BODY mass index (BMI) between 18 and 25 is generally considered to be normal. Anyone who has a BMI between 25 and 30 is considered to be overweight, whilst anyone who has a BMI of over 30 falls in the category of obesity.
Obesity is a medical condition in which excess body fat has accumulated in the body to an extent that it may have adverse effects on one’s health. Within the category of obesity, if the BMI crosses the 35 mark, he/she is said to be suffering from morbid obesity.
Whilst these are the generally accepted universal definitions, there are variations across various regions in the world, with the cut-offs for these categories lowered for people living in Asia.
Obesity – causes and current status:
Although there are many endocrinological diseases that can cause increased weight gain, for the vast majority who are obese, the main causes are usually unhealthy diet and lifestyle. Foods which are rich in carbohydrates and fats are always likely to generate more calories than required. This combined with a sedentary lifestyle that allows little opportunity for the calories to be burnt away causes a cumulative build up of excess calories in the body, which leads on to obesity over a period of time.
According to WHO, more than 1.4 billion adults, aged 20 and over, are overweight. Of these, nearly 500 million are obese. Obesity has nearly doubled worldwide since 1980. In India it is estimated that 35% are overweight and about 5 to 10% are obese.
However, surveys conducted in urban areas of India suggest that the problem is even more severe with an estimated 50% falling in the overweight category.
There is also an alarmingly increased incidence of obesity in Gulf countries. WHO data indicates that the prevalence of obesity in the gulf is currently very high with the highest estimated to be in Kuwait where the obesity prevalence is 36% for males and 48% for females, closely followed by Saudi Arabia, UAE and Bahrain.
As in everything in medicine, prevention is better than cure. However, many individuals are now in a situation where they had lost the opportunity to have prevented obesity earlier in their lives.
Even with utmost motivation, sincere following of dietary regimes and change in lifestyle measures, they are unable to reverse their situation of obesity. These individuals are now having to live a life, knowing fully well that they have a serious life-threatening illness of obesity and also have to put up with all the medical problems such as diabetes, hypertension, hyperlipidaemia, arthritis and so on that go hand in hand with obesity. It is for these individuals that weight-loss surgery or bariatric surgery comes as a very good treatment option.
There are a number of bariatric surgeries described in the world literature, the most common worldwide being Laparoscopic sleeve gastrectomy (LSG), Laparoscopic Adjustable Gastric Band (LAGB) and Laparoscopic Roux-en-y Gastric Bypass (LRYGB).
These surgeries are performed under general anaesthesia by the laparoscopic method (keyhole surgery). These surgeries are generally very well tolerated and successful and patients tend to lose approximately 50 to 70% of their excess body weight in the first 12 to 18 months following surgery. During this period, patients are advised to have regular blood tests to ensure that they do not have develop nutritional deficiencies. It is also expected that these patients remain on lifelong vitamins and other nutritional supplementation tablets.
It has been shown in various studies throughout the world that patients who undergo bariatric surgery not only lose weight, but also show significant remission/ cure of various associated diseases such as non-insulin dependent diabetes mellitus, hypertension, hyperlipidaemia, degenerative joint disease, polycystic ovarian disease, migraine, asthma, obstructive sleep apnoea.
An interesting observation in the post-operative outcome of these bariatric surgical patients is that some of these beneficial effects (such as normalisation of blood glucose) happen even before the weight loss begins to occur.
Numerous animal and human experimental studies have been performed on this subject in the last decade or so and it has now been fully established that these effects are due to some of the changes that occur in the levels of various hormones secreted within the gastrointestinal system as a consequence of bariatric surgery.
So Bariatric Surgery is therefore not cosmetic surgery and should not be understood as a surgery performed to just lose weight and make one look better, rather it should be understood as surgery that will improve one’s appearance, over-all health, quality of life and as a consequence his/ her life-span.
DR. J. K. A. JAMEEL is a Consultant Surgical Gastroenterologist, Laparoscopic & Bariatric Surgeon, Apollo Hospitals