Tackling Obesity With Diet And Exercise Is Not Enough!

Dr. Prakash K
Senior Consultant, GI & HPB Surgery
Aster Medcity, Kochi

Obesity is a major health risk. Changes in eating habits with a sedentary lifestyle has lead to an increased prevalence of obesity worldwide. In India according to National Health Survey, obesity is increasing, particularly in Delhi, Punjab and Kerala. India’s 180 million adults, including 14.4 million children between the ages of two and 19 years, are obese, second highest in the World. According to the National Family Health Survey (NFHS-4), one-fifth of Indian women, or 20.7 per cent to be precise, in the age group of 15-49 are overweight.

This rise in obesity comes with a rise in the risk of many diseases like high blood pressure, diabetes, high cholesterol levels with in turn increased risk of heart disease and stroke. It is well known that some cancers, gallbladder stones, osteoarthritis, gout, breathing problems such as sleep apnoea and asthma are common in obese patients. In short, obesity affects you health and life expectancy.

Obesity Treatment

The mainstay in the treatment of obesity is to keep a balance of diet and exercise. While this works most of the time, some people find it difficult to lose weight in spite of trying various diet and exercise regimens, particularly when they are overweight. This is especially in cases of second and third degree obesity with BMI (Body Mass Index) of 35 and above, especially in individuals where obesity is accompanied by health problems like diabetes and heart disease. Bariatric Surgery can help in these cases, as along with losing weight it reverses the co morbid conditions like diabetes and blood pressure.

Bariatric surgery works on the concept of causing weight loss by restricting the amount of food the stomach can hold and or by causing malabsorption of nutrients. Bariatric procedures also often cause hormonal changes, which makes you more healthy. These are not invasive surgeries and most weight loss surgeries are performed using modern minimally invasive techniques like laparoscopic surgery.

In the last few years, bariatric surgery has transformed into a standard, safe procedure with consensus among the

medical fraternity as to its effectiveness. But it must be noted that some of these procedures are not reversible.

There are four main kinds of procedures. The simplest is the laparoscopic gastric band, which constricts the neck of the stomach with a band. While reversible, this is not very effective in the long run as the bands can break and it does not cause reduction in the secretion of the hunger hormone “ghrelin” by the cells in the G.I. Tract.

The other procedures involve considerable changes to the stomach and intestines, and result in sustained weight loss in majority of cases. The weight lost is usually around half of a patient’s excess weight. These procedures are Sleeve gastrectomy, Gastric bypass and Bilio-pancreatic diversion.

Sleeve Gastrectomy is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food and thus calories that can be consumed. The greater impact, however, is the effect the surgery has on gut hormones impacting a number of factors including hunger, satiety, and blood sugar control.

Gastric Bypass is considered to be the gold standard of weight loss surgery. Gastric bypass is a complex operation in which a small pouch is created from the stomach and connected to the small intestine. This facilitates smaller meals and changes how the stomach and small intestine handles the food eaten. After the surgery, the stomach is smaller and the patient feels full with less food. The food eaten no longer goes into some parts of the stomach and small intestine that absorb food. Because of this, the body doesn’t get all of the calories from the food eaten, restricting calorie intake and promoting weight loss.

The Bilio-pancreatic Diversion with Duodenal Switch is a procedure with two components. First, a smaller, tubular stomach pouch is created, similar to the sleeve gastrectomy. In addition, a large portion of the small intestine is bypassed. This procedure reduces absorption of fat by 70% or more and results in the greatest amount of weight loss. Because this procedure causes change in body metabolism it is opted for only select group of patients

Bariatric surgery gives magical results, but only if the patient is disciplined. Apart from losing weight, most patients can get rid of their associated illness like diabetes, high blood pressure, cholesterol etc and regain their health after bariatric surgery. The patient has to change his lifestyle, eat healthy foods, control portion sizes, and exercise. These steps are essential for the success of a Bariatric procedure.