PERMANENT WEIGHT LOSS
Dr Amit Thadhani MS, FMAS
Head, Department of Minimal Access Surgery, Niramaya Hospital
Maitri Park, Sion Trombay Road, Chembur, Mumbai-400071
WHAT IS OBESITY?
Obesity is an accumulation of excess fat that results in a significant impairment of health. It is measured by a calculation of Body Mass Index (square of the weight in kg divided by height in cm). A person with BMI of upto 25 is considered normal, 25 to 29.9 is considered overweight, 30 to 34.9 is considered obese and 35 to 39.9 is considered severely obese. BMI above 40 is considered morbid obesity.
OBESITY FACTS
- It is now estimated that upto 20% of urban population is obese
- Changing lifestyles are responsible for the pandemic of obesity. This is due to:
- Improving standard of living with proportionate increase in the expenditure on food
- Low physical activity due to convenience of electronic gadgets for doing all our work, vehicles for reducing our walking/running, easy availability of all items required for day-to-day activities etc.
- Reduced overall energy requirements due to greatly reduced physical activity coupled with food intake that has remained the same or has increased over the years, resulting in accumulation of the excess intake in the body as fat
- Refined and so-called “junk” foods along with soft drinks which are very high in calories provide us with far in excess of what we consume every day
- Many related problems are seen in obese persons, such as arthritis, heart problems, diabetes mellitus, high blood pressure, sleep apnea etc
- The heavy load of their own body and numerous health problems markedly affect the person’s daily functioning
- Surprisingly, morbidly obese persons are often malnourished as their diet pattern deprives them of essential nutrients
- Almost all people who are obese can be cured of it, most try to lose their excess weight but few manage to keep it off for good
- Overweight and obese persons usually suffer from low self-esteem and poor body image, which may sometimes worsen to depression and other psychiatric conditions
WHAT IS INTENTIONAL WEIGHT LOSS?
Intentional weight loss refers to the loss of total body mass in an effort to improve fitness, health, and/or appearance. It is different from weight loss due to medical conditions.
TIPS TO ACHIEVE HEALTHY WEIGHT LOSS
- Follow a weight loss plan that is tailored to individual requirements. Such a plan will primarily consist of regular exercise and diet modification to restrict caloric intake while maintaining good nutrition.
- Cut out junk foods and energy drinks that add to the caloric intake without providing adequate nutritional support
- Spend more energy in work and heat than the body is gaining from food or other nutritional supplements by increasing your activity level in general.
- Use of drugs and supplements that decrease appetite, block fat absorption, or reduce stomach volume should be used only if necessary
WHAT CAN BE DONE IF THIS FAILS?
There are several surgical options available if a person tries and fails to lose his or her excess weight.
- Plastic and Cosmetic Surgery such as liposuction is a method to reduce the fat in specific areas of the body. It is usually safe and effective in short term; however, long tem results are disappointing
- Obesity surgery (also called bariatric surgery or metabolic surgery): Bariatric or Metabolic surgery artificially reduces the size of the stomach, limiting the intake of food energy and also brings about hormonal changes resulting in cure of diabetes mellitus. It is usually done for morbidly obese individuals in whom all other measures have failed. It is reasonably safe and highly effective, with 60% to 70% excess weight being lost permanently and usually complete reversal of associated medical problems. Procedures can be grouped as:
- predominantly malabsorptive procedures: although also reducing stomach size, these operations are based mainly on malabsorption. These include Biliopancreatic Diversion, Jejuno-ileal bypass etc
- predominantly restrictive procedures: this kind of surgery primarily reduces stomach size such as Laparoscopic Adjustable Gastric Banding (LAGB), Sleeve Gastrectomy, Gastric bypass, Sleeve gastrectomy with Duodenal Switch etc.
- Intragastric balloon placement by endoscopy: The Intragastric Balloon placement is rapidly increasing as a feasible option in patients unwilling or unfit for surgery. An individual can rapidly lose from 20 to 30kg within a short span of six months by this treatment. It is safe, well tolerated and usually done on day-care basis. The balloon is placed into the stomach through endoscopy. Once the balloon is inside the stomach, it is immediately filled with sterile saline through a small filling tube (catheter) attached to the balloon. In conjunction with a supervised diet and modified lifestyle, it can help the patient achieve the benefits associated with weight loss.
All modalities of treatment of the problem of obesity require consistent efforts on the part of the patient. A healthy country is built on its healthy citizens and we must all strive to work towards a fit society by regular exercise and judicious diet management to reverse the pandemic of obesity.
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