
Incidence
of obesity:
The worldwide incidence of obesity is
increasing. In fact a new word - "globesity" has now been coined to
reflect the escalation of global obesity and overweight. World Health Organization (WHO),
announced the new 1.7 billion obese worldwide. According
to WHO, if immediate action is not taken, millions will suffer from an array of
serious weight-related disorders. Unfortunately, obesity has reached epidemic
proportions in India, with morbid obesity affecting 5% of
the country's population, in maharashtra incidence of obesity in adult males is
16 % and in females its 13%. With
growing affluence, unhealthy, processed food has become much more accessible
following India's continued integration in global food markets. Indians are
genetically susceptible to weight accumulation especially around the waist.
Complications
of Obesity :
Some people can be very overweight and not suffer
any major medical problems – you may be one of them. However, the truth is that
being overweight dramatically increases your chances of suffering a serious
health problem in the near future (sometimes referred to as an obesity–related
disease). Here are some scary statistics for you:
If you are obese you are:
And probably most importantly of all, your life
expectancy is much shorter than that of a normal weight person .On average, obesity reduces life expectancy by six to
seven years: a BMI of 30–35 reduces life expectancy by 2 to 4 years,
while severe obesity (BMI > 40) reduces life expectancy by
10 years.
How
overweight are you?
To measure this, experts now talk about your BMI,
or body mass index. This is calculated by dividing your weight in kg by your
height in metres, twice. Here are some basic definitions for you:
This
classification is for western population, for indians, the BMI cut-offs
have been reduced by 2.5 kg/mt2 .
How do I deal with obesity?
The aim of treatment for obesity is to
lose weight in order to improve your general quality of life, both physically
and psychologically. For example, losing weight may help you sleep better, or
help you to improve your self-esteem. The best way to treat obesity is to
reduce the amount of calories in your diet and to exercise more. The type of
diet and exercise that will benefit you, and that you can follow safely, will
vary from person to person.
At jehangir hospital, Pune there is a
dedicated obesity surgery unit lead by Dr Girish Bapat. Dr Bapat has been
trained in the leading hospitals in london and was working as a consultant
before relocating to Pune. Dr Bapat brings with him a vast experience in
dealing morbidly obese patients. The obesity unit has a dedicated surgical
team, specialist dietician, anaesthetist, diabetologist, physiotherapist and
psychological assessment team.
There are various ways you can deal
with morbid obesity:
-Diet:
In order to lose weight, you need to
eat a healthy diet and reduce the amount of calories in your diet. This will
mean changing your eating habits.
A healthy diet should contain:
A calorie-controlled or
low-fat diet should only be attempted with expert support and advice. Similarly
dieting in adolescents and pregnant women should be done under expert
supervision.
-Increase your exercise
Research suggests that increasing the amount of
exercise you do is an effective way to lose weight, and the results are even
better when combined with changes to your diet.
Recommended types of physical exercise include:
Chose physical activities that you enjoy, as you
are more likely to continue doing them.
The advice from experts about exercise will vary depending on how fit
you are to start with, and what it is safe for you to do.
-Medication
Medication for obesity is considered for
selected patients by our weight loss team. You need to show you can lose weight
on a calorie controlled diet before it is considered. Medication is normally
one part of a weight loss programme, and requires a long-term change in
lifestyle for lasting results.
Orlistat: Orlisat
works by blocking the action of an enzyme (a protein that speeds-up and
controls chemical reactions in the body) that is used to digest fat. The
undigested fat is not absorbed into your body, and is passed out with your
faeces (stools). Treatment with orlistat, which initially is for 3 months, must
be combined with a low fat diet and other weight loss strategies, such as doing
more exercise. Treatment can have serious complications and should be
undertaken under medical supervision.
Intragastric balloon for
obesity
With the failure of conventional treatments like
diet therapy, increased physical activity and drug therapy in producing long
lasting weight loss in people with obesity, other approaches like surgery are
performed in specialised centres, an option to be considered for patients with
morbid obesity who do not respond to clinical treatment. The silicon
intragastric balloon (IGB) has been developed as a temporary aid to especially
achieve weight loss in obese people with 40% or more their optimal weight, who
have had unsatisfactory results in their treatment for obesity, despite of
being cared for by a multidisciplinary team and in super obese patients who
often have a high risk for surgery. The concept is
simple. A deflated soft silicone gastric balloon is inserted into the stomach
via the mouth and filled with liquid or air, reducing the amount of food the
stomach can hold and causing leads
to a premature feeling of satiety
The balloon can be left in place for up to
six months.
Surgery for obesity:
We have
now enough evidence to suggest that surgery for morbid obesity offers an
effective and sustained weight loss as compared to other modalities such as
lifestyle modification and medications.
What is obesity surgery: Bariatric (obesity) surgery,
also known as weight loss surgery, refers to the operations designed to reduce
weight (bariatric come from the Greek meaning pressure or weight). Operations
may restrict the amount you are able to eat (restrictive operations such as the
gastric band or sleeve gastrectomy) or both restrict the amount you can eat and
reduce the amount you can absorb (gastric bypass ). The term does not include procedures for
surgical removal of body fat such as liposuction.
How
surgery works
The human body lays down fat stores if
the calories in the food you eat exceed the energy you burn up. There are a
number of complex processes which the medical profession are only just starting
to understand that seem to contribute to increasing obesity - the appetite
mechanisms go wrong and you continue to eat even though you do not need the
calories. And of course, once your body is carrying the extra weight, it
becomes harder to be physically active which would help to regulate your
weight.
Obesity surgery works by helping to reduce the
number of calories that are available in your body. There are two ways this can
be achieved surgically:
The operations that work by restriction are:
The operations that work by a combination of
restriction and malabsorption are:
Obesity
surgical unit at Jehangir Hospital, Pune, which is lead by Dr Girish Bapat is
able to offer all types of bariatric surgery as key hole (laparoscopic)
procedures which has less post surgery pain, complications, early discharge,
faster recovery and better cosmetic results. For further information log on to
www.obesitycare.co.in
Is
surgery a right option for me?:
The obesity surgery team at jehangir hospital will
assess each patient in detail and recommend surgery thats going to benefit that
particular patient most. Dr Girish Bapat, says, that to gain the maximum
benefit from surgery patient selection is paramount. He strictly follows NICE guidelines, however patients
personal circumstances, coexisting medical conditions such as diabetes,
hypertension etc., and ethnic origin is taken into account before recommending
any surgery. Each patient undergoes detailed counseling and plenty of time is
given to the patient and relatives to understand the whole procedure. This
policy in his experience helps patient and relatives to have realistic
expectation and achieve better long lasting weight loss.
Life
after weight loss surgery:
Weight loss of 65 to 80% of excess body weight (the
amount by which actual body weight exceeds actuarial ideal body weight) is typical of most large series of Gastric Bypass operations reported.
The medically more significant effects are a dramatic reduction in co-morbid
conditions:
·
Hyperlipidemia (high cholesterol) is corrected in over 70% of patients.
·
Essential hypertension
(high BP) is relieved in over 70% of patients, and medication requirements are
usually reduced in the remainder.
·
Obstructive sleep apnea
is markedly improved with weight loss and bariatric surgery may be curative for
sleep apnea. Snoring also improves in most patients.
·
Diabetes mellitus type 2
is reversed in up to 60- 80% of patients usually leading to a normal blood
sugar without medication, sometimes within days of surgery.
·
Gastroesophageal reflux disease is relieved from the time of surgery in almost all patients.
·
Venous thromboembolic disease
signs such as leg swelling are typically much improved.
·
Low back pain and joint pain are
typically relieved or improved in nearly all patients.
Weight loss surgery can achieve often impressive
results in the amount of weight lost, but it should not be seen as a magic cure
for obesity. Both the sleeve gastrectomy and bypass
restrict how much food you can take at one time helping you to limit food
intake, thus lose weight. Dr Bapat says, surgery is a tool
to help patients loose weight, people who have had weight loss surgery will
need to stick to a lifelong plan afterwards to avoid putting weight back on or
long-term complications.
This plan will include:
At jehangir obesity surgery unit, our specialist
dietician will advice you before and after surgery to settle into your new life
style. After surgery patients are seen at our clinic at regular basis to ensure
that they settle well into their new life style. We make sure that while undergoing
surgical treatment and recovery, you are not alone, help is always at hand and
always call us for any help or advice.
Dr Girish Bapat
MBBS, MS (Gen. Surgery), FRCS (Glasgow), FRCS
(Intercollegiate), FRCS (London)
CCST in General and G.I. surgery, England
Senior SpecialistFellowship in Bariatric Surgery,
A-Z Sint- Jan Hospital, Brugge, Belgium.
Consultant (past) in Bariatric surgery, Mid-
Yorkshire NHS Trust, UK.
Currently Consultant Obesity Surgeon at Jehangir
Hospital, Pune