Obesity is probably one of the most mis-understood diseases. Even today, a lot of people think that obesity is just a cosmetic issue. Unfortunately, today obesity has reached epidemic levels and more people are dying of obesity and related diseases than any other non-communicable disease. There are many myths about the treatment of obesity and it is important to understand that just like any other disease, obesity needs to be treated according to the stage and severity of the disease.
Overweight and obesity are categorised in terms of body mass index (BMI). When a person’s BMI is between 23.5 and 27.5 Kg/m2 they are considered to be in the overweight category. Dietary intervention and lifestyle modification are the recommended treatment in this stage. A supervised diet by a qualified dietician usually leads to a weight loss of 0.5 to 1 kg per week.
Grade 1 obesity is when the BMI falls between 27.5 to 32.5 Kg/m2. In this stage, diet and lifestyle modification can be attempted. If the patient fails to lose weight or fails to maintain the weight loss, then an endoscopic intra-gastric balloon insertion may be considered. Pharmacotherapy may be tried in this stage too. This is a reversible, non-surgical procedure during which a fluid filled silicon balloon is placed in the stomach. This leads to significant weight loss over a period of 6 months to a year depending upon the type of balloon. Metabolic surgery may be recommended for patients suffering from grade 1 obesity if they have uncontrolled type 2 diabetes despite best medical management. Metabolic surgery has been included in the treatment algorithm of diabetes for such patients by multiple diabetes associations across the world.
Grade 2 obesity is when the BMI falls between 32.5 to 37.5 Kg/m2. In this stage also diet and lifestyle modification can be attempted. If the patient fails to lose weight or fails to maintain the weight loss, then an endoscopic intra-gastric balloon insertion may be considered. Patients in this category are eligible for bariatric/metabolic surgery, if they are suffering from atleast 2 obesity related co-morbidities such as- type 2 diabetes, high blood pressure, high cholesterol, sleep apnoea, knee joint pains, PCOD etc. One must visit a qualified medical professional to assess which type of treatment will be best suited for them.
Grade 3 obesity is when the BMI is more than 37.5 Kg/m2. Bariatric/metabolic surgery is the best treatment option in this stage. Bariatric surgery/metabolic surgery is the only treatment modality that leads to sustained weight loss in patients with such severe obesity. Along with weight loss, it also leads to a significant improvement in obesity related co-morbidities such as- type 2 diabetes, high blood pressure, high cholesterol, sleep apnoea, knee joint pains, PCOD etc. It leads to an overall improvement in the quality of life of such patients.
It is also important to understand that obesity is a chronic progressive disease and needs life-long support. No treatment modality works alone and a combination of therapies is needed for successful management of obesity. Dietary intervention and lifestyle modification form the basis of all treatment modalities and is an inherent part of obesity management.
Bariatric and Laparoscopic Surgeon
Global Hospital, Parel; Apollo group of hospitals; Currae Hospital, Thane; Namaha and Suchak Hospitals, Kandivali