Why talk about obesity
Obesity is not viewed as a condition anymore. It is now believed that it is a disease which when in excess leads to other diseases like diabetes, increased blood pressure , heart disease, joint pains, snoring, immobility, poor sex life, infertility, psychological problems, etc. Obese subjects also tend to live 10-20 years less than their nonobese counterparts. The incidence of obesity has increased tremendously in the last few decades due the faulty eating habits and sedentary lifestyle. Twenty five percent of adult population in the world is either overweight or obese and growing daily. The WHO has declared it as a global pandemic in 2002. It has become the second highest cause of preventable deaths after smoking.
Why am I fat
Being fat is a net result of a lot of factors in ones life such as lifestyle, genetics, endocrine disorders, etc. The most important is the lifestyle of the person in terms of what one eats and how active is the person. Most of the obesity can be attributed to poor eating habits (junk food, oily food, sweets, colas, etc) and a sedentary lifestyle, a part and parcel of modern life.
So what if I am fat
Most people equate advice to reduce fat with instruction to look better when slimmer. This is only a fraction of the truth. The fact is that increase in body fat leads to increased co morbidities such as diabetes, hypertension, heart disease, joint pains , immobility, poor sex life, psychological problems and cancer. So the major reason to reduce fat is to decrease one s chances of dying early from diabetes, heart disease, etc and more importantly to lead a fitter and more productive life
Is obesity surgery for me
If one has a BMI( body mass index) calculated as weight (in kgs)/ height (m2) of 40 or more OR BMI of 35 + one comorbid condition like diabetes / hypertension one is a candidate for considering bariatric surgery (surgery for the morbid obese).
Which procedure is for me
There are many procedures for bariatric surgery. They are lap band, lap sleeve gastrectomy, lap gastric bypass and biliopancreatic diversion. The first 2 procedures(restrictive) work by limiting food intake and last 2 (malabsorptive) by causing decreased absorption and food intake . The former will achieve a weight loss of 50 -70% of excess body weight whereas the latter will achieve 70-80% excess body weight loss.
Band procedure however mandates more compliance and follow up and is more susceptible to cheating.
Gastric bypass is offered to patients who understand that it is the most effective procedure for weight loss but it comes with a price of a little more risk of leaks and death than other procedures. It also requires regular monitoring of vitamins and minerals to prevent deficiency states.
Gastric bypass is also the procedure of choice for patients having obesity with diabetes because of its 87% chance of curing diabetes.
How is life after Bariatric surgery
All post bariatric surgery patients need to know that they will not be able to eat as much they used to because of their smaller stomach size. Their hunger is satisfied eating much less than before. However this should not be interpreted as becoming weak because on the contrary these people start leading a more active life as soon as they start losing weight and gaining confidence. The usual instructions for a healthy lifestyle of eating correctly (no sweets, colas, fried food) and moving more applies even after surgery.
All patients with band have to come for regular follow up to see that the band is in the right place and is not too tight or loose. One may need to adjust the band sometimes and may require removal too.
Patients who undergo gastric bypass however have to consume iron and vitamin B regularly and also need to be checked for the same periodically with some blood tests.
Will I be able to have a normal sexual and reproductive life after weight loss surgery?
Many obese people have a poor sex life. They have associated psychosocial complexes originating from the same and needs to be addressed preoperatively. Post surgery as the weight starts reducing the patient gains his or her mobility not to mention the pelvic anatomy which starts getting restored from amidst the sea of fat.
It has been seen that they become more sexually active.
Fertility is a major problem with obesity and many female patients have polycystic ovarian disease, endometriosis as part and parcel of obesity. The fertility rates have also been shown to improve dramatically following weight loss after bariatric surgery.
Childhood obesity
In the USA 1 in 4 child is obese and they carry a huge risk of persisting obesity in adulthood. In India the scenario is not too different either with an incidence of 1 in 5 urban children being obese. The scary part is most of them are going to stay fat lifelong. Preventing an unhealthy lifestyle in children (fried food, pizzas, burgers colas, long hours at TV to name a few) should be undertaken by parents, teachers and policymakers to avoid a loss of productive healthy generation next .
What are the complications of weight loss surgery
Like all surgeries bariatric surgery is not exempt from its share of troubles. Morbid obese subjects are high risk for anaesthesia. They could have preexisting lung and cardiac problems along with risk for venous thrombosis(clots in leg veins) which may aggravate after surgery. Surgery entails joining bowels with sutures or staples which may leak and result in infection, prolonged hospital stay, increased cost, second surgery and rarely even death. Having said that advances in modern anaesthesia and availability of stapler buttressing technology has brought down these risks tremendously . Late complications are rarer . Bands may slip from their position or may require adjustment or may erode requiring removal.
Gastric bypass procedures may lead to iron and vitamin B deficiencies which needs replacement regularly.
The stomach pouch or sleeve have a theoretical possibility of regrowing to original size and plateauing of weight loss benefits but experience and literature have not held it as something alarming.
How long do I stay in the hospital?
Usually patients are sent home in 2 to 3 days since the operation is done through keyhole surgery. They are allowed to drink and move within 24 hours.
I have heard similar surgery is done to cure diabetes
The same surgeries are being done apart from some new ones to cure adult onset diabetes. There is now enough evidence in literature to advocate this procedure to cure diabetes. Immediately after surgery and usually before the patient is discharged home the patients have normal blood sugar. It is an exciting option for diabetics who wants a permanent solution. After all who wants to take pills and injections on a regular basis and live with the fear of diabetic complications.
Obesity is not viewed as a condition anymore. It is now believed that it is a disease which when in excess leads to other diseases like diabetes, increased blood pressure , heart disease, joint pains, snoring, immobility, poor sex life, infertility, psychological problems, etc. Obese subjects also tend to live 10-20 years less than their nonobese counterparts. The incidence of obesity has increased tremendously in the last few decades due the faulty eating habits and sedentary lifestyle. Twenty five percent of adult population in the world is either overweight or obese and growing daily. The WHO has declared it as a global pandemic in 2002. It has become the second highest cause of preventable deaths after smoking.
Why am I fat
Being fat is a net result of a lot of factors in ones life such as lifestyle, genetics, endocrine disorders, etc. The most important is the lifestyle of the person in terms of what one eats and how active is the person. Most of the obesity can be attributed to poor eating habits (junk food, oily food, sweets, colas, etc) and a sedentary lifestyle, a part and parcel of modern life.
So what if I am fat
Most people equate advice to reduce fat with instruction to look better when slimmer. This is only a fraction of the truth. The fact is that increase in body fat leads to increased co morbidities such as diabetes, hypertension, heart disease, joint pains , immobility, poor sex life, psychological problems and cancer. So the major reason to reduce fat is to decrease one s chances of dying early from diabetes, heart disease, etc and more importantly to lead a fitter and more productive life
Is obesity surgery for me
If one has a BMI( body mass index) calculated as weight (in kgs)/ height (m2) of 40 or more OR BMI of 35 + one comorbid condition like diabetes / hypertension one is a candidate for considering bariatric surgery (surgery for the morbid obese).
Which procedure is for me
There are many procedures for bariatric surgery. They are lap band, lap sleeve gastrectomy, lap gastric bypass and biliopancreatic diversion. The first 2 procedures(restrictive) work by limiting food intake and last 2 (malabsorptive) by causing decreased absorption and food intake . The former will achieve a weight loss of 50 -70% of excess body weight whereas the latter will achieve 70-80% excess body weight loss.
Band procedure however mandates more compliance and follow up and is more susceptible to cheating.
Gastric bypass is offered to patients who understand that it is the most effective procedure for weight loss but it comes with a price of a little more risk of leaks and death than other procedures. It also requires regular monitoring of vitamins and minerals to prevent deficiency states.
Gastric bypass is also the procedure of choice for patients having obesity with diabetes because of its 87% chance of curing diabetes.
How is life after Bariatric surgery
All post bariatric surgery patients need to know that they will not be able to eat as much they used to because of their smaller stomach size. Their hunger is satisfied eating much less than before. However this should not be interpreted as becoming weak because on the contrary these people start leading a more active life as soon as they start losing weight and gaining confidence. The usual instructions for a healthy lifestyle of eating correctly (no sweets, colas, fried food) and moving more applies even after surgery.
All patients with band have to come for regular follow up to see that the band is in the right place and is not too tight or loose. One may need to adjust the band sometimes and may require removal too.
Patients who undergo gastric bypass however have to consume iron and vitamin B regularly and also need to be checked for the same periodically with some blood tests.
Will I be able to have a normal sexual and reproductive life after weight loss surgery?
Many obese people have a poor sex life. They have associated psychosocial complexes originating from the same and needs to be addressed preoperatively. Post surgery as the weight starts reducing the patient gains his or her mobility not to mention the pelvic anatomy which starts getting restored from amidst the sea of fat.
It has been seen that they become more sexually active.
Fertility is a major problem with obesity and many female patients have polycystic ovarian disease, endometriosis as part and parcel of obesity. The fertility rates have also been shown to improve dramatically following weight loss after bariatric surgery.
Childhood obesity
In the USA 1 in 4 child is obese and they carry a huge risk of persisting obesity in adulthood. In India the scenario is not too different either with an incidence of 1 in 5 urban children being obese. The scary part is most of them are going to stay fat lifelong. Preventing an unhealthy lifestyle in children (fried food, pizzas, burgers colas, long hours at TV to name a few) should be undertaken by parents, teachers and policymakers to avoid a loss of productive healthy generation next .
What are the complications of weight loss surgery
Like all surgeries bariatric surgery is not exempt from its share of troubles. Morbid obese subjects are high risk for anaesthesia. They could have preexisting lung and cardiac problems along with risk for venous thrombosis(clots in leg veins) which may aggravate after surgery. Surgery entails joining bowels with sutures or staples which may leak and result in infection, prolonged hospital stay, increased cost, second surgery and rarely even death. Having said that advances in modern anaesthesia and availability of stapler buttressing technology has brought down these risks tremendously . Late complications are rarer . Bands may slip from their position or may require adjustment or may erode requiring removal.
Gastric bypass procedures may lead to iron and vitamin B deficiencies which needs replacement regularly.
The stomach pouch or sleeve have a theoretical possibility of regrowing to original size and plateauing of weight loss benefits but experience and literature have not held it as something alarming.
How long do I stay in the hospital?
Usually patients are sent home in 2 to 3 days since the operation is done through keyhole surgery. They are allowed to drink and move within 24 hours.
I have heard similar surgery is done to cure diabetes
The same surgeries are being done apart from some new ones to cure adult onset diabetes. There is now enough evidence in literature to advocate this procedure to cure diabetes. Immediately after surgery and usually before the patient is discharged home the patients have normal blood sugar. It is an exciting option for diabetics who wants a permanent solution. After all who wants to take pills and injections on a regular basis and live with the fear of diabetic complications.
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