Obesity is the scourge of the new century. A combination of genetic, environmental and dietary factors leads to obesity. Obesity, when beyond a particular limit, which is variable according to body type, is itself harmful to the life of the person and is responsible for diabetes, hypertension, heartdisease, cancers and ultimately lowers life expectancy. Is every overweight person obese? This cannot be answered simply because the obesity that causes problems is related to the fat that is deposited inside your abdomen rather than what’s just under your skin. Measuring that proportion of abdominal fat is not so simple because itvaries according to race and body type. But for practical purposes body mass index or BMI is acceptable. So, simply put ,a BMI of more than 30 is mild , more than 35 is severe. Your ideal body weight is easily calculated by height in cms-100. Excess body weight is the difference between this and your present weight. Traditional strategies to tackle obesity have been dietary, drugs and exercise. No drug has been proven to produce any meaningful effect in long term weight control in obese patients. All exercise and diet regimens can at best produce a maximum weight loss of 15-20 kgs, which depends on the age, ability to exercise and motivation of the person. Typically crash diets produce weight loss but are also easily regained. This see-saw pattern of weight gain/losscan be harmful. Bariatric surgery is the only intervention presently that can produce weight loss of up to 80 % of your excess body weight that gives durable results. Additionally the as-sociated illnesses like diabetes, sleep apnoea, high cholesterol, polycystic ovarian syndrome, hypertension, heartburn, stress incontinence are also cured. Only those with BMI higher than 35 are considered for surgery. In Asians however, who have a higher percentage of fat alreadyin the abdomen, these cut offs can be revised by 2-3 points earlier. All surgeries are performed laparoscopically( keyhole).They are 2 types of surgeries - Restrictive, wherethe hunger hormone (grehlin) producing part of the stomach is removed and converted to a thin tube like your food pipe so that you feel full while eating just a little. In the second type, Combined restrictive and malabsorptive, in addition to the above effect the food is made to bypass a lot of your small intestine and reach the later part faster leading to poorer absorption of fattening sugars and fats etc . Patients who undergo surgery must be explained the immediate risks of surgery and anesthesia after proper assessment so that they can make an informed choice. Also patients who undergo surgery must be explained that after surgery that they will not be able to eat as much as before , so they need to eat enough protein dense foods and follow dietary advice and do regular exercise, sthat muscles also are not lost in addition to the fat. Also they need to take regular vitamin and mineral supplements and be on regular follow up with their treating doctors.
Dr Bejoy Abraham
Consultant GI Surgeon