Obesity And Bariatric Surgery
Obesity – A Growing Health Hazard
Obesity is a leading preventable cause of death worldwide, with increasing prevalence in adults and children, and health organizations view it as one of the most serious public health problems of the 21st century. Obesity is stigmatized in much of the modern world (particularly in the Western world), though it was widely perceived as a symbol of wealth and fertility at other times in history, and still is in our part of the world.
Obesity dramatically increases the risk of Type 2 diabetes, high blood pressure, high levels of cholesterol, Heart disease, Stroke, Arthritis, Obstructive sleep apnea, and Polycystic ovarian syndrome. Higher body weight is also associated with cancer, infertility, depression, asthma and early death. India has the second largest diabetic population in the world. We have 7 Crore diabetics at present with a prediction that it would cross 11 crore in 2030. 25.4% urban & 25.2% rural obese populations are diabetic.
We are also the second largest hypertensive population in the world with 11 Crore hypertensives and a prediction of 21 crore hypertensives in 2025. This will make us the hypertension capital of the world by 2025.
20 % of all present deaths are either obesity or metabolic related.
Most 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 90% of people regain the weight they lose within a few years after treatment.
Several factors can contribute to weight gain. Diet and exercise programs address factors that can be modified, such as lifestyle and behavior. However, because these methods fail to help people achieve and maintain a healthier weight, a strong link between our genetic makeup (which we're born with) and obesity are postulated.
Facts About Morbid Obesity
What is morbid obesity?
Obesity is a condition in which one has too much body fat (adipose tissue). Obesity is determined by calculating the Body Mass Index (BMI), which measures weight for height and is stated in numbers.
|BMI =||Weight (in kg)|
|Height (in m2)|
18.5 - 24.9Normal
25 - 29.9Overweight
30 - 34.9Obese
35 - 39.9Severe Obesity
> 40Morbid Obesity
> 50Super morbid Obesity
Health Hazards of Morbid Obesity
Severe obesity damages the body by its mechanical, metabolic and physiological adverse effects on normal body functioning. These "co-morbidities" affect nearly every organ in the body in some way, and produce serious secondary illnesses, which may also be life threatening. The cumulative effect of these co-morbidities can interfere with a normal and productive life and can shorten life as well. The risk of developing these medical problems is proportional to the degree of obesity.
- People who are obese do not live for as long as those who are not obese and the earlier a person become obese; the more years of life are lost.
- Heart Disease- Severely obese persons are approximately 6 times as likely to develop heart disease as those who are of normal weight. Heart disease is the leading cause of death today and obese persons tend to develop it earlier in life.
- High Blood Pressure- Hypertension is much more common in obese persons and leads to development of heart disease, and damage to the blood vessels throughout the body, causing susceptibility to strokes, kidney damage, and hardening of the arteries.
- Diabetes Mellitus- Overweight persons are 40 times as likely to develop Type 2, Adult-onset diabetes. Once diabetes occurs, it becomes even harder to lose weight, because of hormone changes which causes higher fat accumulation in the body.
- Sleep Apnea Syndrome- Sleep apnea – the stoppage of breathing during sleep – is commonly caused in the obese, by compression of the neck, closing the air passage to the lungs.
- Respiratory Insufficiency
- Heartburn - Reflux Disease and Reflux Nocturnal Aspiration
- Asthma and Bronchitis
- Gallbladder Disease -Gallbladder disease occurs more frequently in the obese, in part due to repeated efforts at dieting, which predispose one to this problem.
- Stress Urinary Incontinence.
- Degenerative Disease of Lumbo-Sacral Spine (Backbone)
- Degenerative Arthritis of weight bearing joints like knee and hip
- Venous Stasis Disease in the lower extremities.
- Emotional/Psychological Illness- Extremely overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, and remarks from strangers. They often experience discrimination at work. Stereotypes of obese people – such as that they are lazy – may result in lower self esteem and poor body image.
- Social Effects- Severely obese persons suffer inability to qualify for many types of employment and there tends to be a higher rate of unemployment among them. There is a general societal belief that obesity is a consequence of a lack of self-discipline, or moral weakness.
Bariatric Surgery For Obesity
Over the last decade, weight loss or Bariatric surgery has been continually refined to improve results and minimize risks. Today, bariatric surgeons have access to a substantial body of clinical data that supports the use of surgery as a safe and effective weight loss treatment when other methods have failed.
Compared to other weight loss methods, such as dieting, surgery provides the longest period of sustained weight loss in patients for whom all other therapies have failed. It has also been shown to improve many obesity related health conditions, such as type 2 diabetes and high blood pressure.
Many patients who have had bariatric surgery report improvements in their quality of life, social interactions, psychological well-being, employment opportunities, and economic conditions.
Surgical Options For Treating Morbid Obesity
The morbidly obese have to seriously consider surgery for reducing weight to avoid its ill effects. Surgery for Morbid Obesity is for the following situations:
- The person's BMI is over 40, or is 35 or higher and a serious medical problem (hypertension, diabetes, heart disease, joint problems, reflux) that is made worse by obesity is present
- If it has not been possible to reduce or maintain weight under a medically supervised program
- If the person has been obese for at least 5 years
Surgical Treatment options available are :
1. Laparoscopic Adjustable Gastric Banding:
- An Inflatable Gastric Band is used, thus creating an Hourglass structure to the Stomach.
- This procedure may lead to about 39% of the excess weight being reduced within 18 months after the surgery.
- This procedure needs a high level of compliance from patient regards lifestyle and diet post surgery.
- There is always a risk of the Band eroding into the stomach, slipping out of place, and can also produce vomiting, development of GERD or sometimes the device can also fail to function.
2. Laparoscopic Sleeve Gastrectomy:
- Laparoscopic Sleeve Gastrectomy is safer than other procedures.
- In this procedure, 80% of the stomach is stapled and removed which induces weight loss by restriction in food intake and early satiety, due to loss of hunger producing hormones.
- Digestion and absorption is normal.
- By eating less the body draws the required energy from its own fat stores and thus you lose weight.
3. The R oux-en-y Gastric Bypass – The Gold Standard procedure:
- In this procedure, a small, 15 to 20 cc, pouch is created at the top of the stomach.
- The small bowel is divided. The bilio-pancreatic limb is reattached to the small bowel and the other end is connected to the pouch, creating the Roux limb.
- The small pouch releases food slowly, causing a sensation of fullness with very little food intake.
- The bilio-pancreatic limb preserves the action of the digestive tract.
4. Bilio-pancreatic Diversion with Duodenal Switch:
- In this procedure, greater weight loss can happen with less dietary compliance from the patient.
- There may be an increased risk of malnutrition and vitamin deficiency and intermittent diarrhea can also occur.
- Constant follow-up is needed for this procedure in order to monitor for complications.
Apollo Hospitals -A Pioneer in Bariatric Surgery
Apollo group of hospitals has been one of the earliest centers in the country to start Bariatric Surgery way back in 2005. We have successfully performed more than 1000 surgeries across the entire group so far with highest safety rate, with very minimal morbidity and no mortality. Apollo Hospitals Chennai has performed more than 300 surgeries so far , which include all varieties and techniques available with the least amount of morbidity and no in-house mortality.
We are proud to have performed all types of Bariatric surgeries including Gastric Band, Sleeve Gastrectomy, Gastric Bypass, Minimal Gastric Bypass and Metabolic surgeries for control of Diabetes.
Apollo Chennai performed the world's first scarless endoscopic revision gastroplasty for failed bariatric surgery in association with Apollo Endosurgery, USA and has tied up with them for its clinical studies on Endoscopic Bariatric surgeries.
Apollo Chennai has also performed World's first Single Incision Revision Bariatric Surgery, India's first Single Incision Gastric Bypass and is one of the few centers in the country to perform Single Incision Bariatric surgery on a regular basis.
Apollo Chennai is the first hospital in India to perform Robotic Gastric Bypass & Sleeve gastrectomy in the country through its Apollo Robotic Surgery department.
Institute for Bariatric Surgery
An exclusive center for Bariatric Surgery has been launched at Apollo Hospitals Chennai on 26 November 2012, aimed at holistic healthcare for patients dealing with obesity & metabolic syndromes. Every obese individual's needs are different and our group of highly trained specialists will analyze and tailor the management protocols that best suits them. With literally all modalities of surgical and non-surgical options available at the Centre, , coupled with our enviable safety record, our patients are indeed assured of a safe journey with us during their weight loss process.
With department guidelines based on international standards, we will soon have India's first integrated theater system for laparoscopy, Robotics, SILS and NOTES surgeries all under one platform, specially designed rooms and patient facilities including cots, chairs and transport devices to help our obese patients have a comfortable experience with us.
With a dedicated team of specialists, nursing and support staff, Apollo Bariatric Institute is indeed a world class facility and one of the most advanced Bariatric centers in the country.For more details, call Apollo Bariatric Institutes Helpline: 72999 52999
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