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Combating Obesity

Every third person is obese in the US and every fifth struggling with excessive weight in the UK

"Remember, there is much misinformation about weight loss surgery that you may encounter from unqualified sources" - Dr V Venkatesh Consultant Gastro-Intestinal Endo Surgeon Indian Institute of Laparoscopic Surgery Coimbatore

Obesity is emerging as the next big killer in India with over 2.2 crore people in India being obese. Of these, there is big percentage of people who are morbidly obese with a Body Mass Index (BMI) of more than 32.5. These people are highly vulnerable to high blood pressure, diabetes, cardiac problems, sleep apnea, high cholesterol and a host of other illnesses.

In the US and UK, obesity is already is a cause of huge health concern as every third person is obese in the US and every fifth struggling with excessive weight in the UK. Lifestyle changes like diet, exercise, medication may help people who are overweight but not in morbidly obese people. Studies indicate that weight loss is not substantial in 95-97 per cent morbidly obese people who undertake exercise and diet. Even if they lose weight, most regained it in the span of five years. In fact repeated dieting leads to more obesity due to yo-yo effect.

When all fails, surgery comes to the rescue of the obese. Specialised surgery for the obese known as bariatric surgery now offers a number of options popular amongst which are gastric banding, gastric bypass and sleeve gastrectomy.

What causes morbid obesity?

The reasons for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of over-eating. Research has shown that, in many cases, a significant underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.

Science continues to search for answers, but until the disease is better understood, the control of excess weight is something patients must work at for their entire lives. That is why it is very important to understand that all current medical interventions, including weight loss surgery, should not be considered medical cures. Rather, they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease.

Not Just Fat, the Surgery Cures Diabetes as Well

The cutting edge surgeries have benefited diabetics the most, where obese patients get completely cured of Type -2 diabetes. "This is the most promising effect of obesity surgery."

Morbid Obesity - Threat on Your Health

Morbid obesity carries an increased health risk. The risk of death from diabetes or heart attack is five to seven times greater. Apart from increased risk of death, social, psychological and economic effects of morbid obesity, however can be especially devastating. Obesity can ruin your health as it leads to patients develop resistance to insulin, excessive risk to paralysis, arthritis of knees, sleep apnea/ respiratory problems, gastro-oesophageal reflux/ heart burn, depression and infertility.

Bariatric Surgery - A Serious Approach to a Serious Problem

Bariatric surgery is a laparoscopic surgery performed on morbidly obese people with a BMI of 37.5 or above and BMI 32.5 with associated medical diseases.

Gastric Banding

In gastric banding, a band is placed around the stomach which divides the stomach into two halves, thereby restricting the amount of food intake. This procedure is easy to and is reversible. On the flip side, sustained weight loss may not be possible.

Roux-En-Y Gastric Bypass Surgery

Gastric bypass is considered the gold standard in treating morbidly obese patient worldwide. Here, the stomach is made smaller to about one-tenth of the original size and allows food to bypass part of the small intestine.

Sleeve Gastrectomy

This is considered a safe procedure where the stomach is shaped like a tube, reducing the size to about 3/4th.

The surgery works in rapid weight loss as the person feels full much more quickly than when the stomach was its original size. This cuts down on the amount of food that is eaten. In gastric bypass part of the intestine is bypassed, and hence results in fewer calories being absorbed. Bariatric surgeries are being done laparoscopic ally by making a small incision and using small instruments and a camera to guide the surgery. Through minimum invasion, the procedure can be completed in one hour time and requires one to three days of hospital stay, just like in medically advanced centers in the US, UK and other countries.

Care is taken to check leakage of the anastomosis or the new joint, one of the most common complications in obesity surgery, right on the operation table through an intra-operative endoscopy procedure. This safeguard procedure helps to and gives good results to the patients. The patient will loose around 40 - 50 kgs in six to nine month's time, which really may not be possible in any other modalities of treatment in obesity. This has gained worldwide acceptance and the procedure hence performed routinely like any other laparoscopic surgeries. These procedures should be performed by an experienced laparoscopic surgeon well-trained in the art of advanced laparoscopic surgeries. Indian Institute of Laparoscopic surgery, VG Hospital, MTP Road, Coimbatore, India is managed by Dr V Venkatesh, Consultant Gastro-Intestinal Endo Surgeon, who has trained over 1,350 specialists in the art of laparoscopic surgery from all over the country and globe, both in the basics and advanced laparoscopic surgery. This is truly a world record by any individual in the country. He is at present Regional Governor of Endoscopic and Laparoscopic Surgeons of Asia (ELSA). He may be contacted at www.vghealthcare.com.

Significant Obesity-Related Health Conditions

Obesity-related health conditions are health conditions that, whether alone or in combination, can significantly reduce your life expectancy. A partial list of some of the more common conditions follows. Your doctor can provide you with a more detailed and complete list:

• Type two diabetes.
• High blood pressure / heart disease.
• Osteoarthritis of weight bearing joints.
• Sleep apnea / respiratory problems.
• Gastroesophageal reflux / heart burn.
• Gallbladder.
• Depression.
• Infertility.
• Skin breakdown.
• Swollen legs/ skin ulcers
• Urinary stress incontinence.
• Menstrual irregularities.
• Lower extremity venous stasis.
• Dyslipidemia (lipid metabolism abnormalities).
• Pulmonary embolus.
• Pancreatitis.

Minimally Invasive Surgery

For the last two decades, laparoscopic procedures have been used in a variety of general surgeries. Many people mistakenly believe that these techniques are still 'experimental'. In fact, laparoscopy has become the predominant technique in all areas of surgery and has been used for weight loss surgery for several years. When a laparoscopic operation is performed, a small video camera is inserted in to the abdomen. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this offers better visualisation and access to key anatomical structures.

The camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. Study shows that patients having had laparoscopic weight loss surgery experience less pain after surgery resulting in easier breathing and lung function and higher overall oxygen levels. Other realised that benefits with laparoscopy have been fewer wound complications such as infection or hernia, and patients returning more quickly to pre-surgical levels of activity.

Diet

The modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss. It is important to remember that every surgeon does not perform the same weight loss surgery procedure and that the dietary guidelines will be different for each type of procedure. What is most important is that you adhere strictly to your surgeon's recommended guidelines.

The following are some of the generally accepted dietary guidelines for a weight loss surgery patient.

• When you start eating solid food it is essential that you chew thoroughly. You will not be able to eat steaks or other chunks of meat if they are not ground or chewed thoroughly.
• Don't drink fluids while eating. They will make you feel full before you have consumed enough food.
• Avoid desserts and other items with sugar.
• Avoid excess salt intake.
• Avoid carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat foods and foods with high fiber content.
• Avoid alcohol.
• Avoid snacking between meals. Instead you can take some fruit juices using sugar free tablets.

Post-Surgery Recovery

Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Many patients return to full pre-surgery levels of activity within four weeks of their procedure.

Birth Control and Pregnancy

It is strongly advised that women of child-bearing age use the most effective forms of birth control during the first 16 to 24 months after weight loss surgery.

Long-term follow-up

Nutritional deficiencies that occur over the course of many years will need to be corrected. Over time, you will need periodic checks for anaemia (low red blood cell count), vitamin B12 levels, folate and iron levels. Follow-up tests will initially be conducted every three to six months or as needed and then every one to two years.

Taking the First Step

Where do you begin once you've decided to explore the option of weight loss surgery? This booklet is a good place to start. It has been created to give you a thorough understanding of the risks and benefits of the procedures. Talking to your primary care physician, physician specialist or family physician is a good next step. Finding a local weight loss surgeon and support group is another good step. Remember, there is much misinformation about weight loss surgery that you may encounter from unqualified sources. Talking to others who have taken the path that you are now considering, may help you to understand what you need to know to make a decision you can be comfortable with. In the end the best source of information is your surgeon who knows how to handle your special needs before, during and after weight loss surgery.

Indian Institute of Laparoscopic Surgery Research and Training Centre
Mettupalayam Road
Coimbatore, India.
Tel : 0422 - 2642071, 2642772, 4226777.
Fax: 0422 - 2643499, 4226799.
E-mail: vghospital@eth.net
Website : http://www.vghealthcare.com