CHENNAI: Most patients with severe obesity cannot lose and maintain weight with nonsurgical treatment and lifestyle modification. Even available drugs can only lead to modest weight loss. As this is often unsustainable, studies have shown that surgery offers a permanent and viable solution compared to other options.
“Surgery is the best option to reduce weight up to 100 - 200kg. Laparoscopic sleeve gastrectomy (LSG) and laparoscopic balloon gastrostomy (intragastric balloon placement) apart from bariatric surgery are the most preferred procedures for weight loss,” said Dr Tapas Mishra, senior laparoscopic, gastrointestinal and bariatric surgeon at CARE Hospital, Bhubaneswar.
“Although new drugs (injectables) are now available for modest weight loss, these imported injections may not be beneficial for those who want to lose more than 15 kg,” he added.
Although doctors advice to exercise regularly and avoid gulping down junk food filled with calories, they never prescribe heavy workout or extreme diets, even for obese patients, as they may cause more harm than good. However, weight loss can be managed with medical intervention. “Following diet plans like crash diet - drastically reducing intake of calories to lose weight faster, ketogenic diet where they cut down on carbodydrates and increase intake of fat, paleo diet involving high protein and other methods without supervision are risky,” said health experts.
A multidisciplinary approach is essential, says Dr Vijay Kumar Gurjar, senior consultant and head of internal medicine, Primus Super Speciality Hospital. Treatment options may include lifestyle modifications, medical management and surgical interventions.
“Tailoring treatment plans to each individual’s specific needs by considering their age, overall health and personal circumstances are paramount to achieving successful weight loss outcomes. Collaboration with a team of healthcare professionals, including dietitians, exercise specialists, psychologists and surgeons ensures a holistic and effective approach to weight loss for obese individuals seeking treatment,” he added.
When going on a diet, it is important to ensure that the body gets the nutrients it requires. “Cutting down meals totally or partially should be supported with nutritional supplements because the body will lose nutrition during weight loss,” said J Supraja, senior dietician, Dr Mohan’s Diabetes Specialities Centre, Chennai. “There are patients who landed in trouble by following their own diet,” she added.
“A dietician plans customised diet by taking into account the age of the patient, weight and other medical complications like diabetes, PCOD in women, etc.,” said Meenakshi Bajaj, dietician at Tamil Nadu Government Multi Super Specialty Hospital, Chennai. “An individual can only burn 500 calories per day and only 4kg of weight loss in a month is recommended,” she added.
There are eight to ten types of bariatric surgery. The procedures make changes in the digestive tract and limit the amount of food which can be eaten and/or reduces the absorption of nutrients. They also make hormonal changes which improve satiety and reduces weight.
“Bariatric procedures remain the most effective tool in managing morbid obesity and is typically offered to patients with BMI of more than 37.5 kg/m2 without associated diseases and to those with BMI of 32.5 kg/m2 or more with associated diseases such as type 2 diabetes, hypertension, obstructive sleep apnoea, joint pains, snoring, PCOS, infertility and depression etc,” said Dr Nikhil Agnihotri, senior consultant, department of minimal access metabolic and bariatric surgery, Aakash Healthcare.
Bariatric surgery is now called metabolic surgery as it controls blood sugar and blood pressure, resolves snoring and sleep apnea other than weight loss.
LSG is the commonly performed weight loss surgery in the country. Patients who have had gastric sleeve surgery normally lose between 50% and 60% of their excess body weight in 12-18 months. If patients follow their dietary restrictions and exercise diligently they may lose more.
“These procedures are now even performed with robotic assistance which further increases the safety profile. The biggest advantage is that along with excess weight loss over a period of time, a complete resolution of associated diseases is also possible depending on the duration of disease and prevents development of their complications such as kidney failure, cardiovascular problems (myocardial infarction, brain stroke, heart failure) and respiratory failure,” Agnihotri said.
“There are a few medicines which can be taken for a maximum of one year for weight loss. People with 10-20kg of excess weight can use these medicines and is recommended only for people over 18 years of age. It is not recommended for pregnant women and other risk groups,” said Dr Raj Palaniappan, director, institute of bariatrics, Apollo Hospital.
“The medical expenditure would be `10,000 per month. But, along with the medicines, the patient can also take nutritional supplements which cost again around `2,000 per month,” he added.
“If the patient has 30kg extra weight with an eating disorder, then endoscopic ballooning is recommended in which a patient is made to swallow a tube balloon and 5cc of water is injected in the swallowed balloon. This way, three fourths of the stomach is filled, so patients cannot eat much. This will reduce food intake,” said Palaniappan.
“Bariatric or metabolic surgeries are recommended to people overweight by 30kg or more with uncontrolled diabetes, BP and other complaints. Bariatric surgery is to only reduce weight. Metabolic surgery resolves the disease of obesity and weight loss,” he added.
“For people below 18, surgery is recommended only if the patient has a life threatening problem like obesity, difficulty in breathing and other problems. Otherwise, obesity can be managed with diet control, exercise and lifestyle changes,” Palaniappan said.
With inputs from Ashish Srivastava (New Delhi), Hemant Kumar Rout (Bhubaneshawar)