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Introduction

Obesity is a treatable disease, where an excess amount of fat accumulated in the body adversely impacts the overall health of an individual and also significantly reduces life expectancy. Obesity is a rapidly increasing health issue reaching epidemic proportions affecting both sexes and involving adult as well as pediatric age groups. One-third of the world’s population or one in every three individuals is considered to be overweight or obese. The United States of America has the highest incidence accounting for about 13%. In India, the incidence is on the rise with one in every five individuals being categorized as either overweight or obese. Obesity among children has increased at an alarming pace compared to adults. Recent data from India report up to 20% of children being overweight or obese compared to 16% in 2005.

Causes of Obesity

Obesity occurs due to an interplay between several factors or from a single factor. An imbalance between energy consumption and expenditure, along with inadequate physical activity with a sedentary lifestyle is the usual culprit. Genetic &Endocrine disorders, Polycystic ovarian disease, Medications, and Psychological disorders are the other causes of Obesity.

Diseases associated with obesity

Obesity affects almost all the systems in the body over time. The ensuing diseases can be life-long and debilitating, resulting in significant financial burdens on the individual and society.

These include:

Type II Diabetes mellitus, Hypertension, Gastrooesophageal reflux disease (GERD), Obstructive sleep apnoea (OSA), Respiratory disorders, Dyslipidemia, Myocardial infarctions, Osteo-arthritis, Cerebrovascular accidents, Infertility, Polycystic ovarian disease, Renal disorders, Urinary disturbances and incontinence, fatty liver and chronic liver diseases, Depression and other psychological disorders, Malignancies, Skin allergies and infections.

Classification of Obesity

Obesity is diagnosed using multiple parameters. One which is most commonly used is the Body mass index (BMI), calculated using the height and weight of the individual.
The World Health Organization (WHO) classifies a BMI of 18.5 to 25 as normal, > 30 as obesity, > 40 as morbid obesity, and > 50 as super obese. For the Asian population, however, a BMI of > 25 is considered obese, and > 37.5 is morbid obesity.

Treatment for Obesity

Obesity is a chronic disease that can be treated. Complete evaluation of the individual is important as it helps identify any direct cause and also aids in planning further treatment.

.Diet & Exercises

.Medical management / Medications

.Endoscopic procedures

.Bariatric Surgery

Bariatric Surgery : Surgery for morbid obesity is called Bariatric surgery. It is a ‘tool’ to reduce weight. Some of these procedures have been in practice for over four decades and are a proven modality of treatment for weight loss. These surgeries are performed laparoscopically which significantly enhances recovery, and reduce post-operative pain and morbidity. Criteria for Bariatric surgery: – BMI above 32.5 with comorbidities, – BMI above 37.5 with or without comorbidities – Age: 16 years to 70 years Commonly performed Bariatric Surgeries include: Sleeve Gastrectomy.Roux-en-y Gastric Bypass.Mini Gastric Bypass.Banded procedures.Re-do Bariatric procedures. The choice of procedure is decided based on the preoperative evaluation.

Questions and Answers:

What are the duration of hospitalization, diet after surgery, and follow-up?
.. Average stay in hospital is 3 to 4 days. No bed rest is required after surgery and patients are encouraged to walk at the earliest.
Liquids are started from the day following surgery and continued at discharge.
Regular follow-up is important. At follow-up, patients are guided on diet and physical activity goals. Patients are encouraged to inculcate healthy lifestyle practices, continue simple nutritional supplements and actively participate in support group meetings
Is the surgery safe?
Bariatric surgery has proven to be safe in multiple clinical trials. Its safety standards are comparable to any other commonly performed laparoscopic operations like hernias, appendices, etc.

Case:

30 years old female, with a BMI of 38 had a Laparoscopic sleeve gastrectomy in her country.
2 weeks after surgery she developed recurrent vomiting and slowly progressed to intolerance to oral liquids.
The evaluation revealed 180-degree torsion of a sleeve with narrowing in a mid-body portion of the stomach with gall bladder sludge.
After counseling and optimization, performed a Laparoscopic conversion of sleeve gastrectomy to Rouxen-y gastric bypass with cholecystectomy.
She had an uneventful postoperative course, on an oral soft diet from week 3 has no reflux symptoms and has recovered extremely well.