Obesity and the associated disease burden is increasing worldwide with proportion of obese persons have nearly tripled since 1975. It is well known that obesity is a vexing problem in the developed economies as well. While the developed country like United States topped the list with 13 per cent of the obese people worldwide in 2013, China and India together accounted for 15 per cent of the world’s obese population, with 46 million and 30 million obese people, respectively. For developing countries like India, morbid obesity has not yet become a public health priority. Development brings with itself urbanization and reduction in physical activity. Unhealthy, processed food has become much more accessible for Indians, globalization and with rising middle class incomes the average caloric intake per individual among the middle class has increased. Obesity is inevitable in the society when the energy intake is much more than its expenditure. Thus, Obesity in India has reached epidemic proportions in the 21st century, with morbid obesity affecting 5% of the country’s population. According to a study published in the Lancet, India has seen a significant rise in obesity. India’s rank for total number of obese men has gone from 19th in the world in 1975 to 5th in 2014. For the number of obese women, India ranks 3rd in the world. The prevalence of childhood obesity has increased from 9.7% in 2001 to 19.3% in 2010, making India to have second largest number of obese children in the world second only to China. Kerala and Punjab has highest number of obese individuals in India.
Obesity clearly predisposes one to increased risk of developing diabetes, hypertension, hypercholesteremia and thereby increasing one’s risk by 49% for cardiovascular mortality and stroke. The risk of death from respiratory disease was higher by 38% and that from cancer was higher by 19%. Researchers at the Harvard showed that every 5 units higher BMI above 25 kg/m2 was associated with about 31% higher risk of premature death.
How do we control Obesity?
As a disease, obesity is complex and its solutions too are difficult. The epidemic of obesity needs to be tackled at several levels: the individual level, the community level, and the government level. At an individual level the mainstay of interventions are diet, exercise and adopting a healthy lifestyle. Essentially the measures are about adopting a healthy lifestyle and improving awareness. And finally, while preventive programs are in progress, guidelines must be made for treating obesity with lifestyle measures, medications for co morbidity, and finally bariatric surgery for severe cases of obesity.
How does Bariatric surgery or obesity surgery help?
Bariatric surgery promotes weight loss by restricting food intake and, in some procedures, altering the digestive and absorptive process. Bariatric surgery is not cosmetic surgery! Weight loss surgery, often done by laparoscopy changes your digestive system so that your body takes in fewer calories. Bariatric surgery has been shown to help improve or resolve many obesity-related conditions, such as resolution of type 2 diabetes in up to 85%, reduction in high blood pressure, heart disease, and more. Essentially by shredding excess weight person get in to healthy BMI and improves overall health.
Most commonly performed surgery for weight loss or bariatric surgery in current day practice are laparoscopic sleeve gastrectomy, laparoscopic Roux Y Gastric bypass (RYGB) and Laparoscopic Mini Gastric bypass. Laparoscopic sleeve gastrectomy is a restrictive type bariatric surgery, where stomach size is reduced to limit the quantity of food intake. Gastric bypass of mini gastric bypass are similar weight loss operations or obesity surgery where the stomach size is reduced and intestine is bypassed in a controlled manner to limit the absorption of food. So these operations have a restrictive and a malabsoptive component. Obesity surgery or bariatric surgery provides sustained weight loss of about 60-70% of excess body weight without major side effects. It’s important for the patient to understand the surgery and to adhere to the treatment plan, diet and follow up with the bariatric surgeon to have good long term result.