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Obesity and Bariatric Surgery

By Dr. Vandana Soni in Laparoscopic / Minimal Access Surgery

Mar 19 , 2020 | 2 min read

Obesity is a complex disease and a major health risk factor linked to heart disease, diabetes, hypertension,stroke, cancer and early death. Large scale developmental activities and urbanization in India have brought significant changes in lifestyle and dietary habits in the population.  This has led to a surge in lifestyle disorders like obesity and diabetes. Together with high cholesterol and high blood pressure theygive rise to a condition known as metabolic syndrome. Together they contribute to a significant medical and economic burden worldwide.

The global switch from diseases of nutritional deficiency to conditions of over nutrition has occurred, over a remarkably short span of time.  The availability of the mass media and web networking has tremendously enhanced global communication to spread the awareness regarding the deleterious effects of obesity.

Treatment of Obesity.

Management of obesity involves several modalities, all focused around patients diet. The diet forms the base of the treatment obesity pyramid. With increasing BMI(Basic Metabolic Rate), the treatment modality changes to progress higher on pyramid scale. BMI more than 32.5 is associated with diseases like diabetes, hypertension, osteoarthritis, obstructive sleep apnea etc. Diet and physical activity together contribute to lifestyle modifications mandated to treat obesity.

Lifestyle modifications

The lifestyle modification is a combination of diet, physical activity and behavior therapy.Life style modification is the foundation of obesity management but its compliance in the long run is difficult. Diet and exercise is the mainstay of treatment strategy when BMI is more than 23.5. Facilitating lifestyle changes is challenging and requires complete dedication and commitment from patients who are obese to inculcate new dietary and behavior regimes.

Pharmacotherapy

The next in the sequence of pyramid management of obesity is pharmacotherapy when the BMI > 27.5. There are different drugs used for treating obesity. Drugs are useful in treatment of obesity but their side effects preclude long term use.

Bariatric Surgery (Weight Loss Surgery)

Bariatric surgery has proven to be the most effective treatment for achieving and maintaining long term weight loss. The success achieved in resolution of obesity associated co morbidities and sustaining long term weight loss after surgery is notably significant. The advent of minimally invasive surgical techniques and increasing experience with these procedures has led to a marked decrease in the overall morbidity following bariatric surgery .To ensure safe practice in bariatric surgery, a multidisciplinary team approach is required. A team of professionals including surgeon, anesthesiologist, physician, endocrinologist, psychologist, co-coordinator and nutritionist manage the patients undergoingbariatric surgery for weight loss. Bariatric Surgery modifies the patient’s digestive system by decreasing the stomach size and altering the pathway of food resulting in patient feeling less hungry and decreasing the absorption of fat and sugars.Thus, bariatric surgery is probably a very effective way to achieve the diet necessary for weight loss.

To optimize the outcome of the procedure, bariatric surgery should be performed on carefully selected patients, in bariatric centers, specially equipped to care for the obese, within a broadly based, multidisciplinary setting that provides lifelong postoperative care.  However, there is a need to make the society aware about obesity as a metabolic disorder, and to control and improve the co-morbidities associated with the combined approach of medical and surgical intervention.