What is Obesity?

Obesity is defined as excess body fat. Because body fat is difficult to measure directly, obesity is often measured by body mass index (BMI), a common scientific way to screen for whether a person is underweight, normal weight, overweight, or obese.

Common ailments caused by obesity

• Diabetes
• Cancer
• Cardiovascular Disease(High Blood Pressure/Heart Disease)
• Depression, Sleep Apnoea
• Infertility
• Swollen Legs
• Pulmonary Embolism
• Joint Pain And Stiffness
• High Cholesterol And Obesity
• Hypoventilation

Obesity Is Defined

• Healthy range of weight is 18.5-23
• Overweight is 23-27.5
• class l obesity is 27.5-32.5
• Class 2 obesity is 32.5-37.5
• Class 3 obesity or morbid obesity is >37.5
• Class 4 as super obesity is 40-49.9, and
• class 5 obesity super-super obesity >50

How obesity can be treated?

It can be treated by-

• Walking,gyming,exercise, yoga
• Diet control
• Medicine
• Bariatric surgery

If Unlikely to lose weight or keep it off over the long term using other methods then the patient opt for bariatric surgery

What is Bariatric Surgery?

Bariatric surgery promotes weight loss by changing the digestive system anatomy, limiting the amount of food that can be eaten and digested. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouch (gastric bypass surgery). It cures or improves most of the medical problems like diabetes, blood pressure, arthritis etc.

What criteria candidates should meet

• Have morbid obesity (BMI >37.5 )
• Have a BMI of at least 32.5 and serious health problems linked to weight, such as type 2 diabetes or sleep apnoea, or heart disease that may improve with bariatric surgery.
• Are at least 18 years of age

Types of Bariatric Surgery

• Bariatric surgery may be performed through "open" approaches which involve cutting the stomach in the standard manner
• By laparoscopy
• Nowadays laparoscopic approach is commonly followed.

There are four types of operations that are commonly offered

• Roux-en-y gastric bypass (RYGB)
• Mini gastric bypass(MGB)
• Biliopancreatic diversion with a duodenal switch (BPD-DS)
• Vertical sleeve gastrectomy (VSG).

Roux-en-y gastric bypass (RYGB)

In this procedure the surgeon creates a small pouch and attaches a section of the small intestine directly to the pouch. This allows food to bypass a portion of the small intestine.

Vertical sleeve gastrectomy (VSG).

During sleeve gastrectomy procedure a thin vertical sleeve of stomach is created using a stapling device.The sleeve is about the size of a banana.The rest of the stomach is removed.

Mini Gastric Bypass

The stomach is divided with a laproscopic stapler. The new stomach is much smaller and shaped like a small tube. Between 2-7 ft of intestines are bypassed. The surgeon attaches the remainder of the intestine to the new stomach. The food flows to the small tube like stomach and bypassed between 2-7 ft of intestine where it resumes the normal digestive process in the remaining intestine.

What is the age limit for bariatric surgery?

To be eligible for bariatric surgery, you must be between 18 and 70 years of age.

What is the expected hospital stay for the surgery?

Most patients stay in the hospital actually for 24 hrs -36 hrs. If there are no complications but he is only under observation then the stay is for 2-3 days.

How much weight patient will lose?

A person is expected to lose an average of 60% of extra body weight (beyond the normal expected weight of the individual according to the height) over a duration of about 12-18 months. Gastric bypass patients tend to lose an average of 60-80% of EBW(excess body weight) sleeve patients tend to lose 50-70% of EBW.

How does surgery promote weight loss?

• Bariatric surgery restricts food intake, which leads to weight loss.
• Patients who have bariatric surgery must commit to a lifetime of healthy eating and regular exercise.
• These healthy habits may help patients maintain weight loss after surgery

Benefits of Surgery

Marked improvement is seen in

• Migraine
• Depression
• pseudotumor cerebri
• obstructive sleep apnoea
• hypercholesterolemia
• Asthma
• Fatty liver disease
• Cardiovascular disease
• Hypertension
• Type II Diabetes mellitus
• Polycystic ovary syndrome
• Degenerative joint disease
• Gout

Quality of life is improved in 90% of the patients

How long will I be off work after surgery?

Your time off work will depend on the type of weight loss surgery you have and the type of work you do.

In general, plan to take about one week off from work. While you will not be incapacitated by any means, you will use this period to focus on healthy eating and drinking habits.

Dietary tips for Bariatric Patients

• Eat balanced meals with small portions.
• Follow a diet low in calories, fats and sweets.
• Follow a diet high in protein
• Eat slowly and chew small bites of food thoroughly.
• Allow 30-60 minutes for each meal
• Eat 6 small meals throughout the day instead of 3 big meals. DO NOT snack between meals.
• STOP EATING AS SOON AS YOU ARE FULL.
• Do not use straws, or drink carbonated beverages or chew ice. They can introduce air into your pouch and cause discomfort.
• Avoid sugar, sugar-containing foods and beverages, concentrated sweets and fruit juices
• Don’t tempt yourself with a pantry full of junk foods.
• Eliminate fast food.
• We recommend drinking at least 2 litres (64 ounces or 8 cups) of fluids a day.
• We strongly warn against drinking any alcoholic beverages. After surgery, alcohol is absorbed into the system much more quickly than before, making its sedative and mood-altering effects more difficult to predict and control
• Take your vitamin and mineral supplement every day

Activity and Exercise

• Walking, running, biking, weight lifting, aerobics, badminton, hiking, and dancing in your bedroom like a crazy person can all be added to your weekly routine
• Ensure that you are getting at least 30 minutes of exercise 5 to 7 days a week