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Bariatric Surgery: An Answer to the Big ‘O’

Dr Nandakishore Dukkipati

 

Remember your New Year resolution? Most frequent resolutions are to become healthy, lose weight and look good. With resolutions fluttering between the desire to reach the ever elusive size 0, and just trying to stay within the healthy weight limits, people continue to look for an easy solution or, a ’quick fix‘ to achieve their goals.

The old fashioned way of diet control and rigorous exercise seems to be the mainstay at conversational level, but doesn’t seem to extend to practicality with everyone. Amongst us, there are those who suffer ailments and disabilities that prevent them from leading an active life.

The question on the table is - Is there an answer to the problem called the ’Big O’ or obesity?
In this age of nature cures, appetite suppressants, herbal products, magic diets with the promise of significant weight loss and self induced food deprivation to achieve the goal of ’weight loss,’ is there a solution that is proven and effective to achieve the weight loss goals?

Weight loss medications are limited by their side effects, length of time they can be used, lack of desired effect in some, and potential complications. Weight loss programs are wonderful if people can continue to follow the guidance provided, and stay with the suggested diet plans and exercise programs. The typical reaction seen is that the participants of such programs have regained their original weight - and then some more.

Why does this regaining of weight happen?

If people have the self control and will power to restrict their diet and mend their life style into a healthy pattern, the problem of obesity will not be so prevalent. On an average, India continues to have substantially lower percentage of population with obesity related issues compared to the western world; however, this population is on the rise. The IT sector jobs, call centers and the out-sourced positions from multinational companies are promoting sedentary lifestyles and sleep deprivation, with altered sleep-wake cycle in many of our professionals.

This in turn leads to poor dietary habits and inability to lead an active life, which then causes weight gain. Obesity is usually referred to in terms of BMI (Body Mass Index).
The consensus statement from world renowned organizations such as National Institute of Health (NIH), American Society for Metabolic and Bariatric Surgery (ASMBS) is that,
“Bariatric surgery is known to be the most effective and long lasting treatment for morbid obesity and many related conditions, but now mounting evidence suggests it may be among the most effective treatments for metabolic diseases and conditions including type-2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease and obstructive sleep apnea.”

Surgical options for weight loss have been in existence for a few decades. This field of science has evolved significantly in the last decade, as obesity became a global epidemic. The availability of new technology and instrumentation that allowed for these procedures to be performed in a minimally invasive or laparoscopic approach, also contributed to this development. Surgical procedures are performed with very small skin incisions and camera guidance. Some of those procedures are:

Laparoscopic adjustable gastric band placement
 


 


In this operation, a silicone gastric band is placed around the upper part of the stomach, creating a small pouch. The small size of the pouch means that you feel full sooner.
The band can be adjusted in size by inflating or deflating the band. This allows the health professional to adjust the size of the opening between the pouch and the stomach, and in turn can effectively control the amount of food required to obtain early satiety. Gastric band procedure is the simplest and safest of all weight loss procedures, and yields similar weight loss to all other procedures over a course of time.

Laparoscopic gastric sleeve resection
Approximately 85 percent of the stomach is removed during this surgery, leaving a narrow tube like stomach. Due to the very small capacity of the tubular stomach, less food can be consumed and early satiety achieved.
 

 

This procedure is irreversible and is relatively new with data of efficacy for past 3 years. This procedure, originally designed as an initial stage of another extensive surgery, has been shown to be effective for weight loss by itself. 

 
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