Obesity is a complex condition caused by more than simply eating too much and moving too little. It is a metabolic, chronic and progressive disease with a significant genetic tendency. It is true that conventional measures such as controlled eating, regular exercise etc can help in weight loss. However, long term follow up studies have shown that morbidly obese individuals regain their lost weight within 1-3 years.
Dr Ramen Goel is Director, Center of Bariatric & Metabolic Surgery at Wockhardt Hospitals.
In India, obesity is emerging as an important health problem particularly in urban areas, paradoxically co-existing with undernutrition.
“Indians suffer from abdominal obesity compared to people in the West whose bodies are uniformly obese. Almost 30-65% of adult urban Indians are either overweight or obese or have abdominal obesity. This body composition puts Indian in the high-risk zone for diabetes and hypertension,” shares Dr Ramen Goel, Director, Center of Bariatric & Metabolic Surgery, Wockhardt Hospitals.
What is bariatric Surgery and how does it work?
Bariatric surgery, popularly known as weight loss surgery is a type of procedure performed on obese individuals for sustained weight loss.
In this type of surgery, the weight loss is achieved through removal of a portion of the stomach (sleeve gastrectomy) or by re-routing the small intestines to a small stomach pouch (gastric bypass). Though everyone loses weight, results of surgery can be improved with permanent changes in your lifestyle.
Sleeve Gastrectomy: During this procedure, a thin vertical sleeve of stomach is created using a stapling device, and the rest of the stomach is removed. The sleeve is about the size of a banana. This procedure helps you feel full sooner.
Gastric bypass: Gastric bypass is one of the most frequently performed procedures for obesity. It restricts food intake and the amount of calories and nutrients the body absorbs. In addition to creating a smaller stomach pouch, the surgery changes the body's digestive process. Studies have shown that gastric bypass patients typically lost 61.6% of their excess weight. Many health problems (back pain, sleep apnea, high blood pressure, type 2 diabetes, and depression) improve or are resolved following surgery.
Do you need a weight loss surgery?
Bariatric surgery is not for everyone. There are different factors which determine if one is a right candidate for this procedure.
The Obesity Surgery Society of India (OSSI) has recommended that bariatric surgery can be offered to:
· Patients with Body Mass Index (BMI) of over 37.5 even without any other disease
· Patients with BMI of 32.5 with coexisting medical conditions such as diabetes, hypertension, sleep apnoea, PCOD, osteo-arthritis and seriously impaired lifestyle
International Diabetes Federation (IDF) in a position statement has recommended surgery for patients with >27.5 BMI, with uncontrolled Type 2 diabetes.
Generally speaking, if you are more than 20-25 kgs overweight, then you may fall in this category.
According to Dr Ramen Goel, Director, Center of Bariatric & Metabolic Surgery, Wockhardt Hospitals, there are various benefits of Bariatric Surgery:
1. Reduces the risk factors that can lead to cardiovascular conditions:
Bariatric surgery may be an appropriate treatment option for those with serious obesity-related health issues such as high blood pressure and cardiovascular conditions. For such people, the risk of complications of the disease and even sudden death is high if they do not lose weight. Bariatric surgery not only helps lose weight but also reduces the risk factors that can lead to cardiovascular conditions.
2. Bariatric surgery for diabetes remission: Diabetes is considered a lifetime disease with no possibility of remission or cure. Despite medicines and lifestyle modifications over 56% - 70% remain uncontrolled diabetics. The serious complications of diabetes like high BP, heart attacks, brain strokes, kidney failures, nerve damages with amputations and blindness are usually seen in these uncontrolled patients. Bariatric surgery has gained acceptance in last one decade as a possible mode of diabetes remission. International Diabetes Federation (IDF) and American Diabetes Association (ADA) has clarified role of this surgery for uncontrolled diabetic patients with BMI over 27.5.
3. Obstructive Sleep Apnea (OSA) and weight loss: Obesity results in obstructive sleep apnea where the person is not able to sleep well and snores, while remaining drowsy during the day. Besides problem of insomnia, if not treated in time OSA results in high BP, heart failure etc. OSA treatment includes lifelong use of a CPAP machines. Worldwide research suggests that after bariatric surgery such patients improve within 2-4 weeks and most of the persons need not use CPAP ever again.
4. Bariatric surgery and joint pains: Weight-loss surgery not only reduces the weight of a patient but also helps him/her get relief from weak knees and back pain. Most patients with OA develop joint pain involving weight bearing joints including lower limb and back pain. Studies have demonstrated that among patients with knee OA pain, bariatric procedures can predictably provide relief. Dramatic reductions in pain can occur as quickly as three months post-surgery.
5. Bariatric surgery effective for PCOS/Infertility: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. It is strongly associated with obesity. It is found in 30 % to 70 % of obese women of reproductive age and is associated with irregular period, excessive hair and a high risk of infertility. Studies have shown that most obese women who effectively achieved weight loss following a bariatric surgery had restored menstrual cycles, marked improvement of excessive hair and decreased androgen level.
For PCOS patients with infertility, bariatric surgery also has been shown to increase the fertility rate. Even in women with regular menstrual period, observational studies have shown obesity is associated with decreased spontaneous pregnancy rates and increased time to pregnancy. Studies from Italy, Canada and United States all showed that bariatric surgery significantly increased the fertility rate in obese women.
Benefits at a glance:
Ø Improved mood - Many patients report less depression and other improved aspects of psychosocial functioning.
Ø Improved quality of life- Most patients have more energy and can be more active.
Ø Most patients lose at least 50% of excess body weight.
Ø Most people with hypertension and/or diabetes no longer need medications.
Ø A return of normal periods for young women with abnormal or absent menses and improvement of fertility.
Ø Improved sexual function for many males.
Ø Eliminates or slows the disabling effects of arthritis.
Ø Improved self-esteem.