KOCHI: March 4 is observed as World Obesity Day, to spread awareness on obesity and related illnesses. Modern medicine has come up with techniques to reduce body weight as well as abdominal fat.Body Mass Index (BMI) is an estimate in relation to the weight and height of a person. It is alculated as weight in kilogram divided by two times the height in meter. BMI of 20 to 25 is considered normal, while 26 to 30 is over weight and values above 30 is considered obese.
If overweight is a predisposition for illness, obesity is a disease itself and needs treatment. Obesity is increasing in India too. On one side when the nation is trying to reduce poverty related illnesses it is undesirable to see that people are falling ill due to over-eating and obesity. Abdominal obesity is predominant in Kerala.
Reasons for obesity
1. Hereditary factors
2. Food habits
3. Lifestyle
4. Hormonal changes
Effects of obesity
When weight increases, it directly affects the heart and the respiratory system. Being made to pump in greater force, to a larger area weakens the heart. This leads to heart attack at an early age. Cholesterol deposition causes reduction in lumen of blood vessels leading on to high BP (hypertension). Chances of vascular events like heart attack and stroke are high due to blockage of vessels in these patients.
Requirements for coronary angioplasty and cardiac bypass are three to four fold compared to persons of normal weight.
Obesity also leads to sleep disorders and respiratory problems called as sleep apnoea. Excess fat causes damage to pancreas and induce insulin resistance. This in turn result in high blood sugar (diabetes mellitus). Increased weight damages joints and bones leading to early arthritis necessitating joint replacements.Women with increased body fat suffer from polycystic ovarian disease (PCOD), which causes infertility and is mostly reversible if person loses the excess weight. Body image issue is a significant contributor for mental disease like depression.
Solutions
Controlled diet and exercise helps counter the problem. Drugs which induce malabsorption of fat, which in turn reduces calorific value of food can be administered. A permanent solution for extreme obesity and related illness is surgery. Measures such as reduction of size of stomach and diversion of food from the stomach to the distal part of the intestine have proved effective in dramatic reduction in fat and weight. As these procedures are done through laparoscopy, they are comfortable, safe and simple for a patient.
Intra-Gastric Balloon (IGB )
A balloon folded in the shape of a small tube is introduced in to the stomach under endoscopic guidance. 600 ml fluid will is instilled to fully expand it. It stays in the stomach for six to eight months, while the patient loses 10 to 15 kg weight. It is then removed under endoscopic guidance. The procedure is suitable for age group below 18 where bariatric surgery cannot be performed and also for females suffering from infertility due to PCOD.
Laparoscopy
In obese patients open surgery is extremely difficult and can result in respiratory distress, blood clots in the vessels and slowing of the intestinal motility (Ileus). Laparoscopic surgery avoids such problems and the patient does not require long periods of rest.
Sleeve Gastrectomy
A portion of stomach which secretes ghrelin is removed. This reduces the hormone release and quantity of food patient intake.This is sure to bring down the weight of the patient drastically with desirable effects on co-existing illness.
Gastric bypass
In this procedure, the stomach is made into a small pouch and connected to a distal part of the intestine so that the absorption of nutrients is reduced, resulting in weight loss. Many studies have shown that surgery helps in dramatic weight loss and also resolves conditions associated with obesity.
The requirement for insulin is reduced to 90 percent and hypertension medication can be discontinued by almost 80 percent of persons.Post surgery patients may require procedures like liposuction, lipectomy or abdominoplasty for cosmetic purpose. So it is advisable for everyone who has obesity to resort to some of the above mentioned procedures, to get back to quality lifestyle. The author is the senior consultant and HOD - General and Laparoscopic Surgery, VPS Lakeshore Hospital, Kochi