What is Obesity?
Obesity is the excessive accumulation of fat that exceeds the body's skeletal and physical standards.The National Institute of Health (NIH) states that excessive weight becomes a health hazard when it is 20 percent or more above ideal body weight. Patient with serious health risk are susceptible to serious diseases like heart disease, respiratory diseases or even infertility.It can result in either significant physical disability or even death.
Causes of Obesity:
Obesity can be caused due to various reasons like changed lifestyles, energy dense diets, low level of physical activity, environmental factors, heredity, psychological and cultural influences and many others
- Heredity : Genes may increase vulnerability to obesity
- Metabolic Factors : Obesity is directly linked to a slow metabolism or reduced metabolic activity
- Endocrinological factors : This is a rare occurrence and contributes to less than 1% of all weight gain in the world.
- Hypothyroidism : Hypogonadism in men and Polycystic Ovarian Syndrome in women are closely associated with obesity
- Medication :
Certain drugs may contribute to weight gain, such as corticosteroids, sulfonylureas for diabetes, steroidal contraceptives and anticonvulsants such as valproate used in epileptic therapy. Antipsychotics, antidepressants, mood stabilizers like lithium are medicines that have weight gain as a side effect.
- Psychological Factors :
Though psychological factors play a minor role in the development of obesity, they are important in relation to responses to treatment. For example, many patients reduce depressive symptoms by eating. These people may gain weight with one episode of depression and increase it with the next. Further, concepts of dietary restraints, body image dissatisfaction and binge eating disorders have been intimately linked to the increase in obesity
- Dietary Factors :
An increase in caloric intake, changes in lifestyle, food systems and increased portion sizes, eating out frequently also leads to increased calorie intakes as one meal served in restaurants and fast food outlets exceeds a person's caloric needs for the entire day.
Research shows that excessive body weight is linked to overall health and susceptibility to chronic ailments. It has been proven that a BMI beyond 30 kg/m2, increases the risk of cardiovascular death, heart attack and diabetes, even after adjusting for age, smoking, social class, alcohol consumption and physical activity. Studies show that non smoking overweight men and women lose 3.1 and 3.3 years of life respectively, as compared to normal weight non smokers. These studies have also established that weight fluctuations increase the risk of death.
Coronary heart disease is the major cause of weight-related death followed by diabetes mellitus, Liver diseases and cancer. Evidence suggests that women can reduce mortality rate by 25% in diabetic, cardiovascular and cancer conditions by achieving a weight loss of 9 kgs. However if an obese person has already developed an associated co-morbidity, then planned weight loss of any amount has been reported to reduce mortality by 20%. It has also been established the risk of mortality is greater in younger patients suffering from obesity as compared to older ones.
Obesity is associated with chronic diseases such as heart disease, Type 2 diabetes, hypertension, stroke, gallbladder disease, sleep apnoea, certain cancers and osteoarthritis. These chronic ailments tend to worsen with increasing degree of obesity. Non alcoholic fatty liver disease which may progress to end-stage liver disease is now also being recognized as a consequence of obesity. Obesity may also lead to poor wound healing and poor antibody response.
Regional Distribution of fat & Health Risk :
There are two type of Obesity
1. Android or apple-shape obesity
2. Gynoid or pear-shape obesity
This fat distribution is determined genetically and varies among men and women. Android obesity is more common among males whereas females are more susceptible to gynoid obesity. While in case of gynoid obesity it is more difficult to shed weight, the android obesity is linked to chronic ailments such as glucose intolerance, insulin resistance, hyperlipidemia and hypertension. This type of obesity is also closely associated with the development of metabolic syndrome (a complex of unified conditions like glucose intolerance, high blood pressure and alterations in serum lipids).
Assessing the Risk Factor :
BMI = Weight in Kg / (Height in meters) 2
Indian - Asian Standards
||18 – 22.9
||23 – 27.9
|Grade 1 Obesity
||28 – 32.9
|Grade 2 Obesity
||33 – 37.9
|Grade 3 Obesity or Morbid Obesity
||40 and above
||38 and above
Grade 1 to Grade 3 Obesity is applicable to all age groups (Source: World Health Organizations)
Increased Risk to Life
Substantial Risk to life
||> 94 cm (= 34 inches)
||> 102 cm (= 37 inches)
||> 80 cm (= 32 inches)
||>88 cm (= 35 inches)
NORMAL WAIST / HIP RATIO < 1.0 in Males < 0.8 in Females
Is Surgery for me?
- Presence of serious sequelae of morbid obesity
- 30 kg overweight or a BMI> 33 kg/m2 for more than 5 years with at least one co-morbidity (ASIA PACIFIC GUIDELINES)
- BMI > 37 with or without co-morbidities
- Failure of sustained weight loss on supervised dietary and conservative approaches (OR Multiple unsuccessful attempts at Weight loss with non-surgical methods)
- Absence of an endocrine cause
- Acceptable operative risk
- Compulsive eaters
- Educated, compliant patient. Demonstrate willingness to maintaining dietary guidelines and other follow-up care.
- Have support from family, spouse, or close friends.
- Surgery is not recommended for the mentally ill or impaired, patients known to abuse alcohol or drugs, or those with an eating disorder such as bulimia.
If the answer to the above is yes, then you should be seeking the opinion of our Bariatric expert.
A. Restrictive Procedures: The Lap Gastric band
Restrictive weight loss surgery works by reducing the amount of food consumed at one time. The theory is simple; due to the restriction created, you feel satiated with small amounts of food and because of a smaller outlet, food stays in the stomach for a longer time. The net result is - a reduction in daily caloric intake without a feeling of deprivation.
Entails laparoscopic implantation of a Silastic band around the stomach just below the gastro-esophageal junction to section off a small portion called as stomach pouch creating an hour-glass effect. A small outlet, about the size of a pencil eraser, is left at the bottom of the stomach pouch.
B. Combined procedures: Roux -En- Y Gastric Bypass
Procedures that alter digestion are known as malabsorptive procedures. Malabsorptive techniques reduce the length of intestine that comes in contact with food so that the body absorbs fewer calories. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is completely stapled shut and divided from the stomach pouch. It is not completely removed. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, called the Roux limb, thus eliminating the duodenum and a small portion of the jejunum from the absorptive circuit. The omitted segment is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be adjusted to produce lower or higher levels of malabsorption.
- The duodenum being bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia.
- A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
- A condition known as "dumping syndrome" can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
- Metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones.
- All the above listed deficiencies can be easily managed through a proper diet and vitamin and calcium supplements. It is mandatory for patients undergoing gastric bypass to consume a multivitamin and calcium supplement daily.
Why Choose Our Center?
Our Bariatric Surgeon, Dr Jayasshree Todkar, is a highly skilled and world renowned surgeon. She is a speaker and faculty member for live demonstrations of the advanced laparoscopic and bariatric operations, at multiple International and national conferences. She performs minimally invasive or key hole surgery techniques, with very high success rates and low complication and mortality rates.
Our centre is easily accessible in the metro city of Mumbai with availability of experienced team of doctors round the clock. Our center is the first in India and the Indian subcontinent to start training surgeons and multidisciplinary members in the field of Obesity surgery.
Importance of Support
Obesity and it treatment requires tremendous support. Unlike what most people think, obesity is not caused by over-eating or eating disorders. It is a chronic disease, the causes of which may vary. People suffering from obesity may suffer from severe depression as well and need tremendous support from their loved ones. What one needs to understand is that the first step towards any kind of remedy is fraught with many unexpressed fears and tensions – the support of friends and family is of incalculable help at such times.
Diseases Related to Morbid Obesity
- Essential hypertension
- Myocardial infarction, hypertension and congestive heart failure
- Fatal or non-fatal myocardial infarction
- Risk of coronary heart disease
With every 1 kg of weight loss, there is a corresponding reduction by about 1% in total cholesterol and LDL and a rise by 1% in HDL and a 3% decrease in triglycerides.
- Central adiposity is also more closely associated with the development of metabolic syndrome than the absolute degree of fatness.
- Prevalence of diabetes mellitus and cardiovascular disease.
- Obesity hypoventilation syndrome (OHS)
- Obstructive sleep apnoea syndrome (SAS)
- Fatty liver
- GERD - Gastroesophageal reflux disease
- Colorectal cancer
- Endometrial cancer
In India, childhood obesity has become an important public health problem affecting all sections of the society. Given the magnitude of problem and the future risk of diseases like diabetes, hypertension, heart diseases and polycystic ovarian disease that obese children face, there is an urgent need to address this issue. Over-eating, inappropriate portion sizes, junk food in addition to sedentary lifestyle, prolonged indoor on-screen time spent by our children because chronic positive energy balance and obesity.
Combined effort of healthcare personnel with individuals from all sections of society is needed to reverse the problem of obesity that threatens the health of future of our nation.
- School awareness program for parents, teachers & students
- Obesity awareness program walks/run
- Specific competetion addressing issue of childhood obesity like poster competetion