Dr. Ashish Vashistha
Consultant Bariatric Surgeon,
Bhatia Global Hospital & Endosurgery Institute
Max Super Speciality Hospital

Obesity is a burgeoning public health problem. That will strain healthcare service and increase incidence of having diabetes, high blood pressure, coronary artery disease and even arthritis. Changes in diet coupled with increasingly inactive lifestyle have sparked off epidemic of obesity in India and several Asian countries. Changes in obesity prevalence in adult is alarming as in 1991, it was 12% which has taken a quantum jump to 17.9% in 1998, which is an increase of 49%.

WHAT IS OBESITY?
Obesity is defined as a condition of excess body weight and fat. A person is said to be obese when the body weight is 20% or more above ideal body weight.

WHAT IS BMI?
BMI or Body Mass Index is a measure of calculating a person's excess weight. It is calculated by the following formula:
BMI= Weight / Height 2
(Kilograms / sq meter)

WHAT ARE THE CAUSES?
Dietary and life style practices are directly related to obesity. The most important cause is the imbalance between the energy intake and output. The extra energy which is not used by the body is stored as fat. On the expenditure side, if a person is physically less active, then less energy is utilized and more is converted to fat. Children of obese parents are 10 times likely to be obese than those of non-obese parents. Genes influence how the body burns calories or stores fat. In some rare cases, hormonal imbalance, such as over- activity of the adrenal glands or under-activity of the thyroid gland, can also cause obesity. Injury or inflammation of the hypothalamus can interfere with the appetite centre and thereby, cause obesity.

WHY SHOULD OBESITY BE TREATED?
Obesity is a disease like any other disease. It has become necessary to recognize this entity as a cause of severe mental and physical morbidity which shows significant improvement following weight loss. It is even more important for the patients themselves to understand this disease, its morbid implications and their inability to control it on their own.

WHAT IS THE TREATMENT?
The simplest and the most basic principle is to reduce food intake, especially the fat content, and increase physical activity. The sense of well-being and weight loss motivates an individual to make changes in his or her diet as well.

Your initial goal of weight loss therapy should be to reduce the body weight by 10%, from baseline. Let physical activity tip the scale in your favor. You can perform aerobic exercises 30 minutes a day thrice a week. Avoid a sedentary lifestyle.

Certain medicines are also available for weight reduction. There are two main types of weight reducing drugs: one class decreases appetite while the other prevents dietary fat from being absorbed by the body. Surgery to cure obesity should be undertaken for people who are very obese, have tried all the other options available and have medical problems. The main surgical option is to have your stomach banded or stapled so that it cannot accommodate more food.

WHAT ARE WEIGHT LOSS SURGERY PROCEDURES?
Only surgery has proven effective, over the long term for most patients with severe obesity as a tool for sustained or permanent weight loss. The choice of procedure should be decided after a thorough discussion with your surgeon. Bariatric surgery is now being performed laparoscopically which is highly beneficial for these patients as it minimizes trauma of surgical access.

HOW DOES OBESITY SURGERY CHANGE YOUR LIFE?
Weight loss starts soon after surgery and continues for 2 years with loss of 60 80% of excess weight. Improvement occurs in obesity related medical condition, with almost 60% of patient not requiring medication. There is enhanced quality of life, with improved stamina, mood, self-esteem and body image.

Obesity surgery is not cosmetic surgery. In fact, plastic surgery may be required in a few cases following weight loss after obesity surgery.