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Obesity Team :
Initial Consultation By :
Dr. Maharra Hussain (Consultant Gastrointestinal and Laparoscopic Surgeon)
Mrs. Sweety Mandot (Chief Dietician)
Surgeons :
Dr. K P Balsara
Dr. K K Khandelwal
Dr. C R Shah
The Problem
The World Health Organisation estimates that there are nearly 1 billion people who are overweight and of these almost 300 million are obese. Surprisingly six percent of Indians suffer from morbid obesity, which figures from studies conducted by the Nutrition Foundation of India show that 38% of women and 25% of men in urban areas are obese. In morbid obesity individuals carry excess body fat and are prone to ailments, which can lead to life threatening situations.
BMI
BMI or body mass index is the most common method of measuring obesity. BMI is calculated by dividing weight in kilograms by the square of the height in meters. While the BMI does not measure body fat accurately, it tends to correlate well with the degree of obesity. The BMI can not distinguish between fat and muscle and hence each person needs to be judged individually.
The following BMI range has been adopted by the National Institute of Health :
BMI 25 to 29
kg / m2
overweight
BMI 30 to 34
kg / m2
obese
BMI 35 to 39
kg / m2
serverely obese
BMI > 40
kg / m2
morbidly obese
Problems with Obesity
Obesity can lead to several problems, some of the important ones being :
Diabetes (type 2)
Hypertension
Premature death and reduced life expectancy
Certain Cancers
Polycystic ovary syndrome (infertility)
Hyperuricemia
Sleep apnoea (disturbed sleep)
Physical Limitation
Social Ostracism and ridicule
Methdos of dealing with obesity
Diet / drugs
Exercise
Surgery
Various diets and drugs complemented by exercise have been used but morbidly obese patients rarely lose more than 10% weight by these methods. Further there is tendency to regain weight. This is where a surgical option has a role to play.
What surgical options are available ?
Surgery comprises of two types of procedures.
Restrictive procedures.
Restrictive and malabsorbtive procedures
Restrictive procedures
Gastric banding
Sleeve Gastrectomy
Restrictive procedures reduce the capacity of the stomach, hence the person tends to eat less and lose weight. The weight loss in this procedure is slow but sustained so the optimal weight loss is achieved after 1 to 2 years.
Restrictive and malabsorbtive procedures
Roux - Y Gastric Bypass
In this operation, the stomach size is reduced and a portion of the intestine is by-passed. Patients lose weight more rapidly but the procedure can be associated with mineral and vitamin deficiencies.
Laparoscopic surgery for obesity
Laparoscopic surgery is now used extensively for obesity. Both restrictive and malabsorbtive procedures can be done using this approach. Laparoscopic operations reduce morbidity and allow quick recovery.
Laparoscopic adjustable gastirc banding (LAGB)
The procedure is simple to perform and has the advantage of being reversible and adjustable and produces no nutritional deficiency. The band is made of silicon and has an inflatable ballon attached to a tube which is connected to a reservoir. The reservoir is implanted under the skin.
The band is introduced around the upper part of the stomach using laparoscopic technique.
by using the reservoir the band can be inflated or deflated as per desired weight loss.
Laparoscopic Sleeve Gastrectomy
This procedure , also known as tube gastrectomy, is carried out Laparoscopically.
It involves removing the lateral 2 /3 of the stomach ( about 70- 80% ) using a stapling device.Sometimes, it can be offered to patients as part of a two stage Gastric Bypass operation, particularly if the patient is super obese (BMI>60 ), But in recent years it has increasingly been performed as a primary procedure.
The residual stomach capacity is about 150 - 200 mls ( normal stomach is 1,200 -1,500 mls. ) ,so patients feel full after a small meal.
Laparoscopic Gastric Bypass
Gastric bypass though a more difficult procedure, is eminently suited for Laparoscopic technique .
The stomach is divided with staplers to create a 20 ml gastric pouch .
A Length of small bowel is brought up and anastomosed to the gastric pouch .
The distal limb is anastomosed to the ileum low down to create some degree of malabsorption .
Choice of Procedure
The choice of procedure depends on the BMI of the patient and their eating habits , The decision is made jointly by the patient and the surgeon.
Follow Up
For optimal result after surgery a regular and long term follow up with the surgeon and dietician is required . Dietary modifications and exercise regimes are introduced as the weight loss proceeds .
Consultation
Wed 2:00 pm to 4:00pm at Obesity Clinic in G1. For further details and assistance call : 66660099 / 66660157
