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Home  Medical Treatment - Obesity Treatment |
Obesity Treatment
Welcome to Mediserve india’s ‘Cure Obesity’ campaign . We are dedicated to help people who are struggling with a significant weight problem and looking for a permanent weight loss solution . We understand the many physical, emotional and psychological issues that are caused by obesity. First , we need to understand a few things about obesity and its many treatments .
But the thumb rule is that curing obesity is a life long process and one needs to change his/her lifestyle .
The National Institute of Health (NIH) USA ,classifies obesity as a chronic disease.
What is it ?
Obesity is another term for excess body fat. Normal body fat percentages range from 18%-23% in men and 25%-30% in women. Men with a body fat percentage greater than 25% and women with a body fat percentage greater than 30% are considered obese. Obesity occurs when intake of calories exceeds the daily caloric requirements.
Obesity means having too much body fat (adipose tissue). Obesity generally is determined by calculating body mass index (Bmi), which measures weight for height and is stated in numbers. BMI is calculated by the weight in kilograms divided by height in meters squared.
In American standard measurements BMI is calculated as
| BMI |
Status |
| Below 18.5 |
Underweight |
| 18.5 – 24.9 |
Normal |
| 25 – 29.9 |
Overweight |
| 30 – 34.9 |
Obese |
| 35 – 39.9 |
Severe Obesity |
| > 40 |
Morbid Obesity |
| > 50 |
Super Morbid Obesity |
Mediserve india is not about how you look but rather an indication of the effect your weight has on your health. A BMI of 30 or higher is considered obese in adults—you are at a higher risk for certain health problems than those with a lower Bmi. As Bmi increases, your risk of health problems increases.
What are the risks of being obese?
Obesity can affect anyone -- there are no defined absolute risk factors. However, it is known that certain groups of people are more likely to become obese. Risk factors for becoming obese include the following:
- Being overweight as a child
- Having a family history of obesity
- Lack of physical activity
- Excessive intake of high-fat food and decreased intake of fruits and vegetables
Along with risk factors for becoming obese, once a person is obese, they are at greater risk for developing chronic diseases and suffering from premature death. Common chronic diseases associated with obesity include the following:
- Type 2 diabetes mellitus
- High blood cholesterol
- Cardiovascular diseases such as hypertension, stroke, heart attack, and heart failure
- Osteoarthritis
- Sleep apnea
- Males: cancer of the colon, rectum or prostate
- Women: cancer of the gallbladder, breast, uterus, cervix or ovaries
- Gallbladder disease
- Liver disease
- Gout
- Menstrual irregularities and infertility in women
The amount of excess fat an individual has is not the only concern when discussing obesity. Where the fat is located on the body is also a concern. Men and women tend to have varying patterns of fat distribution. Women often carry fat on their hips and buttocks, giving their figures a "pear" shape. Men often carry fat around the belly, giving them more of an "apple" shape. Individuals with an "apple" shape are more likely to develop health problems as a result of their obesity than "pear" shaped individuals. To determine whether an individual is an "apple" or a "pear," the waist-to-hip-ratio is calculated.
This is calculated by dividing the waist circumference by the hip circumference. Men and women with a waist-to-hip ratio of 1.0 or higher are considered to be "at risk" for chronic health problems as a result of being overweight.
The following are the most common ways to reduce weight :-
- Gastric By Pass
- Gastric Binding
- Laparoscopic Sleeve Gastrectom
Gasric By Pass:
 Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.
The most common gastric bypass surgery is a Roux-en-Y gastric bypass.
In normal digestion, food passes through the stomach and enters the small intestine where most of the nutrients and calories are absorbed. It then passes into the large intestine (colon), and the remaining waste is eventually excreted.
In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).
This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach).
What To Expect After Surgery
This surgery usually involves a 4- to 6-day hospital stay (2 to 3 days for a laparoscopic approach). Most people can return to their normal activities within 3 to 5 weeks.
Gastric bypass surgeries may cause dumping syndrome. This occurs when food moves too quickly through the stomach and intestines. It causes nausea, weakness, sweating, faintness, and possibly diarrhea soon after eating. These symptoms are made worse by eating highly refined, high-calorie foods (like sweets). In some cases you may become so weak that you have to lie down until the symptoms pass.
Why It Is Done
Although guidelines vary, surgery is generally considered when your body mass index is 40 or higher or you have a life-threatening or disabling condition related to your weight.
Your doctor may only consider doing gastric bypass surgery if you have not been able to lose weight with other treatments.
The following conditions may also be required or are at least considered:
- You have been obese for at least 5 years.
- You do not have a history of alcohol abuse.
- You do not have untreated depression or another major psychiatric disorder.
- You are between 18 and 65 years of age.
All surgeries have risk, and it is important for you to discuss your treatment options to decide what is best for your situation with our panel of experts.
How Well It Works
Most people who have gastric bypass surgery quickly begin to lose weight and continue to lose weight for up to 12 months. One study noted that people lost about one-third of their excess weight (the weight above what is considered healthy) in 1 to 4 years.Some of the lost weight may be regained.
The laparoscopic approach showed similar results, with 69% to 82% of excess weight lost over 12 to 54 months
Gastric Binding
Developed to aid in long-term weight loss, the Adjustable Gastric Band System has been used by leading laparoscopic surgeons worldwide to overcome severe obesity. Sustained weight loss with the Gastric Band is achieved by reducing the capacity of the stomach
The Adjustable Gastric Band System
 The band is a simple silicone ring with an inflatable balloon fitted on the inside. The balloon is connected to an injection port by a long, thin, kink resistant silicone tubing. Like a wrist- watch, the band is fastened around the upper stomach, about 15mm below the gastro-esophageal junction. This divides the stomach into a small upper pouch (15ml) and the remainder lower stomach. The injection port is implanted under the skin and is accessible to an injection needle. On injecting fluid into the access port, the balloon inflates and the exit opening of the upper pouch (by which the pouch will empty) becomes narrow. The band will therefore limit and control the amount of food you eat and slow the emptying process from the stomach pouch. By injecting or withdrawing fluid the opening can be adjusted. These adjustments can be performed during simple outpatient visits guided by the speed of weight loss, amount of food tolerated, exercise regimen etc. Thus the band can be fine tuned to the requirements of each patient at a given time. Fullness and satisfaction is experienced with just a small amount of food. The reduced food intake results in dramatic weight loss.
The surgery is done laparoscopically (also known as keyhole surgery).
A large incision is not required. The stomach area is accessed via four to six very small incisions (0.5 to1cm) that are then closed with self- dissolving sutures. The recovery time is rapid. Hospitalization is required only for one night. Many people are able to resume their regular activities a week after their surgery. The operation is performed under general anesthesia and can last between 30 minutes to over an hour. Since no cutting, stapling or rerouting is required, the operation is considered the least traumatic of all weight loss surgeries.
Laparoscopic Sleeve Gastrectomy
A Safe and Effective Surgical Weight-Loss Procedure for Higher-Risk Patients or those who Want to minimize the Risk of Weight Loss Surgery
The laparoscopic sleeve Gastrectomy procedure (also called vertical Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction and even Vertical Gastroplasty) is an emerging procedure that is becoming increasingly popular worldwide. It causes weight loss by restricting the amount of food that can be eaten without any bypass of the intestines or malabsorption.
What is Sleeve Gastrectomy and how does it work?
This procedure generates weight loss solely through gastric restriction (reduced stomach volume). In this procedure, a narrow tube of the stomach, approximately the same diameter as the esophagus and duodenum is fashioned by dividing it vertically. The part of the stomach along the medial (lesser) curvature, which is in continuity with the food pipe (esophagus), is retained as the tube and the part outside the tube, which is the greater curvature of the stomach and the fundus, is removed.
 Almost 85% of the stomach is removed. The removed section of the stomach is actually the portion that "stretches" the most on eating food, has the reservoir function and is responsible for storing the food. The stomach that remains is shaped like a banana and measures from 2-4 ounces (60-120cc) depending on the surgeon performing the procedure. The holding capacity of the stomach is thereby drastically reduced. This procedure significantly restricts the volume of the food that can be consumed. Very small amounts of food will now evoke feeling of extreme fullness. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while reducing the volume. There is no intestinal bypass with this procedure, only stomach reduction. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded.
Laparoscopic sleeve gastrectomy procedure was initially performed laparoscopically as a first stage procedure in very high Bmi patients to try to reduce the overall risk of weight loss surgery. In patients with Bmi above 60Kg/m2, it is difficult to perform a Roux en Y gastric bypass or a Duodenal Switch laparoscopically. Additionally, Roux en Y gastric bypass may not yield adequate weight loss for patients with a Bmi greater than 60Kg/ m2 since
these patients may not attain a healthy Bmi of 30 after gastric bypass. Duodenal Switch is very effective for high Bmi patients but unfortunately it may also be quite risky. First stage Laparoscopic Sleeve Gastrectomy emerged as a reasonable solution to this problem. It can be done laparoscopically in patients weighing over 500 pounds. The stomach restriction that occurs allows these patients to lose more than 100 pounds and in many patients more than 200 pounds. This weight loss allows significant improvement in health and effectively "downstages" a patient to a lower risk group. Once the patient’s Bmi is lower (35-45) they can return to the operating room for the "second stage" of the procedure, which can either be the Duodenal Switch, Roux en Y gastric bypass or even a Lap Band®.
Soon it was realized that some patients with laparoscopic sleeve gastrectomy not only lose significant weight but also maintain their weight loss for longer than expected and may not opt for a second stage procedure. This gave birth to the idea of Laparoscopic Sleeve Gastrectomy as the sole procedure for weight loss. It had been originally conceived of by Dr. Johnston in England (Magenstrasse and mill operation). The procedure was slightly modified and the stomach pouch is made smaller than the pouch that Duodenal Switch patients have. It is a significant improvement over prior gastroplasty procedures, which are rarely done due to problems related to the placement of staples, silastic rings and mesh around the stomach pouch.
Advantages of the Sleeve Gastrectomy Weight Loss Surgery:
- The stomach is reduced in volume but tends to function normally so most food items can be consumed, though in small amounts.
- The excess stomach volume is removed, not left in place. This possibly eliminates most Ghrelin hormone (secreted from the fundus of the stomach and stimulates hunger) production and helps to reduce the sensation of hunger these people have.
- As there is no bypass of the intestinal segment involved, absorption of minerals (calcium, iron) and vitamins does not suffer and it is not necessary to supplement these minerals and vitamins in the diet as is essential after the gastric bypass. This may also be important in older patients who are likely to be on multiple medications and may later develop cancer or other serious medical conditions.
- Since the pylorus (sphincter that regulates release of food from stomach into the intestines) is intact after the sleeve gastrectomy, there is no dumping (of food into the intestines) and its symptoms (palpitation, sweating, tremors, and abdominal colicky pain) which occur after gastric bypass with high carbohydrate liquid foods.
- By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated.
- minimizes the chance of an ulcer occurring.
- It can be converted to almost any other weight loss procedure.
When compared to lap Band procedure, Laparoscopic sleeve gastrectomy is a one time procedure and no subsequent adjustments are required. It also avoids the possible complications of a long term foreign body with no possible risks of slippage, erosion, infection etc. The 4 year weight loss results seem to be superior to lap Band.
Laparoscopic Sleeve Gastrectomy in Low Bmi patients (Bmi 35-45 Kg/M2):
This procedure was started in England as a stand alone weight loss procedure for anyone with a Bmi greater than 35 Kg/M2 (Johnston D. Obesity Surg 2003; 13:10-16). It proved to be quite safe and quite effective even at 5 years. 10% of the patients did fail to achieve a Bmi below 35 at 5 years and these tended to be the heavier patients, the same ones we would expect to go through a second stage as noted above. Low Bmi individuals who should consider this procedure include:
- Those who are concerned about the potential long term side effects of an intestinal bypass such as anemia, osteoporosis, protein and vitamin deficiency, intestinal obstruction, ulcers etc.
- Those who are considering a LapBand® but are concerned about a foreign body or are not sure that they have access to regular filling of the band which is mandatory for optimal weight loss after this procedure. In patients with lower Bmi, initial decrease in the appetite, restriction and weight loss after the lap band may be slow till one or two fillings are done. These patients do better after sleeve gastrectomy. The restriction and weight loss after sleeve gastrectomy starts immediately, weight loss is faster and weight loss is more as compared to the band (equivalent to gastric bypass).
- Those who have other medical problems that prevent them from having weight loss surgery such as anemia, Crohn's disease, extensive prior surgery, and other complex medical conditions.
- People who need to take anti-inflammatory medications may also want to consider this. Usually, these medications need to be avoided after a gastric bypass because the risk of ulcer is higher.
Laparoscopic sleeve Gastrectomy is very effective as a first stage procedure for high Bmi patients (Bmi>55 kg/m2). It can be done laparoscopically in patients weighing over 500 pounds. Available results appear promising as a single stage procedure for low Bmi patients (Bmi 35-45 kg/m2). It is also a very appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
Disadvantages of the Vertical Gastrectomy Weight Loss Surgery:
Laparoscopic sleeve Gastrectomy is a relatively newer procedure being in use as the sole procedure for weight loss only for about 4 years. This is less than lap Band and laparoscopic gastric bypass which have been in use for more than 10 years. This is an active point of discussion for bariatric surgeons. There is a possibility for inadequate weight loss or weight regain in the long term because of the pouch dilatation/enlargement. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass. Since the stomach pouch in sleeve gastrectomy is based on the thick and muscular lesser curvature which is relatively nondistensible, this fear and skepticism may not hold true. Four years follow-up results of laparoscopic sleeve gastrectomy were discussed in the Annual Conference of American Society of Bariatric Surgery in San Diago in July 2007 and the reported weight loss results are equivalent to Laparoscopic Gastric Bypass roux en Y. Higher Bmi patients (above 55) will most likely need to have a second stage procedure later to help lose the rest of the weight. Two stages may ultimately be safer and more effective than one operation for these high Bmi patients. Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss while after gastric bypass they will cause dumping and will be avoided due to their unpleasant symptoms. Because the stomach is removed, it is not reversible. It is considered investigational by some surgeons.
Sleeve Gastrectomy: Risks and Complications
As with any surgery, there can be complications. This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur, though significantly less as compared to bypass. The others include: Deep vein thrombophlebitis 0.5%, Non-fatal pulmonary embolus 0.5%, Pneumonia 0.2%, acute respiratory distress syndrome 0.25%, Splenectomy 0.5%, Postoperative bleeding 0.5% and Small bowel obstruction.
Post-Op Dietary Plan for Vertical Gastrectomy Weight-Loss Surgery Patients
As with all surgical weight-loss programs, it is imperative that Sleeve Gastrectomy patients adhere to a strict postoperative diet. Patients must stick to a liquid-based diet for 2 weeks after surgery; 4-6 weeks after the operation, patients graduate to a 600-800 calorie/ day solid diet. Once goal weight is achieved, usually 1-2 years after surgery, most patients can consume about 1000-1200 calories per day.
Long-Term Weight-Loss Results
On average, patients who undergo Vertical Gastrectomy surgery experience a 60-80% loss of excess body weight. Large and rapid weight loss and very few complications make Sleeve Gas
trectomy surgery a smart choice for weight-loss in many patients.
The sleeve gastrectomy seems to give the weight loss of the stronger operation (gastric bypass) with the complication profile of the band.
To receive an approximate idea of cost and other information regarding treatments, please contact us.
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