Obesity can generally be managed by diet and physical activity. But in some cases surgical intervention may be required.
Being overweight and morbid obesity are rapidly increasing problems, especially among the young. Many schoolchildren are overweight or obese. There are many causes for this but two most important ones are eating more than required and less physical activity like. So it is important to analyse the cause for the overweight, so that the treatment becomes easy.
Obesity is measured in terms of Body Mass Index (BMI).To calculate BMI use the following formula: Weight in kg divided by height in meter square (m2).
Normal BMI is in the range of 18 to 24. Between 25 and 29 is considered Overweight and 30-34 is Obese. BMI above 35 is known as Morbid Obesity and requires special attention.
While seeing a patient who is overweight or obese, the cause should be diagnosed. The individual's dietary habits and physical activities are analysed in detail. Other investigations to locate pathological causes also need to be conducted. Common causes include over eating and low physical activity; pathological reasons like tumour in the base of the brain, pancreas, adrenal gland; hypothyroidism; taking drugs especially steroids, for long; idiopathic i.e. the cause cannot be identified.
The common investigations are estimating the levels of serum growth hormone, cortisol, insulin and thyroid hormone. Also, computerised tomography of the base of the brain will help rule out tumours.
Management of obesity is very important because it may lead to lot of problems. Restriction of normal physical activity is a common problem . Other problems are early development of diabetes mellitus, hypertension, CAD, respiratory problems and osteoarthritis of the weight-bearing joints.
The management strategy is to rule out pathological causes. If no pathological causes are identified, then counselling regarding diet and physical activities become very important. Overweight patients without systematic complications can be managed with dietary adjustments.
Patients with systemic complications and a BMI of 35 or above are morbidly obese. They will benefit by common interventions like gastric band, Sleeve gastrectomy and gastric bypass procedures.
The common procedures in India are gastric band, Sleeve gastrectomy and, to some extent, gastric bypass procedures. Gastric bypass has the advantage of maximum and permanent weight loss. But the procedure also has a risk of complication. Sleeve gastrectomy also gives significant weight loss with minimal complications but there may be weight gain five years after the procedure.
It is very important that obese patients with early onset of diabetes and hypertension undergo such surgical procedures since this may help reverse diabetes and hypertension.
The surgical procedure to treat obesity was known as bariatric surgery. Now the term is being changed to metabolic surgery because of the reversal of the diabetes and hypertension.
The writer is a Chennai-based Senior Gastro-Intestinal and Laparoscopic Surgeon.