As per the report, global adult obesity nearly doubled in the last two decades going from 343.1 million in 2000 to 675.7 million in 2016. The report goes on to claim that these incidences of rising obesity are alarming and are going to maintain an incremental trend during the next couple of years.
How to define obesity?
Senior bariatric and metabolic surgeon Dr Raj Palaniappan emphasises: “Obesity is abnormal or excessive accumulation of fat that exceeds the body standards and presents a risk to one’s health and quality of life.” To define in numbers based on the Body Mass Index (BMI), obesity is classified based on ethnicity. For Caucasians & Africans, when someone has a BMI of 30 or above, whereas a BMI of 40 or above is classified as morbid obesity, a disease by itself. For Asians, Arabs and Indians the same calculation is reduced by 2.5 BMI as these ethnicities are prone to obesity-related issues earlier than Caucasians.
Diseases and comorbidities caused by obesity
Obesity is in itself a serious illness, as being obese invites several other diseases some of which are life-threatening. Dr Palaniappan mentions that diseases such as diabetes, cholesterol, high blood pressure, cardiovascular issues and sleep apnea can be linked to obesity. There are even some cancers that are linked to obesity. Apart from these, fatty liver diseases, osteoarthritis and gallbladder issues also develop as a result of obesity. In women, hormonal imbalances like polycystic ovarian disease and infertility are growing at an alarming pace that threatens the entire quality of their life. Such associated disease reduces one’s lifespan by 8 – 10%
How do you find out that lifestyle changes aren’t working?
As we grow older, our metabolism keeps on slowing down which can lead to obesity. Further if one focuses on just controlling his or her diet without giving much emphasis to exercising, then also a person would find it difficult to lose weight.
Apart from the above mentioned factors, hormonal imbalances in women, particularly in the case of PCOD can make women struggle to lose weight. Another important lifestyle factor that affects weight management negatively is our sleeping pattern. Dr Palaniappan adds that “too much stress and too little sleep also won’t let you lose weight despite dieting and exercise.”
When does bariatric surgery become a viable option?
Dr Palaniappan says that Bariatric surgery becomes a viable option when “women gain 30 kg more and men gain 40 kg over the normal weight limit, and when they develop diseases because of obesity.”
He further adds that if your quality of life, including your productivity and your daily routine, gets cut short by half because of your excess weight, then you should look at bariatric surgery as a viable alternative to lose weight.
Types of bariatric surgeries
Broadly speaking, there are three main kinds of bariatric surgical techniques which are detailed below.
Restrictive operation: Restrictive operation is the one in which the size of the stomach is reduced to a banana shape and no other organ is touched in this kind of bariatric surgery.
Malabsorptive operation: The absorption capability of the intestine is reduced by 25 – 50% depending on the weight and associated diseases, therefore fewer calories go into the body ultimately reducing the weight of the individual.
Metabolic operation: In this procedure, hormonal changes are made inside the body by bypassing the first part of the proximal small intestine from allowing food that makes you burn more calories, have less food and feel full even after a small meal.
There is no one-size-fits-all treatment, each patient is offered a tailor-made procedure from the three techniques of bariatric surgery. The ideal treatment plan is based on the patient’s biological history, age, health issues, etc. According to Dr Palaniappan, “a patient benefits much more with a tailor-made approach.”
How will life be after bariatric surgery?
It takes another 1 to 1.5 years for the patient to lose weight after undergoing bariatric surgery. Till then, they need to be supported in their weight loss journey, Dr Palaniappan adds. Typically, the patient will take three weeks to recover completely from the surgery with regards to diet pattern which will be in four phases – liquid, pureed, soft and then normal diet.
Patients need to bring some behavioural changes like eating small request meals, eating and drinking 20 minutes apart from each other, regular physical activity post one month to keep the muscle mass and tone intact, protein and multivitamin supplements and regular follow-up with the team for blood work and progress. He also emphasised that “the success of bariatric surgery will largely depend upon the strength of the patient’s support system.”
When is the right time to visit a bariatric centre?
The decreasing quality of life (affected primarily by weight) is a tell-tale sign that one should visit a bariatric centre. If your weight is continually increasing and correlated diseases are needing more medication, you should visit a bariatric centre as soon as possible.