OBESITY

     Obesity is not just a cosmetic problem. It can lead to more than 200 medical problems including type 2 diabetes, high blood pressure (hypertension), high blood fat levels (hyperlipidemia), heart attack, brain stroke, joint pains (osteoarthritis), snoring (obstructive sleep apnea) and cancers. Females with obesity have irregular periods, higher incidence of abortions and difficult labor. Obesity increases life risk by 50 to 100% and reduces life span by 5 to 20 years.

Body mass index (BMI) is the most commonly used parameter to define obesity. Indians have more fat and less muscle compared to foreigners with same height and weight.

BARIATRIC SURGEON IN HYDERABAD INDIA obesity

     Obesity is not just a cosmetic problem. It can lead to more than 200 medical problems including type 2 diabetes, high blood pressure (hypertension), high blood fat levels (hyperlipidemia), heart attack, brain stroke, joint pains (osteoarthritis), snoring (obstructive sleep apnea) and cancers. Females with obesity have irregular periods, higher incidence of abortions and difficult labor. Obesity increases life risk by 50 to 100% and reduces life span by 5 to 20 years.

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     Body mass index (BMI)

is the most commonly used parameter to define obesity. Indians have more fat and less muscle compared to foreigners with same height and weight. Indians are at risk of developing several medical problems at lower BMI. So Indian BMI categories have been changed. BMI is ≥ 25 kg/m2 indicates obesity in Indians/ Asians (In western countries ≥ 30 kg/m2). It is easy to calculate BMI.

BMI = Body weight in kilograms/ height in meters2 = kg/ m2

Based on BMI individuals are categorized as below

Categories BMI for Indians/ Asians BMI for Western Countries
Normal Range 18.50 to 22.99 kg/m2 18.50 to 24.99 kg/m2
Overweight  23.00 to 24.99 kg/m2 25.00 to 29.99 kg/m2
Grade 1 Obesity 25.00 to 29.99 kg/m2 30.00 to 34.99 kg/m2
Grade 2 Obesity (Severe Obesity) ≥ 30.00 kg/m2 35.00 to 39.99 kg/m2
Grade 3 Obesity (Morbid Obesity)   40.00 to 49.99 kg/m2
Super Obesity   50.00 to 59.99 kg/m2
Super Super Obesity   60.00 kg/m2 and above

 

     Parameters like waist circumference (WC) and waist to hip ratio (WHR) are more specific parameters than BMI to define obesity. 

Following parameters indicate obesity. 

Waist Circumference > 80 cm in females and > 90 in males in Indians

Waist to Hip Ratio > 0.8 in females and > 0.9 in males in Indians

 

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IS YOUR BMI ≥ 30 kg/m2

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     Several hormones and genes control body energy balance. Most of these hormones are produced in stomach and intestine. They utilize part of the energy for metabolism, heat production and convert remaining energy into fat. These hormones and genes decide the amount of fat to be stored in the body. This amount is called “fat set point” or “fat mass”. Fat set point is high in individuals suffering from obesity and low in thin individuals. These hormones include GLP1, peptide YY, Ghrelin, Amylin, Leptin, Adiponectin, GIP and anti-incretins. Even bile acids and gut microorganisms control fat set point.

Triggers altering fat set point –

     Will power can’t alter ‘fat mass’. But following factors can trigger these hormones and genes and reset ‘fat mass’ to a higher level. 

– intake of unhealthy foods

– lack of physical activity 

– irregular food habits

– lack of sleep 

– increased stress

– changes in circadian rhythm (working at night, sleeping in the morning)

– certain medications (steroids, psychiatric medicines)

     Some people have genetic tendency to gain weight. In these individuals, any of the above triggering factors, can trigger weight gain. Overeating of unhealthy foods and lack of physical activity are most common triggering factors. Endocrine and genetic problems are responsible for obesity in some individuals. 

 

Are you gaining weight in spite of eating less? 

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     Lifestyle modifications are necessary to maintain fitness and prevent obesity. They are also necessary to lose weight. These include healthy diet, regular exercise, taking food on regular timings, adequate sleep and stress free life. Obesity prevention should start at childhood. Even children should follow healthy food habits and exercise daily. 

     Majority of the individuals with mild obesity benefit from lifestyle modifications. If your BMI is < 30 kg/m2 you can get rid of excess fat by diet modification, regular physical activity. We need to find out the triggering factors for weight gain and those need to be addressed. If endocrine, genetic problems and medications are triggering weight gain, then they need to be dealt with.

     In most individuals overeating of unhealthy foods and lack of exercise trigger weight gain. Dieting (diet restriction) without altering food habits will not result in long lasting weight loss. If the cause of weight gain is unhealthy diet and lack of exercise, then changing to healthy diet and doing regular exercise can reduce ‘fat mass’. As long as healthy diet and regular exercise are followed ‘fat mass’ remains low. Once stopped, ‘fat mass’ increases again. So you need to continue healthy diet and exercise forever to prevent weight regain.

 

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     When BMI is ≥ 30 kg/m2 body already got adopted to a higher fat mass. Even if healthy diet and exercise are followed, there will not be much weight loss. Even if you lose more, you will regain weight. Lifestyle modifications are not enough for long lasting and effective weight loss when BMI is ≥ 30 kg/m2. 96 out of 100 members fail to lose weight or regain weight with non surgical methods, if BMI is ≥ 30 kg/m2. Even if healthy diet and exercise are followed, there will not be much weight loss. 

     When you start dieting and exercise, you need to fight against the hormones and genes controlling ‘fat mass’ to lose weight. If you fight, these hormones and genes won’t keep quiet. They fight back (increased Ghrelin, reduced GLP 1 & peptide YY) and induce counter changes in the body – increase hunger, reduce metabolism and heat production to conserve energy. A stage will come when you can’t tolerate hunger, start eating more food resulting in weight regain. Even though there is initial weight loss, weight will come back over a period of several months and sometimes you gain more weight.

Very low calorie diet (VLCD)

Keto diet

Veeramachineni diet

Intermittent fasting 

Naturopathy

can’t help when ‘fat set point’ is very high and BMI is ≥ 30 kg/m2.

     Those individuals who fail to achieve long lasting weight loss with non surgical methods, benefit from bariatric surgery. Bariatric surgery is very safe, highly effective and scientifically prove method for long lasting weight loss.

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     Anti obesity medicines help you to increase weight loss to some extent, when you are already losing weight by diet modifications and exercise especially when BMI is < 30 kg/m2. These medicines include orlistat, lorcaserin, phentermine + topiramate (Qsymia), liraglutide (Victoza) and Dulaglutide (Trulicity). Their effect is very less compared to bariatric surgeries. If you lose weight with medications, weight loss will be maintained as long as these medicines are taken. Once discontinued, all the lost weight will come back within two years, because of the effect of hormones and genes controlling fat mass.

Role of medicines in the treatment of obesity is limited.

     Sibutramine, an anti-obesity drug which act on brain and reduces appetite, is banned in India, USA and other countries due to its cardiovascular side effects. Side effects of sibutramine include increased blood pressure, insomnia, headache, constipation, dryness of mouth, risk of heart attack and stroke. Orlistat prevents absorption of up to 30 percent of fat in food by antagonizing the action of pancreatic lipase enzyme in digestive juices. It has no effect on digestion & absorption of carbohydrates. So it is not useful for those consuming excess sugars and eating very excess fat foods. As certain percentage of fat is not absorbed, side effects include steatorrhoea (foul smelling sticky stools because of presence of undigested fat in stools) and sometimes incontinence of stools. According to several reports orlistat has been implicated in liver failure, acute kidney injury and pancreatic injury. Phentermine + topiramate act on brain and reduce appetite. Liraglutide and dulaglutide are GLP1 analogs. They reduce appetite and delay gastric emptying.

Failed to lose weight with medications?

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     Surgical liposuction, non surgical liposuction, cool sculpting, vaser liposuction are body shaping procedures aimed at removal of unwanted fat deposits in a normal weight individuals. These are not for weight loss. In these procedures fat is removed from different body parts to improve cosmetic appearance. Liposuction and cool sculpting can’t alter body fat mass. So whatever amount of fat that is lost will come back in other parts of the body. They may help as a supplementary to  healthy diet and exercise when BMI is < 30 kg/m2. Some feel they can get rid of few kilograms of fat by liposuction and remaining by diet control and exercise. But this never happens. Those individuals who can reduce weight by diet modifications and exercise don’t need liposuction. Those who can’t reduce weight by lifestyle modifications, will not achieve long lasting weight loss even after liposuction and cool sculpting.  

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     Bariatric surgery is scientifically proven, very safe method for long lasting and effective weight loss. Mechanism of weight loss after bariatric surgery is different from other methods. Sleeve gastrectomy and diversion procedures re-set ‘fat set point’ to a lower level by altering several hormones and genes controlling ‘fat mass’. 

     These are performed on stomach and intestine by laparoscopic method (by putting small holes on tummy). Bariatric and metabolic surgeries are essentially same. If the purpose of surgery is weight loss, then it is called bariatric surgery. If the purpose of surgery is remission from diabetes and other co-morbid medical conditions, it is called metabolic surgery.

     Majority of the obese individuals fail to lose weight by diet restriction and regular exercise. Even if they lose initially, weight is regained due to the effect of fat set point. These are benefited from bariatric surgery.

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