Fighting Obesity The Right Way

1. Fighting Obesity The Right Way Obesity is probably one of the most mis-understood diseases today and a lot of people are thinking it is just a cosmetic issue. Unfortunately, obesity has reached epidemic levels and more people are dying of obesity and related diseases then any other non-communicable disease. There are many myths about its treatment and it is important to understand that just like any other disease, obesity needs to be treated in the right ways according to the stage and severity of the disease. Is obesity a disease? Yes, obesity is one of the most dreaded diseases of this century. WHO has defined obesity as DISEASE in which fat has accumulated to the extent that health is impaired. Obesity is defined on your BMI which is calculated as weight in kgs divided by height in meters square. BMI > 25 is termed as overweight and BMI > 30 is termed as obese. Epidemiology of obesity - The current estimates are that 33% of the world’s population of 7.08 billion – a staggering 2.36 billion people are overweight or obese. There are an estimated 2.5 people added to the global population each second and one of them will be overweight or obese. It is estimated that if recent trends continue, by 2030 up to 57.8 percent of the world’s population will be overweight or obese. India is the third fattest nation in the world after USA and China. Almost 3 out of 4 Indians are overweight. Even more alarming is that at least 2.8 million people across the world are dying each year directly as a result of being overweight or obese. Causes of obesity - Energy imbalance over a long period of time is the root cause of obesity. Whenever energy in > energy out, it leads to piling up of calories resulting in obesity. The major causes of obesity are bad eating habits like junk foods or aerated drinks and lack of physical activities. Others include familial, genetic, endocrine causes, few drugs or eating disorders. Impact of obesity – Obesity affects a person from head to toe. As the weight increases, patients suffering from obesity become more prone to developing other diseases like Type 2 diabetes, hypertension, cholesterol, heart issues, sleep apnoea, fatty liver, breathing difficulties, joint

2. pains and mobility issues, PCOD, infertility, many types of cancers, psychological disturbances like depression and many more. What are the treatment options? Diet and exercise – Choosing the right and heathy diet and eating fruits and vegetables over unhealthy fatty foods. Exercising minimum of 45 – 60 mins everyday helps in keeping the calories off you. Diet and exercise is the number 1 treatment option prescribed and tried, but it is only effective for 20% of overweight individuals. So why does diet and exercise fail? 95% of patients who lose weight with rigorous weight loss program will regain the weight (or more) within 2-5 years. It is rightly explained by:- a) YO-YO phenomenon which is linked to the psychological behavior of the obese population. Whenever a patient is given a low caloric diet, there is an initial weight loss which then plateau’s (no further loss). This leads to frustration, discontinuation of diet, regaining fat, and tend to become more obese. This time there is loss of muscle mass and gain of fat. b) Set point theory – In the set point theory, scientists propose that our body decides how much we should weigh and fixes that weight as a “set point”. Metabolic active tissues such as the stomach, send messages to the brain. The brain decides the amount of fat the body should store, called the “set point”. The brain signals the rest of the body to store fat to reach the “set point”. Diet – When we diet, the body thinks it is starving. Fight – The body releases hormones to save energy and causes hunger. Regain – Weight returns as the body tries to get back to the set point. What is bariatric surgery? Bariatric surgery is a type of laparoscopic gastro-intestinal surgery which is performed for the treatment of severe obesity. There is an anatomical and physiological change that results in a metabolic resetting of the weight management system and restriction on intake. This is the only method that leads to sustained weight loss in people suffering from morbid obesity or are atleast 35-40 kgs above their ideal weight. Data suggests that bariatric surgery has the greatest weight loss results when compared to treatment with drugs, diet and / or exercise for those with severe obesity.

3. Who can undergo bariatric surgery? Bariatric surgery can be offered to a patient who has a BMI > 35 or a BMI > 32.5 with one or more serious obesity related conditions. Along with this, the patient must have failed one or more conservative weight loss alternatives, such as supervised diet, exercise, and behavior modification programs and must be at least 18 years of age. Types of bariatric surgeries - 1. Sleeve gastrectomy – 2/3rd of the stomach is stapled off leaving behind 1/3rd stomach. This curbs the hunger hormone – ghrelin and limits the amount of food that one can consume. 2. small intestine is directly attached to the pouch. The pouch limits the amount of food that can be eaten. It also causes your body to absorb fewer calories by re-routing the intestines. Roux – en – Y Gastric Bypass – A small stomach pouch is created and section of the 3. anastomosis with the intestine at a different level. The stomach pouch restricts the amount of food consumed. Bypassing proximal part of small bowel causes your body to absorb fewer calories. Mini – Gastric Bypass – A relatively longer stomach tube is created and there is a single How does bariatric surgery lead to weight loss? Bariatric surgery leads to a weight loss of upto 70 – 75 percent of the excess weight over a year or so. Weight loss is very fast in the first 3-6 months and then it tends to slow down. Reduction in food intake, early satiety and hormonal changes are few of the mechanisms that leads to weight loss. Hunger sensation and food cravings go down significantly after surgery and that keeps the patients comfortable despite less intake. Bariatric surgery also leads to significant improvement in Type 2 diabetes, hypertension, cholesterol, PCOD, infertility, joint pains, sleep apnoea, breathlessness and decreases the overall risk of heart diseases. It leads to significant improvement in the quality of life. Life after surgery​ –

4. The modifications made to the gastrointestinal track will require permanent change in eating habits that must be adhered to for successful weight loss. Exercise is also an integral part of the weight loss journey and it is recommended to exercise daily for 30-45 minutes per day. It is important to understand that obesity is a chronic progressive disease and needs life-long support. No treatment modality works alone and a combination of therapies is needed for successful management of obesity. Dietary intervention and lifestyle modification form the basis of all treatment modalities and is an inherent part of obesity management.