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Bariatric surgery makes permanent weight loss possible
For the morbidly obese, no amount of dieting and exercise alone can help reduce weight permanently, Bariatric surgery is the best option currently available for weight loss and treatment of co-morbidities , opines Mumbai’s Dr. Muffazal Lakdawala, Head of Bariatrics Department, L.H. Hiranandani Hospital, lilavati Hospital, Saifee Hospital.
Morbid obesity is a chronic disease and needs to be treated. Obesity is often viewed lightly as a psychological problem characterized by poor discipline or lack of control.What ever the viewpoint, the truth is that obesity especially morbid obesity is a very high health risk. Risk for morbidity and mortality accompanying obesity is proportional to the degree of overweight. A simple means to define overweight is by the body mass index (BMI) being calculated as weight (kilograms)/height (meters) 2.
The BMI associated with lowest mortality and morbidity is between 20 and 25 kg/m 2. Overweight is identified with a BMI of over 25 and a BMI >30 as obese. Further, a BMI of 40 kg/m 2 is considered severely obese for an average adult male. Persons at the highest risk of morbidity and mortality can be categorized as having "clinically severe obesity," a term that is preferred to "morbid obesity."
Risks of obesity
Increasing body weight is associated with increasing health risk. T his disorder is accompanied by reduction in life expectancy, particularly due to significant co-morbidities. These co-morbidities include Type 2 diabetes, hypertension, sleep apnoea, metabolic syndrome, Ischaemic heart disease, prostrate cancer and breast cancer among others. Other health conditions associated with obesity include, infertility, arthritis, skin diseases. In addition, significant psychosocial and economic problems frequently are experienced by persons with severe obesity. As such obesity without doubt can be called “the disease of diseases”.
This health condition is not restricted to adults as children are increasingly affected by obesity and overweight. Sedentary lifestyles, unhealthy food habits and lack of adequate physical activity are the primary non-genetic reasons for obesity in children and adults. Worldwide a lot of research has been done to develop effective weight management techniques. Drug therapy was one such option to treat clinically severe obese people but that had been disappointing. Procedures such as liposuction are cosmetic in nature and do not provide long term solution for managing obesity or its co-morbities.
Weight management
As mentioned earlier, obesity is mostly the result of inactivity, unhealthy eating habits and genetic & hereditary factors. A lot of people have tried dieting and exercise regimens to counter obesity, but in vain. Effective weight management for obese individuals and groups involve a range of long-term strategies. These include weight loss, weight maintenance and management of co-morbidities.
A proper dietary plan and exercise regimen helps in providing the right amount of calories and burning the excess fat. Avoid eating food fried in oil and those that are high on carbohydrates. Eat more of vegetables and fruits with high fibre content and keep away from sweet stuff. Ensure an exercise regimen of at least 30 minutes for adults to burn the excess fat accumulated around the hips and abdomen. These activities help in weight management for normal and overweight people. However, some people despite their best efforts do not achieve results with only these methods. Weight loss surgeries have proved to be the most effective means to reduce weight and lead a normal life, especially in morbidly obese people.
Effective solution
Weight loss surgery, also known as bariatric surgery, is broadly classified into two types of operations, both done through minimally invasive laparoscopic procedures.
Adjustable Gastric Banding : Also known as restrictive operation, Gastric Banding involves placing of a band of silicon around the upper end of the stomach through laparoscopic procedure. This creates a small pouch and narrow passage into the rest of the stomach.
Adjustable banding, allows the band to be adjusted periodically after surgery at the surgeon’s office. This is effective especially during the first year after the surgery as it maximizes weight loss while minimizing adverse symptoms. Gastric banding encourages weight loss in 2 ways: Firstly, as stomach size is reduced it makes it impossible for you to eat much. Secondly, the outlet of the pouch is only about 1/4 inch in diameter. Because of it’s small size food empties slowly and one feels full for a longer duration, Hence more satiety.
Some of the advantages of gastric band include:• No cutting, stapling or rearranging of the intestines
• Good access to stomach for scopes that diagnose and treat ulcers
• Reversible
• Fewer and less severe complications
• Can be adjusted during pregnancy to allow for adequate calories and vitamins
• Vitamin deficiencies are rare
Gastric Bypass: Roux-en-Y Gastric Bypass (RGB ) is the most common bariatric procedure. Here a small stomach pouch is created with staples or a vertical band. This restricts food intake. Then a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the cavity of the stomach and duodenum directly into the jejunum. This reduces the body's ability to absorb nutrients and calories.
Gastric Bypass has the following advantages:
• Most patients lose weight quickly and continue to lose for 18 to 24 months after the procedure.
• With the gastric bypass, many patients maintain a weight loss of 60 to 70 percent of their excess weight for 10 years or more.
• Greater weight loss than gastric banding help in improving the health problems associated with severe obesity, such as hypertension (high blood pressure), sleep apnea, type2 diabetes, and osteoarthritis.
If one were to compare both the procedures t he weight loss with a gastric band is slower than with the gastric bypass surgery. However, as both employ laparoscopic technique, their benefits include smaller incisions, reduced pain after surgery, shorter hospital stay, shorter recovery time and reduced risk of infection.
Time for action
Obesity is a disease that affects a person both physically and psychologically causing immense trauma. Today, bariatric surgery is one of the most effective solutions to tackle obesity and the associated health conditions. People who have undergone the surgery have immensely benefited and are leading a weight free and confident life which they had only dreamt of earlier. In most cases there has been a significant reduction of weight over a period of time, bringing the patient to their near their ideal weight. There is a hope for the morbidly obese at last.