HEALTHWATCH
Dangerous weights
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Apart from causing physical and health problems, obesity can also have emotional effects. Dr. C. PALANIVEL writes about gastric bypass surgery to treat severe obesity.
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REUTERS
DR. PREM, an ENT surgeon from Kerala, was obese. He had gone through many diets and exercises. Even though there was some weight loss, he found it difficult to maintain. He studied various surgical options and concluded that the gastric bypass was most suitable and the laparoscopic method less invasive compared to open surgery. A 22-year-old young man from Aryialur, weighing 200 kg, had also undergone various diets, nature cures, drugs and even plastic surgery without any improvement. Though he had lost weight initially, he gained more than 40 kg after the procedure and was still putting on weight. These are only two instances of a growing problem.
What is obesity?
Obesity means an excess amount of body fat. Though everyone needs some body fat, too much can cause health problems.
How do we measure obesity?
Though we can measure weight, it does not denote whether an individual is overweight or not. Certain other measurements like Body Mass Index (BMI), Waist Circumference and Skinfold thickness are more useful. BMI is the most accurate.
What is BMI?
BMI is calculated by dividing a person's body weight in kg by their height in metres squared. For example, for a person weighing 86 kg with a height of 178 cm, BMI is calculated thus: 86/1.78 2 = 27.14
Why are so many people overweight or obese today?
Body weight is the result of a combination of genetic, metabolic, behavioural, environmental, cultural, and socioeconomic influences. Overweight and obesity result from an imbalance involving excessive calorie consumption and/or inadequate physical activity. Life style and behavioural habits are the most important reasons. Behavioural and environmental factors provide the greatest opportunities for prevention and treatment.
How does obesity affect health?
An overweight person is more likely to develop health problems like heart disease, stroke, diabetes, cancer (such as colon cancer, endometrial cancer, and postmenopausal breast cancer), gallbladder disease, sleep apnea (interrupted breathing during sleep), osteoarthritis (wearing away of the joints).
Does it cause any other problems?
Emotional problems are also linked to obesity like depression, feeling rejected and unattractive; feeling shy, discrimination at work, at school, and in social settings.
What are the methods to lose weight?
The method of treatment depends on level of obesity, overall health condition and motivation to lose weight. Treatment can include a combination of diet, exercise, behaviour modification, and sometimes drugs. In severe cases, gastrointestinal surgery may be recommended.
How does surgery help?
The surgery for obesity (bariatric surgery) alters the digestive process and promotes weight loss by reducing parts of the stomach to make it smaller. Some operations combine with a partial bypass of the small intestine. These procedures create a direct connection from the stomach to the lower segment of the small intestine, literally bypassing portions of the digestive tract that absorb calories and nutrients.
How does an individual lose weight with surgery?
The concept of gastrointestinal surgery to control obesity grew out of results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine. Patients undergoing these procedures tended to lose weight after surgery, so some physicians began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was the intestinal bypass. But it caused a loss of essential nutrients and its side effects were unpredictable and sometimes fatal. Now procedures like gastric bypass surgery and banding are used.
What about plastic surgery?
Plastic surgery removes excess fat from the skin level. The main problem is the long and sometimes heavy scar. And if the incision gets infected, then it takes months together to heal. These procedures can be done only to certain individuals who have isolated deposition of fat in the abdomen and thigh areas. The patient continues to put on weight, as there is no restriction of food. These surgeries do not tackle the root cause of obesity.
What are the advantages of laparoscopic surgery?
Laparoscopy is easier because it uses very small incisions. Thus there is less damage to body tissue, organs, and muscles. The incisions heal without noticeable scars. There's less trauma to the patient and quicker healing. Many people return to their normal routine three to five days after surgery.
What is gastric band surgery?
The adjustable gastric band is a useful technique to reduce the intake of food by an individual. It acts like a belt around the top of the stomach, creating a small pouch. As intake is reduced, the calories needed are removed and burnt from the excess fat in the body. The patient loses weight slowly. Although this procedure is good for the moderately obese, it tends to have a higher failure rate in the long run. The cost is also prohibitive (more than Rs. 1,25,000).
Why is laparoscopic gastric bypass better than the other types?
Laparoscopic gastric bypass surgery has a higher success rate than gastric band. First, a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This reduces the amount of calories and nutrients the body absorbs. This is to achieve weight loss over a period of time, but permanently.
By the third day, the patient recovers and can eat normal food. But due to the reduction in the size of the stomach they can eat less than before. The second part of the surgery, the bypass surgery, allows the food and the digestive enzyme to mix at a farther level than the normal patients. Due to this, the nutrients are not absorbed in the body effectively.
But he continues to spend the same amount of energy everyday. Once the body is not able to derive energy from the daily food intake, it starts using the energy stored as fat in the body. The stored fat is slowly melted and burnt to produce energy. As a result, the patient loses weight and by four to six months, the patient can lose up to 40 per cent of the excess body weight. Since the weight is gradually reduced the patient does not feel tired.
BMI Chart
18.5-24.9 = Healthy Weight
25 to 29.9 = Over weight
30 to 39.9 = Obese
40 or 59.9 = Severe Obesity
{gt} 60 = Super obese
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