Dr. Aparna Govil Bhasker; MS
Bariatric & Laparoscopic Surgeon
The biggest challenge that we face in the management of “obesity” today is the attitude which assumes that “obesity is a choice, and does not deserve to be treated”. Patients suffering from obesity face a lot of weight-based discrimination and stigma in every walk of life. Society views them as people with low will-power and obesity is still considered as a condition that is self-inflicted.
Obesity has emerged as one of the biggest silent killers of this century and has attained epidemic proportions across the world. Today, India is the third fattest nation in the world and obesity and diabetes together are the leading cause of death amongst the non-communicable diseases.
People who have attempted to lose weight, know how difficult it is to not only lose weight but also to maintain the weight loss. On a daily basis, we see patients who put in their heart and soul into their efforts to lose weight. Unfortunately, more often than not, they meet with disappointment and tend to yo-yo between weight loss and weight gain. This entire process can be extremely disheartening and demotivating.
Weight loss solutions depend on the grade and severity of obesity. Grade of obesity depends on the range of body mass index (BMI) that a person falls in. (BMI= weight in kg/ height in meter2). People with a BMI between 23.5 to 27.5 Kg/m2 are overweight. Those with a BMI between 27.5 to 32.5 Kg/m2 come in grade 1 obesity, from 32.5 to 37.5 Kg/m2 suffer from grade 2 obesity and anyone with a BMI more than 37.5 Kg/m2 has grade 3 obesity.
As the grade of obesity increases, the risk of developing associated diseases increases proportionately. There is a significantly higher risk of heart disease in patients with grade 2 and 3 obesity. Type 2 diabetes, high blood pressure, high cholesterol, sleep apnoea, polycystic ovarian disease, joint pains, infertility, liver and kidney disease, deep vein thrombosis, some kind of cancers etc are a few of the diseases that are closely associated with severe obesity. In clinical practice we see that as the BMI increases, patients tend to become sicker.
Weight-loss solutions vary for different grades of obesity. Diet and lifestyle modification form the basis of all weight loss solutions. Patients who are overweight or those suffering from Grade 1 obesity do very well with diet and behaviour modification. This must be done with the help of a qualified dietician. Today the internet is flooded with fad diets and one may be tempted to follow these. However, every diet has its pros and cons and the clinical profile of the patient must be taken into account before prescribing a weight loss diet. Self-dieting is the same as self-medication and can lead to harmful effects. Under medical supervision a good weight loss diet can lead to a weight loss of 0.5 to 1 kg per week. Physical activity also goes hand in hand along with weight loss diet.
For patients suffering from Grade 2 obesity, multiple options can be tried in combination. These include- diet and behaviour modification, pharmacotherapy or endoscopic intra-gastric balloon insertion. Bariatric surgery can be an option for this group of patients if they are suffering from 2 or more obesity related diseases such as type 2 diabetes, high blood pressure, sleep apnoea, cholesterol related issues and so on.
When it comes to grade 3 obesity, bariatric surgery is the only method that leads to sustained weight loss. It is a gastro-intestinal surgery which entails reduction of stomach size using staplers and sometimes re-routing of small intestines. This is usually performed through key-hole surgery. There are various mechanisms by which bariatric surgery helps to lose weight. Reduction in food intake, early satiety, reduced hunger, hormonal changes, at times decreased absorption of the food and alteration in gut flora are a few of the mechanisms that lead to weight loss after surgery.
Bariatric surgery leads to significant weight loss and also helps to improve other co-morbidities especially type 2 diabetes and others as listed above.
Last but not the least, please remember that like every other chronic disease, obesity is also progressive and continues to adversely affect all other organs of your body. These are silent changes that happen slowly but surely. Treatment of a disease must be done in accordance with the stage of the disease and sometimes treatment delayed is treatment denied. Please treat obesity as a disease and seek timely help from qualified medical specialists.
About Dr. Aparna Govil Bhasker
Dr. Aparna Govil Bhasker is an accomplished and renowned Bariatric Surgeon and Laparoscopic Surgeon.
Read more about Dr. Aparna Govil Bhasker- https://www.bestbariatricsurgeon.org/dr-aparna-govil-bhasker/
Dr. Aparna’s website is- https://www.bestbariatricsurgeon.org
You can read her lovely blogs on- http://www.aparnagovilbhasker.com
Dr. Aparna Govil Bhasker is a visiting consultant at the following hospitals: