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OBESITY NEWER MODALITIES OF TREATMENT

It will be a wish of everybody to have an attractive body figure and lead a healthy life.
There was a time when majority will be running around to find ways to increase body
weight but today great majority are depending on various methods for reducing body
weight. It is very happy to know that modern medicines has come up with good
permanent techniques by which body weight as well as the abdominal fat can be reduced.
These are surgical measures using laparoscope (Bariatric surgery) so that the patient is
comfortable after safe procedure.
Body Mass Index (BMI) is an estimate in relation to the weight and height of a person; it
is calculated as weight in kilogram divided by height 2 times (BMI =Weight in Kg/
height in M2). BMI of 20 to 25 is considered normal. 26 to 30 is over weight. Above 30
is obesity. If overweight is a predisposition for illness, obesity is a disease itself and
needs treatment. Like in developed countries obesity is increasing in India also. On one
side when nation is trying to reduce poverty related illnesses it is undesirable to see that
people are getting illness due to over eating and resultant obesity related illness; and it is
a thing to be strongly discouraged. It’s more problematic to have abdominal obesity like
what we see in Kerala.
Obesity: Reasons;-
1. Hereditary factors
2. Food habits
3. Life style.
4. Hormonal changes
Though hereditary can be contributing factor for obesity, it is usually due to excessive
food intake. Food rich in fat, carbohydrates and low in fiber is the main culprit for
obesity. Meat, sweats in excess quantity and repeated intake of food: causes obesity. Soft
drinks, instead of ordinary water also contribute as they are energy sources, though
people don’t consider it as food. One gm fat gives nine calories where as protein and
carbohydrate gives four calories only. Sedentary life style with no exercise is another
important factor which accelerates obesity. Ghrelin secreted by fundus portion of the
stomach increase appetite and hence induce over eating. It works like a magnet on iron to
keep fat to the body, thus increasing obesity.

Obesity: After effects; –
When weight increases, it directly affects heart and respiratory system. Heart when made
to pump in greater force and to larger area will definitely weakened. This will induce

heart attack at very early age. Cholesterol deposition causes reduction in lumen of blood
vessels leading on to high BP (Hypertension). Chances of vascular events like heart
attack and stroke are very very high due to blockage of vessels in these patients.
Requirements for coronary angioplasty and cardiac bypass are 3-4 fold compared to
persons of normal weight. Obesity also leads to sleep disorders and respiratory problems
called as sleep apnoea. Excess fat causes damage of pancreas and induce insulin
resistance. This in turn result in high blood sugar (diabetes mellitus). Increased weight
damages joints and bones leading to early arthritis necessitating joint replacements.
Women with increased body fat suffer from polycystic ovarian disease (PCOD). It is an
important cause for infertility and is mostly reversible if persons loses excess weight.
The loss of body image is a significant contributor for mental disease like depression.
Morbidly obese people find it difficult to move around and use common facilities &
commuting. Seeing the sarcastic response of the society at sight of the morbidly obsess
person puts them down further.

Solutions:-
Control of diet and increasing exercise are two things which overweight persons can do
themselves to counter the problems. There are some drugs which can induce
malabsorption of fat so that the calorific value of the diet is reduced. But these things can
reduce weight to a minimum extent only. The permanent solution for obesity and related
illness is surgery. Measures like reduction and size of stomach or diversion of food from
the stomach to the distal part of the intestine have proved highly effective in causing
dramatic reduction in fat and weight. As these procedures are done through laparoscopy,
it is comfortable, safe and simple for a patient.

IGB (Intra-Gastric Balloon) :
A balloon folded in the shape of a small tube is introduced in to the stomach under
endoscopic guidance. 600 ml fluid will be instilled to make it full expansion. Once it
stays for 6 to 8 months in stomach, patient can expect 10 to 15 kg weight loss. Then it is
removed under endoscopic guidance. It is highly suitable for age group below 18 years
where Bariatric Surgery cannot be performed and also for females suffering from
infertility due to PCOD & obesity.

Laparoscopy – Keyhole surgery
Lapro means abdomen and scopy means to see. Surgeon makes one cm incision in the
abdomen and puts a telescope which is connected to the monitor outside. Surgeons can
see the picture of the abdominal organ on the monitor and operate. Operating

instruments are less than a pencil size which is introduced through 5 mm incision. In
open operation a big wound is made for surgeon to visualize organs and for putting his
hands for performing surgery. These big wounds were causing severe pain, increase risk
of infections and chance for hernia due to poor healing. Keyhole surgery is very
advantageous as no significant wound is made and hence patient will be going home very
early and resume normal activities in few days time. As the images are magnified 20
times the precision of surgery is very much high. Even small blood vessels can be seen
as big and equipments like ultrasonic scalpel seals these vessels perfectly so that the
blood loss in significantly less. This avoids need for blood transfusion to the tune of 1 %
of open surgeries and patient is saved of the associated illnesses like Hepatitis, AIDS, and
Malaria. In obese patients open surgery is extremely difficult opening these kind of
patients will cause respiratory distress, blood clots in the vessels, slowing of the intestinal
motility (Ileus). Laparoscopic surgery avoids such problems greatly and patients will be
ambulant within few hours and there will not be a need for long term rest.

Sleeve Gastrectomy
Using staplers a portion of stomach which secretes Ghrelin is removed and their by
reduces the hormone and quantity of food patient take. This reduces appetite,
stimulating agents and acid secretions so that patient will be comfortable with small
quantity of food. This is sure to bring down the weight of the patient drastically with
desirable effects on co-existing illness.

Gastric bypass
In this procedure, the stomach is made into a small pouch and connected to a distal part
of the intestine so that the absorption of nutrients is reduced and thus causes weight
reduction.
Many studies have shown that surgery for obesity in addition to causing dramatic weight
loss improves or resolve the conditions associated with obesity. The requirement for
insulin is reduced to 90% and hypertension medication can be discontinued by almost
80% of persons. The joint problems, sleep apnoia improve and quality of life will be
very good.
Later some patients may require procedures like liposuction, lipectomy or
abdominoplasty for cosmetic purpose. So it is advisable for everyone who has obesity to
resort to some of the above mentioned procedure, so that they will be back to normal life
with good quality.

For further inquiries regarding the aforementioned article, we encourage you to establish direct contact with the author. The author’s contact details can be obtained from their profile. Your proactive engagement with the author will ensure a comprehensive understanding of the subject matter.

Author

  • Dr. Padmakumar R

    Dr. R. Padmakumar is a renowned Senior Consultant & HOD in the Department of Minimally Invasive Surgery at VPS Lakeshore Hospital, Kochi, and Keyhole Clinic, Kochi. He is also the Director of Verwandeln Institute, Kochi, which is a Center for Laparoscopy Training. Dr. Padmakumar is recognized as one of the rarest Surgeons in the World, proficient in Bariatric Surgery, Thoracoscopic Surgery, and Endoscopic Thyroid surgeries. With an impressive patient base from 35 countries, he has successfully treated patients from India and Gulf countries. His expertise and skills have earned him a distinguished reputation in the field of Minimally Invasive Surgery worldwide.

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