Dr. R. Padmakumar
Laparoscopic & Obesity Surgeon

Obesity Overview

Obesity Overview: Obesity is a global pandemic. Management of obesity needs a very comprehensive approach by a dedicated team.

Bariatric deals with Obesity. “Baros” is a Greek word which means heavy or large. Bariatric surgery is also referred to as “weight loss surgery” and is performed on people who suffer from obesity. It includes a variety of procedures like Intragastric Balloon Placement, Laparoscopic Sleeve Gastrectomy, various gastric bypass surgeries, and Sleeve with Hybrid Ileal Interposition. These procedures have proven to be effective in long-term weight reduction, resolution of diabetes, improvement in cardiovascular risk factors and obstructive sleep apnea, etc.

BMI = Weight (kg) / Height (m)2

BMI (kg / m2) Nutritional status
Below 18.5 Underweight
18.5–24.9 Normal weight
25.0–29.9 Pre-obesity
30.0–34.9 Obesity class I
35.0–39.9 Obesity class II
Above 40 Obesity class III

Pediatric BMI Criteria

For children BMI is calculated and compared with Z score for age.


5-18 years: IAP Boys Body Mass Index Charts (Click Link Below)


5-18 years: IAP Girls Body Mass Index Charts (Click Link Below)


Z score more than 1.64 or BMI more than +2 SD is considered as obese.
Z score more than 1.04 or BMI more than +1 SD is considered as
Thinness is less than -2 SD.

Asian BMI Cut-off points :
More than 25 BMI – Clinical obesity
More than 27.5 BMI – Metabolic Surgery can be performed
(2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and
International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)
Indications for Metabolic and Bariatric Surgery
Dan Eisenberg, Scott A. et.al. iObesity Surgery volume 33, pages3–14 (2023))

It is due to an imbalance between energy in and energy out. An increased intake of energy-rich foods that are high in fat and sugars and a reduction in physical activity due to the sedentary nature of work make the body switch over to energy saving mode. Genetic factors also play a role in causation of obesity. Excess production of Ghrelin also is a contributing factor.

Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL).

Metabolic syndrome is associated with the risk of developing cardiovascular disease and type 2 diabetes. In the U.S., about 25% of the adult population has metabolic syndrome, a proportion increasing with age, particularly among racial and ethnic minorities.

Insulin resistance, metabolic syndrome, and prediabetes are closely related to one another and have overlapping aspects. The syndrome is thought to be caused by an underlying disorder of energy utilization and storage.

Patient has at least three of the five conditions

  • Fasting glucose ≥ 100 mg/dL (or receiving drug therapy for hyperglycemia)
  • Blood pressure ≥ 130/85 mmHg (or receiving drug therapy for hypertension)
  • Triglycerides ≥ 150 mg/dL (or receiving drug therapy for hypertriglyceridemia)
  • HDL-C < 40 mg/dL in men or < 50 mg/dL in women (or receiving drug therapy for reduced HDL-C)
  • Waist circumference ≥ 90 cm (35 in) in men or ≥ 80 cm (32 in) in women
  • Sleep apnea
  • NASH
  • PCOD
  • Hirsutism
  • Acanthosis nigricans
  • Xanthelasmas

Image showing Acanthosis nigricans

1) Insulin resistance with fatty acid influx.
2) Low grade chronic inflammation and oxidative stress.

Insulin Resistance - Associated Conditions include type 2 diabetes / pre-diabetes, dyslipidemia, hypertension, acanthosis nigricans, hyperuricemia, NASH, sleep apnea, certain malignancies, dementia, polycystic ovarian disease, female and male infertility, decreased fibrinolytic activity such as atherosclerosis, arteria occlusion, venous thrombosis, CVA/MI

Vascular damage:

  • micro-vascular (retinopathy; nephropathy and neuropathy)
  • macro-vascular (premature and more extensive cardio- , cerebro- and peripheral vascular disease)

Premature mortality and morbidity in diabetes result from such complications.

  • It varies between 7.1 to 42.6 % across counties, 26.1 to 29.8 % in South Asia
  • 3 times likely to have MI and stroke
  • Five fold risk of developing type 2 diabetes mellitus

Reference – https://doi.org/10.1016/j.cegh.2020.03.018

Obesity increases the risk of many diseases like

  1. Type 2 diabetes, hypertension, dyslipidemia;
  2. Cardiovascular diseases and stroke, which were the leading cause of death in 2012;
  3. Musculoskeletal disorders (osteoarthritis);
  4. Cancers (endometrial, breast, ovarian, and colon).
  5. Liver and gallbladder disease
  6. Obstructive Sleep Apnea
  7. Infertility
  8. Psycho-social disorders

Childhood obesity is a growing concern as these children have an increased risk of insulin resistance, hypertension, breathing difficulties, fractures, and psycho-social problems as well as later in adulthood, have a higher chance of obesity and even premature death.

The first-line treatments for obesity and overweight include diet, exercise, behaviour therapy, and anti-obesity drugs. But for severe obesity this has limited success and success for long term is very poor. Whenever a patient approaches for weight loss, the screening form is filled and investigations are carried out. Procedure is planned based on BMI, comorbidities, and the investigation results.

Dr. R. Padmakumar is one of the Best Hernia Surgeon in India. He has been changing lives through Keyhole Surgery. He has got more than 30 years of hands-on experience in laparoscopic Surgery in major hospitals across India and has completed more than 7000 cases of Laparoscopic Hernia Surgeries. Dr. Padmakumar has trained more than 300 surgeons from all over the world the art of laparoscopic surgery especially Laparoscopic Hernia Surgery. Dr. Padmakumar is also hailed as one of the Best Bariatric Surgeon in India & UAE. He is renowned for new and improved treatment techniques and the first in the World to perform Scarless Bariatric Surgery with Tummy Tuck / Abdominoplasty. He is also one of the very few thyroid surgeons in India doing Endoscopic Thyroidectomy (scarless thyroid surgery).

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Contact Details

Dr. R. Padmakumar
Senior Consultant Laparoscopic and Metabolic Surgeon &
Director - Verwandeln Institute (Transforming Lives)
CMD - Keyhole Clinic, Metro Pillar no. 448, Edappally, Kochi, Kerala, India
HOD - VPS Lakeshore Hospital, Maradu, Kochi, Kerala, India
(Specialist in Laparoscopy, Hernia, Cancer, Obesity Surgery or Bariatric Surgery, Diabetes Surgery, Endoscopic Thyroid Surgery, Thoracoscopy, Intragastric Balloon)

Website Dr. R. Padmakumar - www.drrpadmakumar.com

Mobile: +919447230370, +919846320370
Email: drrpadmakumar@gmail.com

Past Chairman, Association of Surgeons of India - Kerala Chapter, 2019 - 2020
National President - Indian Hernia Society (2016)
GC Member, Association of Surgeons of India (2013 - 2018)
Vice President- Society of Endoscopic and Laparoscopic Surgeons of India
Jt. Secretary - Indian Association of Endocrine Surgeons (2016)
Founder Member, Obesity and Metabolic Surgery Society Of India
Founder Member, Association of Minimal Access Surgeons of India
International Faculty of IASGO on Hernia and Diabetic Surgery
International Faculty of IFSO on Diabetic Surgery
Associate Editor : Diabetes and Obesity International Journal

Keyhole Clinic - Center for Obesity and Laparoscopy
Keyhole Clinic - Center for Obesity and Laparoscopy

Metro Pillar No. 448, Edappally, Kochi
Tel: 9847296357 / +919645222401