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—Gastric Banding – Gastric Bypass


Management of  Obesity

Prevalence of obesity
Weight problems are growing in India. More than 10 million Indians are overweight. Half of these people are more than 25 yrs over weight 15%-20% oh these people are more than 50kgs overweight. Each year this number is growing

Obesity is rapidly increasing problems all over the world, is number 2 preventable causes of death after smoking. This growing rate represents a pandemic that needs urgent attention if its potential morbidity, mortality and endemic tolls are to be avoided.

Classification of obesity

Obesity is characterized by Body Mass Index (BMI) which is calculate by Weight (in Kgs) divided by Height (in meter) squared.
BMI = Weight in Kgs
(Height in Meters)²
A BMI of:

Classifies one as:
<18.5 Underweight
18.5-24.9 Normal weight
25-29.9 Overweight
30-34.9 Obesity Class I
35-39.9 Obesity Class II
40-49.9 Obesity Class III
50 and above Super Obesity

A BMI more than 30 indicates obesity and it reflected by increased Waist circumference. Waist circumference is a better assessor of metabolic risk than BMI because it’s more directly proportional to metabolic total body fat and the amount of metabolically active visceral fat
Morbid obesity: When obesity is so severe that it threatens ones health and affects life span of individual.

BMI > 35 with medical problems
BMI > 40 without medical problems
Indian & Asian population develop more problems at lesser BMI
Waist circumference of >102 cm in men & 88 cm in women require urgent attention
Waist/hip ratio of 0.95 in men & 0.8 in women needs consideration

Other important criteria
Waist / Hip ratio
The occurrence of heart problems, hypertensions are directly correlated with waist circumference. Waist circumference more than 94cm in men and 80cm women and waist to hip ration more than 0.95 in men and 0.8 in women are associated with increased risk for heart attacks.
Waist circumference of 102cm in men and 88 cm in women indicates very high risk for cardiac problems and diabetes and needs definite treatment.

Asian population with typical normal BMI may conceal underlying excess adiposity characterized by increased percentage of fat mass and reduced muscle mass.

What makes you Over weight

Consumption of food in high calories (high Fat and Carbohydrates)

Consumption of excess food (too much food)

Not enough Exercise and sedentary life

Genetic Factors

Endocrine factor

Obesity increases the chances of developing following diseases

Obesity is one of the leading causes of Death. Obese people die 9 -12 yrs younger than normal people. It results in severe depression, lack of self esteem and certain cancers like uterus, cervix, colon, prostate and breast.

Co morbidities ( medical problems) related to obesity include the following

Cardiovascular - Essential hypertension, coronary artery disease, left ventricular hypertrophy, corpulmonale, obesity-associated cardiomyopathy, accelerated atherosclerosis, pulmonary hypertension of obesity

CNS (Brain) - Stroke, idiopathic intracranial hypertension, meralgia parasthetica
Gastro intestinal system - Gall bladder disease (cholecystitis, cholelithiasis), nonalcoholic steatohepatitis (NASH), fatty liver infiltration, reflux esophagitis

Respiratory - Obstructive sleep apnea, obesity hypoventilation syndrome (Pickwickian syndrome), increased predisposition to respiratory infections, increased incidence of bronchial asthma
Cancers - Association with endometrial, prostate, gall bladder, breast, colon, and, possibly lung cancer

Psychologic - Social stigmatization, depression

Orthopedic - Osteoarthritis, coxa vera, slipped capital femoral epiphyses, Blount disease and Legg-Calvé-Perthes disease, chronic lumbago (back pain)

Metabolic - Insulin resistance hyperinsulinemia, type 2 diabetes mellitus, dyslipidemia (characterized by high total cholesterol, high triglycerides, normal or elevated low-density lipoprotein, and low high-density lipoprotein)

Reproductive - Anovulation, early puberty, infertility, hyperandrogenism and polycystic ovaries in women, hypogonadotrophic hypogonadism in men

Obstetric and perinatal - Pregnancy-related hypertension, fetal macrosomia, pelvic dystocia
Surgical - Increased surgical risk and postoperative complications including wound infection, deep venous thrombosis, pulmonary embolism, and postoperative pneumonia
Pelvic - Stress incontinence

Cutaneous - Intertrigo (bacterial and/or fungal), acanthosis nigricans, hirsutism, increased risk for cellulitis and carbuncles

Extremity - Venous varicosities, lower extremity venous and/or lymphatic edema
Miscellaneous - Reduced mobility, difficulty in maintaining personal hygiene

How to lose weight

The 3 major phases of any successful weight-loss program are (1) a preinclusion screening phase; (2) a definitive weight-loss program; and (3) a maintenance phase, which can conceivably last for the rest of the subject's life but which must last for at least 2 years after the weight-loss program is completed.

Weight loss as medical treatment

A reasonable goal for weight-loss in the setting of a medical treatment program is approximately 0.9-1.5 kg/wk. The concept that the weight-loss goal for each subject must be individualized and cannot be unilaterally based on standard weight-for-height norms is becoming increasingly apparent.
One must consider the family's weight, as well as the patient's weight and cultural, ethnic, and racial background in setting individualized goals of weight loss.
Like all chronic medical conditions, effective management of obesity must be based on a partnership between a highly motivated patient and a committed team of health professionals, including the physician, psychologists or psychiatrist, physical and exercise therapists, dietitians, and other sub specialists, depending on the co morbidities of the individual patient.

Results of weight-loss management

Results of most weight loss management programs are dismal. On average, participants in the best weight-loss programs lose approximately 10% of their body weight, but people generally regain two thirds of the weight lost within a year, and they regain almost all of it within 5 years.
When defined as sustained weight loss over a 5-year follow-up period, the success of even the best medical weight-loss programs is next to nil. Most available data indicate that, irrespective of the method of medical intervention, 90-95% of the weight lost is regained in 5 years. In general, body weight and body fat generally tenaciously regulated. Available data suggest that a loss of approximately 10% of body weight in subjects who are obese (BMI <40) is associated with virtually maximal benefits regarding obesity-elated co morbidities;

Surgical Care

Surgical therapy for obesity (Bariatric surgery) is the only available therapeutic modality associated with clinically significant and sustained weight loss in subjects with morbid obesity associated with co morbidities. Evidence shows that well-performed Bariatric surgery in carefully selected patients and a good multidisciplinary support team substantially ameliorates the morbidities associated with severe obesity Patient selection for these procedures must be addressed along the same stringent lines as those discussed above for potential patients for medical weight-management programs.