New Delhi (India), May 18: Obesity is rising steeply in India and is becoming a major public health concern. According to the NFHS data of 2019, around one fourth of the population is obese while more than 5% of Indians are suffering from morbid or severe obesity. The prevalence of morbid obesity has increased by 10 times over the last four decades. Concurrent with the rise of obesity are the related health concerns like diabetes, hypertension, coronary artery disease, sleep apnea and certain types of cancers.
Morbid obesity has been defined as BMI (Body mass Index) of more than 35 kg/m2 and is associated with serious health risks. The current approach to treatment of morbid obesity encompasses a multidisciplinary approach including diet, lifestyle modification, exercise, behavioural and psychological therapy, pharmacotherapy and lastly bariatric surgery.
Although non-surgical methods do give some results, they are effective in achieving significant weight loss in only 5-10% of people, says Dr Anirudh Vij, Senior Bariatric Surgeon, Dr Sunderlal Memorial Hospital, New Delhi. Whereas, bariatric or weight loss surgery has produced significant excess weight loss in more than 90% of individuals which is maintained over the long term. This weight loss is accompanied by resolution of the comorbid conditions, improved quality of life and reduction in all-cause mortality with increased lifespan.
Bariatric surgery procedures are grouped into two types- restrictive and malabsorptive, elaborates Dr Vij. Restrictive procedures like gastric sleeve and gastric banding reduce the stomach capacity leading to decrease in consumption of food. This produces a long term caloric deficit which accompanied by metabolic and hormonal changes leads to burning of stored fat and long term weight loss. Malabsorptive procedures, like gastric bypass and bilio pancreatic diversion, on the other hand, reduce the absorption of food by altering the length of the intestines leading to caloric deficit and weight loss. Some procedures like the RYGB have a combined effect of restriction and malabsorption and are considered more effective for weight loss.
Bariatric surgery is recommended for individuals who have a BMI more than 40 kg/m2 or BMI more than 35 kg/m2 with serious obesity related complications. It can be performed safely for adults between 18 years to 65 years of age and is done by the laparoscopic approach. This means that there are only a few key hole incisions on the abdomen without any big cut which makes the procedure almost painless, with minimal blood loss and rapid recovery. The patients can resume their routine activities within a week of surgery and are prescribed a special diet plan for around 2 months. After this, they can take a normal diet but are encouraged to take more of high protein and nutritious foods and to avoid high calorie liquids, junk foods and alcohol. The patients are also prescribed supplements in the form of protein, multivitamins. iron and calcium which can be taken for 6-12 months after the surgery to counter any deficiency.
The weight loss after bariatric surgery occurs gradually at the rate of 1-1.5 kgs/week for the first 3 months and 0.5-1 kg/week thereafter. The weight loss can continue for 12-15 months which would translate into a total weight loss of 30-50 kgs and almost 40% of the total body weight. The weight loss is accompanied by improvement or resolution of obesity related conditions like diabetes, hypertension, fatty liver, sleep apnea, PCOD and depression.
Some of the immediate risks associated with the surgical procedure include bleeding, infection, leakage, blood clot formation and embolism. Delayed complications include multivitamin and protein deficiency, hair fall, skin sagging and gastric ulcers. Most of the complications can be prevented by proper patient selection and evaluation, a meticulous surgical technique, proper postoperative care and follow up. The patients should also ensure that they choose their surgeon and surgical centre based on their credentials and experience.
Dr Vij has conducted more than 1500 Bariatric and Metabolic surgeries successfully at his centre in New Delhi for the past 15 years. “We have a very positive patient outcome with low complication rates since we are following all standardized protocols” comments Dr Vij. “I see a rise in the number of such procedures in the coming years because of the increasing demand and acceptance of Bariatric surgery worldwide”
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