Dr Pradeep Jain - Morbid Obesity SurgeriesThe World Health Organization has defined overweight and obesity as abnormal or excessive fat accumulation that may impair health, leading to reduced life expectancy and increased health problems.
Morbid obesity is clinically severe obesity at which point serious medical conditions such as: Type 2 Diabetes, High Blood Pressure, High Levels of triglycerides (a type of blood fat), Knee pain, Heart Attack, Stroke, Cancer, Infertility, Sleep Apnea and even Reduction in Life Span, occur as a direct result of the obesity.
Why we are talking of Morbid Obesity in India ? We are a poor nation !Yes we agree that we are dealing with both under nutrition and over nutrition in India at the same time. According to National family Health Survey - 3 nearly 15% of Indian population is Obese. Out of this one third are morbidly obese. Just because of very large population this number becomes huge.
What are the ill effects of Morbod Obesity?Morbid Obesity is commonly associated with several diseases (co-morbidities) which negatively impact health and the quality of life. In fact obesity is considered even more damaging than smoking or drinking, as it affects almost all of the major body organs. Problems like increased blood pressure, diabetes, heart attack, stroke, cancer (especially breast, uterus and colon), fatty liver, infertility, polycystic ovaries, arthritis, sleep apnea and asthma are all amplified as a result of obesity. It also leads to psychological problems such as depression, low self-esteem and eating disorders. Untreated obesity can also cause premature death.
Can Morbid Obesity be treated ?Yes, obesity can be treated. But it involves more than just swallowing a pill or sticking to a diet. It needs a multi-disciplinary approach involving a dietician, physiotherapist, physician, endocrinologist, psychologist, gastroenterologist, cardiologist and a bariatric (weight loss surgeon).
Our Weight Loss Management team offers a full range of options including behavior therapy, diet and exercise and bariatric or weight loss surgery.
An endocrinologist will evaluate you for hormonal causes of obesity and look for metabolic complications of obesity. A weight loss plan will be set for you and you will get a consultation with a nutritionist who will discuss your diet plan with you. If you are morbidly obese and have tried other treatment without success, you are a candidate for bariatric/weight loss surgery. Bariatric surgery is the most effective therapy available for the morbidly obese population. It markedly lowers body weight, reduces obesity-related diseases mentioned above, and improves the quality of life.
Options for treatment?Most non-surgical weight loss programs are based on a combination of diet, behavior modification, and regular exercise. However, published scientific papers report that these methods do not help resolve morbid obesity because they fail to help people maintain weight loss. In fact, more than 95% of people regain the weight they lose within a few years after treatment.
Who is a candidate for Bariatric Surgery?You are a candidate for bariatric surgery if: Your BMI is more than 37.5. This means, if a 5’6” person weighs 105 Kg or more.
Your BMI is 32.5 to 37.4 and you have obesity related problems (co-morbidities). This means, if a 5’6” person weighs 91 Kg. or more and has co-morbidities.
Sometimes, even though the overall BMI is less than 32.5, the fat is concentrated only over the abdomen (Truncal Obesity/Potbelly). This pattern of fat deposit is very harmful to health and therefore other parameters are also considered in these patients. These are:-
(a) Waist circumference: Waist measurement of more than 90 cm. in males and 80 cm. in females.
(b) Waist: Hip Ration (W/H Ratio): More than 1 in males and 0.8 in females.
What am I supposed to do before Surgery?Preoperative testing includes blood work, ECG, Chest X-ray, Upper Endoscopy, Cardiac Stress test and Echo, Pulmonary Function test.
You will be placed on a high protein, low carbohydrate diet including protein shakes for 2 weeks prior to surgery. This is essential as it reduces the size of your liver and makes the surgery safer.
You will be evaluated by our dietician, physiotherapist, and clinical psychologist who will also guide you regarding post-operative diet and exercise routines.
What are the types of Bariatric Surgery or Weight Loss Surgery?
Laparoscopic Gastric Bypass-
This procedure reduces the size of the stomach thus reducing the amount of food one can eat at a time. It also alters the digestion by absorbing less of the food eaten. It causes intolerance to food that has concentrated sugars. Average hospital stay is two nights and average weight loss is 85% of excess body weight.
Laparoscopic Sleeve Gastrectomy-
It reduces the size of the stomach so that it takes the shape of a sleeve, thereby restricting the amount of food that one can eat at a time. This procedure reduces hunger and makes one feel full quickly, thus helping to lose weight. Average hospital stay is two nights and average weight loss is 75% of excess body weight.
Laparoscopic Adjustable Gastric Banding-
In this procedure, a soft band lined with an adjustable balloon on the inside is placed around the stomach so that it takes the shaped of an hour glass. It reduces hunger and restricts the amount of food that one can eat at a time, thus helping to lose weight. Success of this procedure depends on proper adjustment of the balloon and restricting high calorie liquids. The average hospital stay in one night and the average weight loss is 55-60% of excess body weight.
Result : The results of bariatric surgery are great. The average weight loss is 55% to 85% depending on the procedure. There is an improvement or remission of diabetes in over 90%, high blood pressure in over 80%, sleep apnea in over 75%, and significant reduction in the rates of heart attack, stroke and cancer.
Life after Bariatric SurgeryAfter your surgery, you will be on a liquid diet for 2 weeks, soft died for the next 2 weeks and then a normal diet.
You have to eat small meals, chew well and eat slowly. Do not drink liquids a half hour before and after your food. You must consume adequate protein.
Maintain adequate hydration by sipping water frequently.
You have to commit to taking daily vitamin supplements as recommended according to your surgery.
You may experience temporary hair thinning. Adequate protein intake and biotin supplement can minimize this.
Weight loss is gradual and is at the rate of 4-8Kg/month. And ususally lasts 12-18 months.
Weight loss will significantly improve obesity related medical problems like diabetes, high blood pressure and sleep apnea. Infact about 60% patients may not require medicines.
In women of childbearing age, weight loss improves fertility (chances of getting pregnant), and makes childbirth safer for the mother and the baby. We recommend avoiding pregnancy during the first 1-2 years after surgery.
Weight loss improves your quality of life, stamina and self esteem.
Weight loss surgery significantly increases your lifespan.
You must exercise regularly, make the right food choices and weigh yourself once a week to ensure that the weight is permanent and there is no weight regain.
Regular follow-up with your doctor is a must so that required blood tests can be done. We recommend a visit once in 3 months during the 1st year, once in 6 months during the 2nd year and then once a year.