Obesity - Newer Modalities of Treatment for Weight Loss

It will be a wish of everybody to have an attractive body figure. There was a time when majority were running around to find ways to increase body weight but today great majority are depending on various methods and advertisements modalities for reducing body weight. It is very happy to know that modern medicines has come up with good permanent techniques by which body weight as well as the abdominal fat can be reduced. These are surgical measures using laparoscope (Bariatric surgery) so that the patient is comfortable after safe procedure.

Body Mass Index (BMI) is an estimate in relation to the weight and height of a person; it is calculated as weight in kilogram divided by height 2 times (BMI =Weight in Kg/ height in M2). BMI of 20 to 25 is considered normal. 26 to 30 is over weight. Above 30 is obesity and above 37 will be considered as morbid obesity. If overweight is a predisposition for illness, obesity is a disease itself and needs treatment. Like in developed countries obesity is increasing in India also. On one side when nation is trying to reduce poverty related illnesses it is undesirable to see that people are getting illness due to over eating and resultant obesity related illness; and it is a thing to be strongly discouraged. It’s more problematic to have abdominal obesity like what we see in Kerala.

  • Hereditary factors
  • Food habits
  • Life style.

Though hereditary can be contributing factor for obesity, it is usually due to excessive food intake. Food rich in fat and low in fiber is the main culprit for obesity. Meat, sweats in excess quantity and repeated intake of food: causes obesity. Soft drinks, instead of ordinary water also contribute as they are energy sources, though people don’t consider it as food. One gm fat gives nine calories where as protein and carbohydrate gives four calories only. Sedentary life style with no exercise is another important factor which accelerates obesity.

When weight increases, it directly affects heart and respiratory system. Heart when made to pump in greater force and to larger area will definitely weaken it. This will induce heart attack to a very early age. Cholesterol deposition causes reduction in lumen of blood vessels leading on to high BP (Hypertension). Chances of vascular events like heart attack and stroke are very very high due to blockage of vessels in these patients. Requirements for coronary angioplasty and cardiac bypass are 3-4 fold compared to persons of normal weight. Obesity also leads to sleep disorders and respiratory problems called as sleep apnoia. Excess fat causes damage of pancreas and induce insulin resistance. This in turn result in high blood sugar (diabetes mellitus). Increased weight damages joints and bones leading into early arthritis necessitating joint replacements. Women with increased body fat suffer from polycystic ovarian disease (PCOD). It is an important cause for infertility and is mostly reversible if persons loses excess weight. The loss of body image is a significant contributor for mental disease like depression. Morbidly obese people find it difficult to move around and use common facilities, commuting and seeing the response of the society at sight of the morbidly obsess person puts them down

Control of diet and increasing exercise are two things which an overweight person can do himself to counter the problems. There are drugs available in the market which may reduce the appetite. There are some drugs which can induce malabsorption of fat so that the calorific value of the diet is reduced. But these things can reduce weight to a minimum extent only. The permanent solution for obesity and related illness is surgery. Measures like reduction and size of stomach or diversion of food from the stomach to the distal part of the intestine have proved highly effective in causing dramatic reduction in fat and weight. As these procedures are done through laparoscopy, it is a thing which makes it comfortable, safe and simple for a patient.

Lapro means abdomen and scopy means to see. Surgeon makes one cm incision in the abdomen and puts a telescope which is connected to the monitor outside. Surgeons see the picture of the abdominal organ on the monitor and operate. Operating instruments are less than a pencil size which is introduced through 5 mm incision. In open operation a big wound is made for surgeon to visualize organs and for putting his hands for performing surgery. These big wounds were causing severe pain, increase risk of infections and chance for hernia due to poor healing. Keyhole surgery is very advantageous as no significant wound is made and hence patient will be going home very early and resume normal activities in few days time. As the images are magnified 20 times the precision of surgery is very much high. Even small blood vessels can be seen as big and equipments like harmonic scalpel seals these vessels perfectly so that the blood loss in significantly less. This avoids need for blood transfusion to tune 1 % of open surgeries and patient is saved of the associated illnesses like Hepatitis, AIDS, and Malaria. In obsess patients open surgery is extremely difficult opening these kind of patients will cause respiratory distress, blood clots in the vessels, slowing of the intestinal motility (Ileus). Laparoscopic surgery avoids such problems greatly and patients will be ambulant within few hours and there will not be a need for long term rest.

  • Sleeve Gastrectomy
  • Banding
  • Gastric bypass

Using staplers a portion of stomach is removed and their by reduces the quantity of food patient take additionally. This reduces appetite, stimulating agents and acid secretions so that patient will be comfortable with small quantity of food. This is sure to bring down the weight of the patient drastically with desirable effects on con existing illness.

In this an adjustable band is placed around the stomach so that stomach size at the area of food entry is reduced. Patient can adjust the size of stomach and quantity of food.

In this the stomach is connected to a distal part of the intestine so that the absorption is reduced and thus causes weight reduction.

Many studies have shown that surgery for obesity in addition to causing dramatic weight loss improves or resolve the condition associated with obesity. The requirement for insulin is reduced to 90% and hypertension medication can be discontinued by almost 80% of persons. The joint problems, sleep apnoia improve and quality of life will be very good.

Patient may require procedures like liposuction, lipectomy or abdominoplasty for cosmetic purpose. So it is advisable for everyone who has obesity to resort to the above mentioned procedure. So that they will be back to normal life with good quality.


Contact Details

Dr. R. Padmakumar
MBBS, DNB, MNAMS, DipALS, FAIS, FIMSA, FCLS, FRCS (GL)
Senior Consultant Laparoscopic and Metabolic Surgeon &
Director - Verwandeln Institute (Transforming Lives)
(Specialist in Laparoscopy, Hernia, Cancer, Obesity, Diabetes Surgery, Endoscopic Thyroid Surgery, Thoracoscopy, Intragastric Balloon)
Keyhole Clinic, Thammanam Road, Plarivattom, Kerala, Kochi, India
Lakeshore Hospital, Maradu, Kerala, Kochi, India

Consultant Surgeon
Starcare Hospital, Mawaleh, Seeb, Muscat, Oman (+968 24557200)
Specialist Surgeon
Medeor 24x7 Hospital, Dubai (+971 4 350 0600)

Mobile: +919447230370, +919846320370 (India)
Mobile: 00971567581025 (UAE)
Email: drrpadmakumar@gmail.com

Websites:
www.drrpadmakumar.com
www.endoscopythyroid.com
www.obesitysurgeonkerala.com
www.diabetescuresurgeon.com

National President - Indian Hernia Society (2016)
Chairman (Elect), Association of Surgeons of India - Kerala Chapter
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