BARIATRIC SURGERY
Apollo Hospital is Bariatric surgery center and
Bariatric weight loss surgery center in India. We provide super speciality
weight loss treatment with advanced medical technology and expertise.
WHAT IS OBESITY & CAUSES OBESITY
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.
Weight
(in Kgs,)
BMI = ---------------------------------------
Height (in
meters) X Height (in meters)
In American standard measurements BMI is calculated as
Weight (in
Kgs,)
BMI = ---------------------------------------
Height (in
inches) X Height (in inches) |
To calculate Your BMI Click here |
| 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 |
What causes Obesity ?
- Energy Balance You gain weight when you consume more calories
from food than your body uses through its normal functions (basal
metabolic rate-BMR) and physical activity.The unused calories are
stored as fat. You become obese if you consistently consume excess
calories over a long period of time.
- Genetic or Hereditary Factors In many cases underlying cause of
morbid obesity is genetic you inherit the tendency to gain weight.
Genes play an important role in tendency to gain excess weight. Just
as some genes determine eye color or height, others affect our
appetite, our ability to feel full or satisfied, our metabolism, our
fat-storing ability, and even our natural activity levels
- Environmental Factors Environmental and genetic factors are
obviously closely intertwined. Modern lifestyle and environment like
fast food (high in fat and low in fruits and vegetables), long
sitting at desk, and suburban neighborhoods that require cars all
magnify hereditary factors such as metabolism and efficient fat
storage. For those suffering from morbid obesity, anything less than
a total change in environment usually results in failure to reach
and maintain a healthy body weight by non-operative measures
- Metabolism We used to think of weight gain or loss as only a
function of calories ingested and then burnt. But the equation isn't
that simple. Obesity researchers now talk about a theory called the
"set point" - a sort of thermostat in the brain that makes
people resistant to either weight gain or loss. If you try to
override the set point by drastically cutting your calorie intake,
your brain responds by lowering metabolism and slowing activity. You
then gain back any weight you lost.
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HEALTH HAZARDS OF MORBID OBESITY
Severe obesity damages the body by its mechanical, metabolic and
physiological adverse effects on normal bodily function. These "co-morbidities"
affect nearly every organ in the body in some way, and produce serious
secondary illnesses, which may also be life-threatening. The cumulative
effect of these co-morbidities can interfere with a normal and productive
life and can seriously shorten life, as well. The risk of developing these
medical problems is proportional to the degree of obesity.
- People who are obese do not live as long as those who are not
obese and the earlier a person become obese; the more years of life
are lost.
- Heart Disease Severely obese persons are approximately 6 times as
likely to develop heart disease as those who are normal-weighted.
Heart disease is the leading cause of death today and obese persons
tend to develop it earlier in life and it shortens their lives.
- High Blood Pressure Hypertension is much more common in obese
persons and leads to development of heart disease, and damage to the
blood vessels throughout the body, causing susceptibility to
strokes, kidney damage, and hardening of the arteries.
- High Blood Cholesterol.
- Diabetes Mellitus Overweight persons are40 times as likely to
develop Type-2, Adult-Onset, diabetes. Once Diabetes occurs, it
becomes even harder to lose weight, because of hormone changes which
cause the body to store fat even more than before.
- Sleep Apnea Syndrome Sleep apnea - the stoppage of breathing
during sleep -- is commonly caused in the obese, by compression of
the neck, closing the air passage to the lungs.
- Respiratory Insufficiency
- Heartburn - Reflux Disease and Reflux Nocturnal Aspiration
- Asthma and Bronchitis
- Gallbladder Disease Gallbladder disease occurs several times as
frequently in the obese, in part due to repeated efforts at dieting,
which predispose to this problem.
- Stress Urinary Incontinence.
- Degenerative Disease of Lumbo-Sacral Spine (Backbone).
- Degenerative Arthritis of Weight-Bearing Joints like knee, hip.
- Venous Stasis Disease in the lower extremities.
- Emotional / Psychological Illness Seriously overweight persons
face constant challenges to their emotions: repeated failure with
dieting, disapproval from family and friends and remarks from
strangers. They often experience discrimination at work Stereotypes
of obese people – such as that they are lazy – may result
in lower self esteem and poor body image. There is no wonder that
anxiety and depression might accompany years of suffering from the
effects of a genetic condition -- one which skinny people all
believe should be controlled easily by will power.
- Social Effects Severely obese persons suffer inability to qualify
for many types of employment and tend to have higher rates of
unemployment, There is a general societal belief that obesity is a
consequence of a lack of self-discipline, or moral weakness.
- People who are obese do not live as long as those who are not
obese and the earlier a person become obese; the more years of life
are lost.
- Heart Disease Severely obese persons are approximately 6 times as
likely to develop heart disease as those who are normal-weighted.
Heart disease is the leading cause of death today and obese persons
tend to develop it earlier in life and it shortens their lives.
- High Blood Pressure Hypertension is much more common in obese
persons and leads to development of heart disease, and damage to the
blood vessels throughout the body, causing susceptibility to
strokes, kidney damage, and hardening of the arteries.
- High Blood Cholesterol.
- Diabetes Mellitus Overweight persons are40 times as likely to
develop Type-2, Adult-Onset, diabetes. Once Diabetes occurs, it
becomes even harder to lose weight, because of hormone changes which
cause the body to store fat even more than before.
- Sleep Apnea Syndrome Sleep apnea - the stoppage of breathing
during sleep -- is commonly caused in the obese, by compression of
the neck, closing the air passage to the lungs.
- Respiratory Insufficiency
- Heartburn - Reflux Disease and Reflux Nocturnal Aspiration
- Asthma and Bronchitis
- Gallbladder Disease Gallbladder disease occurs several times as
frequently in the obese, in part due to repeated efforts at dieting,
which predispose to this problem.
- Stress Urinary Incontinence.
- Degenerative Disease of Lumbo-Sacral Spine (Backbone).
- Degenerative Arthritis of Weight-Bearing Joints like knee, hip.
- Venous Stasis Disease in the lower extremities.
- Emotional / Psychological Illness Seriously overweight persons
face constant challenges to their emotions: repeated failure with
dieting, disapproval from family and friends and remarks from
strangers. They often experience discrimination at work Stereotypes
of obese people – such as that they are lazy – may result
in lower self esteem and poor body image. There is no wonder that
anxiety and depression might accompany years of suffering from the
effects of a genetic condition -- one which skinny people all
believe should be controlled easily by will power.
- Social Effects Severely obese persons suffer inability to qualify
for many types of employment and tend to have higher rates of
unemployment, There is a general societal belief that obesity is a
consequence of a lack of self-discipline, or moral weakness.
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TREATMENT OF MORBID OBESITY
WHAT DO THE MEDICAL EXPERTS SAY?
The National Institutes of Health has held three conferences on surgery for
severe obesity in the past 15 years. At the most recent conference, the
panel of experts concluded that "reduced life expectancy and
significant psychosocial and economic problems are experienced by severely
obese people." They went on to say: "Limited success has been
achieved with a variety of non-surgical approaches including medically
supervised dieting. Diet alone cannot be considered a reasonable option for
permanent weight loss surgery. Drug therapy for clinically severe obesity
has been disappointing."
You have to seriously consider the surgical option for reducing weight to
avoid its ill effects.
- If your BMI is over 40.
- If your BMI is 35 or higher and you have a serious medical
problem (hypertension, diabetes, heart disease, joint problems,
reflus) that is made worse by obesity
- If you have been unable to reduce weight or maintain weight under
medically supervised program
- You have been obese for at least 5 years
- Have no history of alcohol abuse
- Not have depression or other major emotional disorder
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The panel endorsed two surgical treatments for obesity:
gastric bypass and adjustable gastric banding, noting that "significant
weight loss usually occurs and a number of associated disorders (such as
diabetes and hypertension, etc) often improve."
Weight reduction surgery is not for all over weight people. It offers an
alternative to those who are unable to maintain weight loss through dieting.
But it is very important to know that to maintain weight loss after surgery,
you still have to eat less food, change the type of food you eat and
increase physical activity. Weight reduction surgery helps you in changing
your food behavior by giving early satiety after a small meal and providing
prolonged feeling of fullness so that you can adher to the dietary control.
HEALTH BENEFITS OF WEIGH LOSS SURGERY
Medical conditions that may be greatly improved after surgery include:
- High Blood Pressure
About 60 percent of patients with high blood pressure are able to
stop all medications and have a normal blood pressure, usually
within two to three months after surgery.
- High Cholesterol
More than 70 percent of patients will develop normal cholesterol
levels within two to three months.
- Diabetes
More than 80 percent of Type-2 diabetics obtain excellent results,
usually within a few weeks after surgery.. There is no medical
treatment for diabetes that can achieve as complete and profound an
effect as surgery.
- Asthma
According to IFSO, successful bariatric surgery reduces the number
and severity of asthma attacks.
- Respiratory Insufficiency
Improvement of exercise tolerance and breathing ability usually
occurs within the first few months after surgery. Often, patients
who have barely been able to walk find that they are able to
participate in family activities, and even sports.
- Sleep Apnea Syndrome
Dramatic relief of sleep apnea occurs as patients lose weight. Many
report that within a year of surgery, their symptoms were completely
gone, and they had even stopped snoring completely-and their spouses
agree. Sleep apnea is cured in about 75 percent of patients after
surgery
- Gastro-Esophageal Reflux Disease
Relief of symptoms of reflux usually occurs within a few weeks of
surgery for many patients
- Gallbladder Disease
When gallbladder disease is present at the time of the surgery, it
is "cured" by removing the gallbladder during the
operation.
- Stress Urinary Incontinence
This condition responds dramatically to weight loss and usually
significant improvement in the control occurs.
- Low Back Pain, Degenerative Disk Disease, & Degenerative
Joint Disease
Patients usually experience considerable relief of pain and
disability from degenerative arthritis and disc disease and from
pain in the weight-bearing joints.
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Results not without efforts
Don't underestimate the physical and social adjustments
you'll have to make after surgery. You'll have a stomach pouch about the
size of a small egg. In the first six months after surgery, eating too much
or too fast may cause either vomiting or an intense pain under your
breastbone. Instead of eating regular-sized meals three times a day, you'll
be required to eat four to six very small meals: about 2 ounces (60 ml)
each. Most people, however, quickly learn how much they can eat at one meal.
And over time, the amount you can eat increases.
Surgery for weight reduction is not a miracle procedure. Though you can
generally expect to lose weight and keep it off, changes needed in your
eating and exercise habits are yours to make. But health benefits of losing
weight are yours as well.
MORBIDLY OBESE VS. UPWARDLY MOBILE:
MINIMALLY INVASIVE SURGERIES OFFER NEW HOPE
- Laparoscopic Surgery: First Choice for "Last Resort"
Treatment
- Two Choices.One Goal.
- What are the Results?
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Laparoscopic Surgery:
First Choice for "Last Resort" Treatment
Many morbidly obese patients are reluctant to undergo
gastric bypass surgery—traditionally an open, invasive procedure. But
thanks to the new, minimally invasive surgical techniques, this "last-resort"
treatment has become more appealing. By laparoscopy, the surgeon performs
the same operation as in open surgery, but through small incisions. Tiny
slits in the abdomen allow a surgeon to insert a camera-equipped scope and
surgical instruments to perform surgical procedures less invasively.
Laparoscopic techniques are equally successful and offer many added patient
benefits. These benefits include less post-operative pain, reduced risk of
wound infection, a shorter hospital stay, faster recovery and a more rapid
improvement in quality of life.
Two Choices. One Goal
There are two types of laparoscopic surgeries that are
popular to treat extreme weight gain.
The most commonly known, Roux-en-Y gastric bypass, involves refashioning
the stomach into a small pouch and bypassing part of the small intestine.
This not only limits the absorption of food but also produces a feeling of
fullness with a small meal.
Roux-en-Y gastric bypass has been used for years with clinical results
attesting to its effectiveness. The procedure is irreversible and patients
are advised to thoroughly evaluate its risk factors before surgery
A less extreme alternative is the Lap-Band surgery, or adjustable gastric
banding. Approved by the FDA, the procedure involves less risk than the
Roux-en-Y. Instead of bypassing the stomach, a balloon-like device is banded
around the stomach to produce a small upper gastric pouch, which causes an
early feeling of fullness and satiety after a small meal. The balloon - like
device is inserted through a small incision and inflated to cinch the
stomach and limit its capacity. The operation takes about 60 minutes and
usually requires a one-day hospital stay. The band can later be tightened or
loosened as needed—without further surgery—by adjusting the amount
of solution through a portal under the patient’s skin. The device can
even be removed entirely if necessary. Reduced risk, simplicity and
reversibility make the Lap-Band very attractive.
What are the Results?
Results depend on a variety of factors and vary with
each patient.
Most gastric bypass patients experience fairly rapid weight loss in the
first three to six months after surgery. Weight loss slows, but generally
continues up to 12 to 18 months after surgery, averaging 70 to 75 percent of
excess body weight.
With the Lap-Band, weight loss is generally slower and more gradual
compared to the gastric bypass. Typically, patients lose up to 55 percent of
their excess body weight within 18 months following laparoscopic adjustable
gastric banding surgery. The normal hospital stay for Lap-Band patients is
one day with a return to most activities in seven days.
Regardless of the procedure, it requires a team approach to solving a
patient’s weight problem. This includes a comprehensive evaluation, as
well as psychological and emotional support before and after surgery for the
greatest chance of weight loss success. The operation itself is not the
whole answer. A multidisciplinary approach—surgeon, internist,
dietician and psychiatrist—is needed to help the patient lose and keep
weight off. The goal is not only weight loss, but the reversal of serious
medical conditions.
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