WHY AM I FAT?

Being fat is a net result of a lot of factors in one’s life. The one we can’t do anything about is our genes which we acquire from our parents who could be obese. Then there are factors we can do something about. It is about eating smartly (and probably less) and moving about in day-to-day activities. Stuffing oneself with food with high calories is definitely not going to help in reducing body fat. Choosing not to lead a sedentary life may not be possible for all but one can modify the hours before and after office work in a way which involves activity (playing a game or walking instead of sitting down with a drink or cards in the evening with friends in the guise of relaxation).

To put it simply, obesity is largely a matter of regular caloric surplus. Which means that you are eating more on a daily basis than you are burning off.

In some patients, some hormonal factors or drugs may be responsible, but these are rare.

SO WHAT IF I AM FAT?

Most people equate advice to reduce fat as a way to look better when slimmer. This is only a fraction of the truth. The fact is that increase in body fat leads to increased co morbidities such as diabetes, hypertension, hyperlipidemia, joint pains, gallstones, back pain, snoring and even cancer. So the major reason to stay slim is to decrease your chance of dying early and, more importantly, to lead a fitter and more productive life without killer diseases like diabetes, heart ailment, etc. Accepting obesity in one’s life is usually a result of failure of weight loss attempts with minimal or even major efforts (usually nonscientific methods).

IS OBESITY SURGERY FOR ME?

If one has a BMI (Body Mass Index) calculated as weight (kg)/ height (m2) of 40 or more OR BMI of 35 + two co-morbid conditions like diabetes / hypertension one is a candidate for being considered for bariatric surgery (weight loss surgery).
Many people are already fed up of their obesity and its associated disadvantages in day-to-day living and have already given up, having tried various gimmicks and workout programs. They are ready for surgery when they are aware of such a proven method.
Many, however, are skeptical regarding surgery and require scientific data and information regarding this form of surgery. These patients are best motivated when they search the Internet and obtain literature regarding the tremendous success of bariatric surgery.

WHICH PROCEDURE IS FOR ME?

There are many procedures for bariatric surgery. The ones that are more popular are laparoscopic adjustable gastric band placement, laparoscopic gastric bypass and more recently sleeve gastrectomy. The other less popular procedures are biliopancreatic diversion, duodenal switch, etc.

Each center may have minor policy differences but the outline is usually the same.

Most subjects desirous of weight loss alone will benefit from gastric band/ sleeve procedure which are both restrictive procedures in the sense they prevent a person from eating more. The former will achieve a weight loss of 40-50% of excess body weight whereas the latter will achieve 60-70% excess body weight loss. The Band procedure, however, mandates more compliance and follow up and is not a procedure for the nonchalant. In fact, no procedure should be considered for the non-serious patient!

Subjects desirous of more weight loss to the tune of 70-80% excess body weight loss will require a more demanding procedure like gastric bypass. This procedure is based on a combination of restriction of food along with causing malabsorption. It is offered to patients who understand that it is the most effective procedure for weight loss but it comes with a price of higher risk of leaks and death than other procedures.

Gastric bypass is also the procedure of choice for patients having obesity with diabetes because of its 87% chance of curing diabetes.

Sleeve gastrectomy is the latest procedure for weight loss that is showing astonishing results. It is very safe and quick procedure, and patients are discharged in 48 hours or so. The dietary restrictions after surgery are not severe at all, and virtually all our patients are happy with the freedom they get with eating.

For the super-obese (BMI over 50 kg/m2) a staged operation is often recommended as the safest option. The first stage is invariably a sleeve gastrectomy, with a second procedure like a gastric bypass or duodenal switch done as the final and definitive operation after a year or two when the patient is much thinner.

WILL I BE ABLE TO MANAGE LIFE AFTER BARIATRIC SURGERY?
WHAT ARE THE RESTRICTIONS IN MY LIFE AFTER BARIATRIC SURGERY?

Life after bariatric surgery is as it should be for any individual who holds health as a priority in his or her life.

All patients with the gastric band have to come for regular follow up to see that the band is in the right place and is not too tight or loose. One may need to adjust the band off and on. This is done by injecting some water through the skin into a port that connects to the band that constricts the stomach. This is a requirement specific to the lap band, and other procedures do not need anything like this.

After the band and gastric bypass, where the stomach capacity is less than an ounce, portion sizes have to be minimal. Eating too much in one go is not an option and may lead to vomiting or discomfort.

Patients are taught to eat small feeds and not drink water at the same time. Lap band patients can potentially cheat the results of the operation by sneaking in liquid calories in the form of condensed milk, liquid chocolate, syrup, ice cream and ghee. The compulsive sweet eater is definitely better off with a gastric bypass, which actually makes sweet eating an unpleasant experience after operation (patients cannot tolerate sugars after the bypass, and have vomiting, giddiness, chest discomfort, etc., all part of the dumping syndrome).

All post bariatric surgery patients also need to know that they will not be able to eat as much they used to because of their smaller stomach size. Their hunger is satisfied eating much less than before. The usual instructions for a healthy lifestyle of eating correctly (no sweets, colas, fried food) and moving more applies even after surgery.

Patients who undergo gastric bypass have to consume iron, calcium and vitamins regularly and also need to be checked for the same periodically.

Managing life after obesity surgery is for most of the patients a new and better deal because they start reducing fat, are often cured of their diabetes, hypertension, sleep apnea (snoring) and other diseases, apart from looking good like never before and taking part in normal recreational and social activities. Most people lose the terrible shyness and fear of ridicule that prevented them from going to parties or to play.

However, it is crucial that patients understand the importance of dietary control and exercise even after operation, because bariatric surgery is only a means to an end, whereby diet and exercise become maximally effective in weight management (something that was previously not achievable in the obese patient).

WILL I BE ABLE TO HAVE A NORMAL SEXUAL AND REPRODUCTIVE LIFE AFTER WEIGHT LOSS SURGERY?

Many obese people have a poor sex life. They have associated psychosocial complexes originating from the same that needs to be addressed preoperatively. Post surgery, as the weight starts reducing the patient becomes more sexually active.

Fertility is a major problem with obesity and many female patients have polycystic ovarian disease, endometriosis as part and parcel of obesity. The fertility rates have also been shown to improve dramatically following weight loss surgery.

MY CHILDREN ARE OBESE- WHAT CAN I DO?

In the USA one out of four children is obese and each such child carries a huge risk of persisting obesity in adulthood. In India the scenario is not too different either with an incidence of 1 in 5 urban children being obese. The scary part is that most of them are going to stay fat lifelong. Preventing an unhealthy lifestyle in children (fried food, pizzas, burgers, colas, long hours of TV watching, to name a few) should be undertaken by parents, teachers and policymakers to avoid a loss of productive and healthy Generation Next.

WHAT ARE THE COMPLICATIONS OF SURGERY?

Like all surgeries bariatric surgery is not exempt from its share of troubles. Morbid obese subjects are a high-risk group for anesthesia. They could have pre-existing pulmonary and cardiac problems along with risk for venous thrombosis (clots in leg veins) that may aggravate after surgery. Surgery may entail joining the intestines to the stomach (or to another part of the gut) with sutures or staples. The suture or staple-lines may leak and result in infection, prolonged hospital stay, increased cost, re-exploration and even death. Having said that, advances in modern anesthesia and availability of stapler buttressing technology and surgical experience have brought down these risks. Late complications are more rare. Bands may slip from their position, erode into the stomach and get infected, or the stomach may prolapse out.

Gastric bypass procedures may lead to iron and vitamin B deficiencies that need treatment. The stoma between the pouch and the small bowel may become too narrow or too wide. The former leads to vomiting and inability to eat as before, while the latter leads to weight regain. The pouch may dilate and lead to the same consequence, especially if the patient eats compulsively. Ulcers may form in the pouch and need medical or even surgical treatment.

The stomach, after a sleeve gastrectomy, may stretch and increase in size, but there is no clear evidence about this, as the procedure is relatively new and the follow up period is, at present, not more than six years.

WHO ARE MY DOCTORS?

Belle Vue Clinic’s Obesity Program is run by BMI (Bariatrics and Metabolism Initiative), founded by our bariatric surgeons Dr. B. Ramana and Dr. Sarfaraz Baig.

They have years of treating obese patients with bariatric surgery, and are pioneers in Eastern India in this regard. In fact, BMI is a unique initiative in India, where doctors work not only to treat obese people but also do social service to raise awareness about obesity in schools and the community at large.

The two surgeons lead a team of anesthetists, Registrars, Medical Officers, trained nurses, technicians, nutritionists, psychologists, and are ably helped by specialists of multiple disciplines like cardiology, diabetes and medicine, physiotherapy, neurology, gastroenterology, orthopedics, radiology, pathology, etc.

The entire team is focused on the bariatric patient and is responsible for the superb results in our clinic.

To learn more about Dr. Ramana and Dr. Baig, please visit their website at http://www.bmi-india.com. They have a lot of free and useful content for anyone interested in obesity, be it a patient or a doctor.

CONTACT:
 

DEPARTMENT OF OBESITY MANAGEMENT Dr. B. Ramana (MS DNB FRCS), Mobile : 98300 31663 Dr. Sarfaraz Jalil Baig (MS FRCS), Mobile : 98300 08668