Obesity is a health crisis which is rapidly on the rise in industrialized nations. Obesity s toll on patients is soon to attain pandemic proportions and has to be addressed urgently. When an individual is overweight or obese, they are heavier than what their normal, healthy body weight should be. A body weight > 20% in proportion to the normal weight is considered as obesity.
The Quetelet Index popularly known as BMI or body mass index is used as an indicator of obesity. The degree of body fat is calculated as weight (kgs) /height2 (mts). The percentage of body fat is calculated with the Deurenberg equation which is 1.2 (BMI) + 0.23 (age) 10.8 (gender) 5.4.
The pathophysiology of obesity is associated with an increase in number and size of the adipocytes and storage of excess fat in persons with obesity. Hypertrophic obesity affects adults while hypercellular obesity can develop during childhood and onwards. There are several etiologies for obesity one of the primary ones being diet choices. Simply put, obesity is a result of too much eating with too little physical activity. Other factors that can lead to obesity are: family history, genetics (Prader-Willi syndrome), environment, metabolism, medical conditions like hypothyroidism, Cushing s syndrome and intake of medications for diabetes, epilepsy with types of medicines (corticosteroids, antidepressants etc.)
Diseases Related To Obesity
Obese individuals are prone to develop the following diseases:
Coronary heart disease:
One of the major risk factors for obesity
Accumulation of plaque inside the coronary arteries which hardens narrowing the artery
Ruptured plaque can cause a blood clot and blockage of blood flow through the artery causing angina and heart attack
High blood pressure:
Force of blood pushes against the arterial walls as the heart pumps blood
Also known as hypertension
Measurements are systolic and diastolic
Blood pressure increases abnormally with increase in body size
Type 2 diabetes:
Chronic and high blood glucose levels also known as hyperglycaemia due to the body s inability to produce enough insulin
Can also lead to blindness, end-stage kidney diseases and non-traumatic lower extremity amputations
90% of overweight and obese individuals suffer from type 2 diabetes
Small, hardened solids develop in the gallbladder
They block the gallbladder ducts leading to inflammation
Patient experiences sudden pain
When a person s body weight is > 120% of normal, they experience higher incidences of gallstones
Several mechanisms of fat cells lead to obesity
Obesity is known to cause cancers of the oesophagus, pancreas, colon and rectum, gallbladder and thyroid among many
Obesity and related disorders requires a multidisciplinary treatment. It is a complex disease where the individuals are prone to develop serious complications after any intervention. The treatment of obesity starts with life style modifications and to some extent drugs to reduce insulin resistance.
Surgical treatment of obesity is indicated in patients who have failed to achieve weight reduction with life style modifications. They needadequae counselling and advice before embarking upon surgical option.
Surgery can be either restrictive (sleeve gastrectomy), Malabsorptive or combination of both (Roux en Y Gastric bypass). All thesescn be done laparoscopiclly. Surgery is the most reliable method to achieve sustained and adequate weight reduction. It also reverses most of the diseases related to obesity like diabetes, high blood pressure, sleep apnea etc.
One of the primary counsels provided by Dr. Deepak Varma is lifestyle changes along with psychosocial modifications for morbidly obese patients. He embarks upon the surgical option in patients who have failed to reduce weight even after life style modifications.