Science
| “BARIATRIC SURGERY -AN ULTIMATE SOLUTION FOR MORBID OBESITY, WORLDWIDE”. |
| By : Vinod K. Singhal | Previous | Next |
| Posted on : 24 Aug, 2007 | Total Views : 213 |
“BARIATRIC SURGERY -AN ULTIMATE SOLUTION FOR MORBID OBESITY, WORLDWIDE”.
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Obesity has become a global problem now. Earlier it was considered to be the disease of high class society or people who are rich but surprisingly it is becoming more and more common in middle class and neo-rich class in our country. It is assumed that there are about 1.5 million people in our country who are coming into the group requiring surgical intervention for the control of obesity. “Globesity” has occurred much faster than can be explained by genetic factors alone. Changing lifestyle has to be the major explanation. Easy availability of calorie rich fast food is as important as sedentary life style like use of vehicles, computer games, TV, use of lifts and elevators and lake of exercises, along with depression are major factors causing it.
To counter worldwide obesity, World Health Organization in May 2002 urged member nations to formulate the global strategy on diet, physical exercise and health (World Health Assembly Resolution 55.23) with the mandate to complete prevention guidelines by 2004.
Obesity leads to type II Diabetes, high blood pressure, stroke, heart and vascular diseases, joint problems, gall stones, urinary incontinence, sleep disorders, psychosocial problems, several types of cancers like endometrial, breast, prostate and colon cancers. It also leads to infertility, impotence and PCOD in females.
Whether a patient is obese or not, is decided on the basis of his or her BMI (calculated as Weight in kilograms / height in meters square). Healthy weight is considered when BMI is between 19 and 24. A person is Overweight when BMI is 25-29, Obese (BMI 30-39.9), Morbidly Obese (BMI >40) and Super Obese when BMI is more than 50.
There have been different options described for the management of obesity including dieting and help of exercises. Unfortunately none of them have shown permanent solution for the relief of the problems and it has also been seen and described as well that, patient gain more weight than it started before the weight loss program (Yo-Yo effect of dieting) which is more dangerous.
Bariatric or Obesity surgery was started long back (about 50 years back) for the control of morbid obesity and has now become the most sought after solution for it. Considering variations in a operation it would not be exaggerating to mention that up to 100 operations have been advocated and practiced. Laparoscopy entered into Bariatrics in late 1990s and has dominated bariatric surgery in current era.
It is considered for patients who have BMI more than 33 with certain medical diseases or BMI more than 37 without other associated diseases. There are various options available like, Gastric Banding, Roux-en-Y gastric bypass, Sleeve gastrectomy, Bilio-Pancreatic Diversion etc.
There are two (LAGB & RYGB) most commonly done procedures worldwide. Gastric Band is done laparoscopically (key hole surgery) and stomach is divided into “Baby Stomach” and remaining stomach. Surgical time is about 45 minutes and hospital stay is for about 48 hours. This band requires adjustments which is started about 3-4 weeks after the surgery and done on OPD basis. Normal anatomy of stomach is maintained and there is no dumping syndrome or mal absorption. Patient starts loosing weight within 4 weeks and about 50 % of excess weight is lost in 1st year.
Roux-en-Y gastric bypass (again done laparoscopically) is slightly more complicated technically and involves division of stomach along with bypassing a certain length of small intestine. This procedure takes about 3 hours and hospital stay is about 6 days. Patient looses 60-70 % of excess eight in 1st year with requirement of vitamin supplementation on daily basis.
There are several other procedures also done for morbid obesity but which procedure is to be done can be decided and tailored according to patient requirements based on certain guidelines only. Most important thing is that patient has to be dedicated to loose weight and follow the guidelines and instructions of treating surgeon.
There are certain measures need to be taken urgently in our country before we fall into the problem which western nations are facing from last few decades.
Food industries should decrease fat, trans fats, salts and sugars in processed food. In all food courts there should be information well displayed about healthy choices and nutritional value of food. Fresh fruits and vegetables, protein rich food should be encouraged.
Government (all levels-central, state and municipal) should adopt regulations to enforce nutritional standards and support strategies and encourage healthy living, recreational activities, nutritional education, play activities at schools, and opportunities of physical exercises at work place too. Advertisements and distribution of energy dense but nutrition-poor fast food should be restricted specially to children. There can be a policy of giving incentives in the form of tax benefits to those food manufacturers who are participating in the program of obesity control.
Local health clubs and health centers should also take lead in spreading awareness about dangerous sequelae of obesity. Incorporation of physical activity as a health choice of daily living would probably more beneficial to the community instead of ad campaigns for the reduction of weight.
Bariatric (Obesity) surgeons treat the top end of obesity spectrum but general practitioners must join in, fostering prevention at the bottom end. Unless governmental policies urgently promote and even legislate a counter attack to the obesity epidemic, mankind will suffer serious co-morbidities of obesity and early death. The co called developing world is now largely developed. This new affluence has led to obesity as a public health problem almost universally, starting in childhood.
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Written By : Vinod K. Singhal
