OBESITY

Bariatric Surgeons in Bangalore | Dr. Prabhu

Obesity is the biggest health epidemic the world is facing now. Obesity is a disease that involves accumulation of excessive amounts of fat in the body, and is usually a consequence of lifestyle changes with time. Obesity can be caused by many factors apart from dietary habits. The disease can manifest due to genetic, environment and other factors like a sedentary lifestyle. Initially, it was considered just as a ‘ cosmetic problem, but in current medicine, this is treated as a ‘ chronic disease’ as it has widespread effects on the body.

Obesity is now the number 1 cause of cancer worldwide and is assosciated with all the following metabolic and physiological sequences:

PICTURE needed for showing the effects:

Best Bariatric Surgeon in Bangalore

There is now evidence to suggest that obese people have  lesser quality of life and lifespan compared to normal poupluation. Though weight-loss is a bigger challenge for obese people, even a modest loss of fat can improve or pre-empt the health problems associated with the disease. Obesity is a treatable condition, and involves the effort of a multidisciplinary team, with the patient being the main focus of a tailored approach.

Causes of Obesity

Obesity is primarily the result of imbalance between consumption and exhaustion of those calories. The excess calories get stored as body fat, and visceral fat.  Much of our diet is too high in calories-often in fast foods, beverages and desserts. The consumption of excessive calories is sometimes also linked to stress,  anxiety and work pressures.  There are many risk factors  that can preclude for obesity including sendentary work and lifestyle, lack of sleep, limited exercise activity and unwarenesss of need to take control of body weight.

There are other contributable  medical conditions  to obesity like:

  • Genetics
  • Hormonal
  • Drugs
  • Medical conditions

Diagnosing Obesity

Though obesity can seem obvious to some, many people with a higher body mass may not look obese. If the doctor suspects obesity, he or she will conduct a physical examination and recommend some tests. It would start with a review of the patient’s medical history, including family history. The review would include the patient’s weight history, efforts at weight-loss, exercise habits, family history of obesity  and other weight-related health issues.

A diagnosis of obesity is pretty much confirmed by the patient’s body mass index (BMI). The doctor will check your body mass index. A BMI of 30 or higher is the threshold for obesity in the western world, while in Asia, BMI greater than 25-27.5 is now being classed as obese. The reason being asians are more prone to develop obesity related illness like diabetes, high blood pressure and other metabolic effects at a lower BMI compared to the western counterparts. A number considerable higher than 30 puts you at higher health risks. Generally, your BMI should be checked at least once a year because it a good indicator of the state of your overall health. If a BMI check result is a little under 30, the person can know that he or she is approaching obesity and take preventive measures.

Even if obesity has been diagnosed, the waist measurement is an important indicator of the health risks involved. High visceral or abdominal fat stored around the waist increases the risk of heart disease and diabetes. Hence, like BMI, waist (circumference) measurement or waist-hip ratio ( WHR) is also used to detemine the degree of obesity.

At the time of diagnosis of obesity, the doctor will also check for other possible health issues including blood tests for diabets cholestrol, liver and kidey function, Body Compositon analysis ( BCA) test, and other tests relevant to the health status.

Why Dr.Prabhu for Obesity

15 + years of Experience

200+ Surgeries

1000+ Happy patients

75+ Obesity cases treated

CLASSIFICATION OF OBESITY ( For Asians):

Based on BMI kg/m

Underweight          < 18.5

Normal                     18.5 – 22.9

Overweight             23.0 – 24.9 

Obese                       >25 ( WHO for western patients : BMI > 30 )

Class 1 Obesity       25.0 – 29.9

Class II Obeisty      30.0  – 34.9

Class III Obesity     > 35.0

Treatment for Obesity

Obesity is still considered as a ‘stigma’ by many, and many patients  actaully defer from seeking treatment for this reason. It is now well known that obese patients on an average have a lesser span of life than normal patients, and have poor quality of life owing to the multiple comorbidities they face. Until 2019, bariatric surgery in India was classified as “cosmetic surgery” for insurance purposes, but now, it is being considered as a life saving surgery for obese individuals. The postive effects of weight loss in just not seen on physcial appearance, but also on mental health, leading to improvement in quality of life.

Lifestyle Changes

Treating obesity depends on the amount of stomach fat to be lost and its persistence despite lifestyle changes and exercises that the doctors may suggest. Counselling informs patients that weight-loss is a slow process, which take hard work and perseverance. The obese patient undergoes a thorough dietic review by the bariatric dietician, and tailored diet plans are adviced to reduce the calorie intake.  Meal replacement shakes are also provided to accelearte the weight loss. Physio/ yoga therapy advice is also provided to enahnce quality calorie loss, and tailored to suit patient’s physcial condtion.

Lifestyle modification can be the primary treatment for patients who are overweight/ marginally obsese, and with effort from the patient, they can lose the  excess weight with desired results.

Pharmacotherapy:

There are very limited drugs having long standing benefits, and is usually reserved for short term outcomes after careful consideration of patient profile.

Endoscopic Therapy:
  1. Gastric Balloon:

 This involves placement of a balloon 450- 650 mls in the fundus of the stomach, and this is inserted using the endoscope. This works by reducing the appetite, and gives a feeling of being full. This is usally left in place for 6-12 months and then removed. This therapy is adviced based on the patient’s BMI, personal choice and determined by the amount of excess weigth loss desired.

  1. Endoscopic Sleeve Gastroplasty:

This is realtively new procedure in the last few years, and has good outcomes from the intial trials. This involves suturing the stomach using a endoscope and special kit called ENDOSTITCH, that enables the bariatric endoscopist to place precise sutures in the stomach to narrow it, similar to a laparosscopic procedure. This reduces the intake of food, and also acts via hormonal mechanisms to aid weight loss. This mimics the laparoscopic sleeve gastrectomy procedure, and is recommended based on patient’s BMI and choice. 

Bariatric Surgery

In case where dietary changes and exercise are not effective, or in patient’s with large BMI, bariatric surgery is a sure shot option for weight loss. There is now exhaustive evidence to show that surgery with dedicated multidisciplinary follow up results in loss of excessive weight and resolution of many comorbidities like diabetes, hypertension, ostructive sleep apnea, joint pains etc and is also shown to imporve fertility in female patients espscially one’s with PCOD. There are several kinds of bariatric surgeries but the most commom are discussed here. They are minimally-invasive surgeries, which require a very short hospital stay. Recovery is faster and the patient can soon lead a more active life.

Gastric Banding

In this procedure, a soft band is tied around the upper part of the stomach. This has the effect of reducing the quantity of food that one can consume in one meal. It also makes the person feel fuller for a longer time. This aids in one weight loss. This was a very popular pocedure few years back, but now is out of vogue due to the complications seen with time. This is usally not recommended as a bariatric procedure in major centers now.

Laparoscopic Sleeve Gastrectomy

This procedure involves taking 2/3RD of the stomach out and leaving behind a sleeve/ banana sized stomach. The stomach is removed by stapling the stomach over a narrow calibaration tube, and the divided stomach is removed from the body. LSG is now the commonest procedure done worldwide with comparable results to the gastric bypass surgery. This procedure is not recommended for patients with reflux/ GERD as the residual stomach exagerates the reflux. With a tailored multidiscplinary approahch the patient casn expect to lose upto 60-80% of his excessive weight ( Eg: patient with a weight of 140 kg, should be ideal weight of 80 kg He has 60 kg excessive weight) patient loses about 60%- 80% of extra weight in over a year and continues upto 2-3 years when the body sets into a new weight.

Roux-en-Y Gastric Bypass:

For more than two decades, this procedure continues to be the ‘gold standard’ procedure for weight loss, and is particularly recommended for diabetic patients. In this surgery, the stomach is divided to form a pouch size of a thumb. The small intestine is divided and one limb is bought up to anastomose to the new stomach pouch. The biliary limb is then anastomosed distally, usually 150-200 cms away to the primary limb. In principle, the food consumed mixes with the digestive jucies nearly 200 cms away ( bypassing the duodenum), and this leads to weigth loss via hormonal and restictive food mechanisms.

Mini-Gastric Bypass (MGB)

MGB is performed using a hybrid of two surgical techniques. The surgery divides one-fourth of the stomach from the rest of the organ with staples. The smaller part of the stomach is then attached to the small intestine at a spot above the existing juncture with the stomach. This results in roughly three-fourths of the stomach and one-third of the small intestine being prevented from participating in the digestion process. These sections are ‘bypassed’ in process of storage and absorption of food. MGB is the successor to an older gastric bypass surgery called the Roux en-Y procedure.

There are complications and side effects of these procedures, and the Bariatric Surgeons in Bangalore will discuss this in detail before recommending the appropriate procedure.

Post-Surgical Pathway:

The patient usually stays in the hospital for 2-3 days after the procedure. They are encouraged to walk from the first day itself to minimise the risks of DVT and improve the cardio-pulmonary function. The patient will be given a dedicated post dietic and physiotherapy plan to adhere to.

Diet:

Week 1-2: Liquid diet

Week 3-4: Pureed diet

Week 5-6: Semi-solid diet

Week 7 onwards: solid diet

The diet will be tailored to patient’s palate, and will include high protein supplemental shake to complement the diet.

Physiotherapy/ Yoga therapy:

Tailored exercises will also be recommended to complement the diet, and accelerate weight loss with time.

Supplements:

The patient will need to take life long multivitamin tablets to negate any nutritional deficiencies that tend to occur in the first two years after the operation.