What is Obesity and How Can it be Treated
The biggest challenge that we face in the management of “obesity” today is the attitude which assumes that “obesity is a choice, and does not deserve to be treated”. Patients suffering from obesity face a lot of weight-based discrimination and stigma in every walk of life. Society views them as people with low will-power and obesity is still considered as a condition that is self-inflicted.
Obesity has emerged as one of the biggest silent killers of this century and has attained epidemic proportions across the world. Today, India is the third fattest nation in the world and obesity and diabetes together are a leading cause of death amongst the non-communicable diseases.
People who have attempted to lose weight, know how difficult it is to not only lose weight but also to maintain the weight loss. On a daily basis, we see patients who put in their heart and soul into their efforts to lose weight. Unfortunately, more often than not, they meet with disappointment and tend to yo-yo between weight loss and weight gain. This entire process can be extremely disheartening and demotivating.
Weight loss solutions depend on the grade and severity of obesity. Grade of obesity depends on the range of body mass index (BMI) that a person falls in. People with a BMI between 23.5 to 27.5 Kg/m2 are overweight. Those with a BMI between 27.5 to 32.5 Kg/m2 come in grade 1 obesity, from 32.5 to 37.5 Kg/m2 suffer from grade 2 obesity and anyone with a BMI more than 37.5 Kg/m2 has grade 3 obesity.
As the grade of obesity increases, the risk of developing associated diseases increases proportionately. There is a significantly higher risk of heart disease in patients with grade 2 and 3 obesity. Type 2 diabetes, high blood pressure, high cholesterol, sleep apnoea, polycystic ovarian disease, joint pains, infertility, liver disease, deep vein thrombosis, some kind of cancers etc are a few of the diseases that are closely associated with severe obesity. In clinical practice we see that as the BMI increases, patients tend to become sicker.
Weight-loss solutions vary for different grades of obesity. When it comes to grade 2 and grade 3 obesity, bariatric surgery is the only method that leads to sustained weight loss. It is a gastro-intestinal surgery which entails reduction of stomach size using staplers and sometimes re-routing of small intestines. This is usually performed through key-hole surgery. There are various mechanisms by which bariatric surgery helps to lose weight. Reduction in food intake, early satiety, reduced hunger, hormonal changes, at times decreased absorption of the food and alteration in gut flora are a few of the mechanisms that lead to weight loss after surgery.
Bariatric surgery leads to significant weight loss and also helps to improve other co-morbidities especially type 2 diabetes and others as listed above.
- What are the treatment options for obesity?Like every other disease, treatment of obesity depends on the grade of severity. Patients who are overweight (BMI 23.5 to 27.5 kg/m2) and those with grade 1 obesity (BMI 27.5 to 32.5 kg/m2) largely benefit from “diet and lifestyle” modification and non-surgical options such as a balloon insertion. For patients with grade 2 obesity (BMI 32.5 to 37.5 kg/m2) with atleast 2 obesity associated diseases and those with grade 3 obesity (BMI ? 37.5 kg/m2), “bariatric surgery” is recommended.
- What is bariatric/metabolic surgery?It is a type of advanced gastro-intestinal surgery which entails reduction of stomach size using staplers and sometimes re-routing of small intestines. This is performed through key-hole surgery which entails 4 to 5 tiny puncture marks on the abdomen. It can also be done through a “single-incision” in selected patients.
There are various mechanisms by which bariatric surgery helps to lose weight. Reduction in food intake, early satiety, reduced hunger, hormonal changes, at times decreased absorption of the food and alteration in gut flora are a few of the mechanisms that lead to weight loss after surgery.
- How is the post-operative recovery and how much weight loss is expected after surgery?As bariatric surgery is performed through key-holes, recovery is much faster. Patients can walk within 6 to 8 hours of surgery and most often get discharged from the hospital within 36 to 48 hours after the operation. Pain levels are also low and most patients get back to routine work within 7 to 10 days of surgery.
Weight loss happens over a period of 12 to 18 months after surgery and most patients lose about 65 to 75% of their excess weight. In addition to weight-loss there is also a marked improvement in obesity associated diseases such as diabetes, high blood pressure, sleep apnoea, PCOS, joint pains, breathing issues etc.
- Is bariatric surgery safe?Bariatric surgery is as safe as other surgeries like gall bladder surgery or a knee replacement. In experienced hands the chances of success are more than 98%.
Last but not the least, fear of surgery pushes sometimes patients into exploring other non-viable options. Please remember that like every other chronic disease, obesity is also progressive and continues to adversely affect all other organs of your body. Treatment of a disease must be done in accordance with the stage of the disease and sometimes treatment delayed is treatment denied. Please treat obesity as a disease and seek timely help from qualified medical specialists.