THIRUVANANTHAPURAM: Obesity is no longer considered a cosmetic issue that is caused by overeating and a lack of self-control. The World Health Organisation (W.H.O), along with National and International medical and scientific societies, now recognize obesity as a chronic progressive disease resulting from multiple environmental and genetic factors. It is now recognized as the second most common cause of ‘preventable death’ after cigarette smoking.
The disease of obesity is characterised by an excessive accumulation of body fat and is clinically defined by measures that ‘estimate’ body fat from weight, build and height.The body mass index (BMI) is a measure used to define overweight and obesity. Large population studies find that the BMI generally reflects the amount of excessive body fat an adult has, although there are certain exceptions, such as a pregnant woman, an athlete, a body builder or the elderly. BMI also does not take into account a person’s distribution of fat (central vs peripheral).
According to the W.H.O., 65 percent of the world’s population lives in countries where overweight and obesity kills more people than starvation. Approximately 500 million adults in the world are affected by obesity and one billion are overweight, along with 48 million children.
Positive energy balance
A positive energy balance causes weight gain and occurs when the amount of calories consumed (energy intake) exceeds the amount of calories the body uses (energy expenditure) in the performance of basic biological functions, daily activities, and exercise.
Weight gain
Weight gain is yet another contributor to weight gain or, in other words, obesity ‘begets’ obesity, which is one of the reasons the disease is considered ‘progressive’. Such obesity-associated biological changes reduce the body’s ability to burn fat for energy, increase the conversion of glucose (carbohydrate) to fat, and increase the body’s capacity to store fat in fat storage depots. This means that more of the calories consumed will be stored as fat.
Diets
A low calorie diet is the primary treatment for overweight and obesity, but surprisingly, dieting is also a contributor to obesity progression! When a person loses weight, the body ‘thinks’ it is starving and energy expenditure is reduced in order to conserve calories.
Such diet-induced changes also favour a positive energy balance and weight regain and, because the conditions responsible for the reduction in energy expenditure and increased drive to eat persist long-term, an individual will often not only regain all of their lost weight, but even more.
How can surgery help?
When combined with a comprehensive treatment plan, weight loss (bariatric) surgery may often act as an effective tool to provide long term weight-loss and help to increase the quality of health. Bariatric surgery has been shown to help improve or resolve many obesity-related conditions, such as diabetes, high blood pressure, heart disease, and more. Significant weight loss through bariatric surgery may also pave the way for many other exciting opportunities for you, your family, your social life and most importantly – your health.
Long term weight loss Success
Bariatric surgeries result in long-term weight-loss. Most studies demonstrate that more than 90 percent of individuals with severe obesity are successful in maintaining 50 percent or more of their excess weight loss following bariatric surgery.
Several large population studies find that individuals affected by severe obesity who have had bariatric surgery have a lower risk of death than individuals affected by obesity who do not have surgery. One of these studies found up to an 89 percent greater reduction in mortality throughout a 5-year observation period for individuals who had bariatric surgery when compared to those who did not.
Another large population study comparing mortality rates found a greater than 90 percent reduction in death associated with diabetes and a greater than 50 percent reduction in death from heart disease.
Bariatric surgeries also lead to improvement and remission of diabetes, which in the past, was considered to be a progressive and incurable disease.Measures of quality of life that are positively affected by bariatric surgery include physical functions such as mobility, self-esteem, workplace and social interactions, and sexual function.
The author is a Consultant Surgeon, KIMS Hospital, Trivandrum.The views expressed by the author are his own.