According to the latest WHO Global Health data, more than 2.5 billion adults were overweight, with 890 million of these individuals being obese. The global prevalence of obesity more than tripled between 1975 and 2022, with significant rise in countries, including the low and middle-income nations like India and other South Asian countries.
We interviewed Dr Arun K Sharma (MBBS, MS, M.Ch, FMBS), an Obesity expert, who recently joined as Consultant at Fortis Escorts Hospital Amritsar, Punjab after spending a significant part of his early career at the prestigious All India Institute of Medical Sciences (AIIMS), New Delhi.
Excerpts:
Q1) Is Obesity a disease & how is it measured/checked or how can we label someone as Obese and are there any categories of Obesity?
Yes Obesity is another form of malnutrition and was long back recognised as a disease by WHO (since it’s inception in 1948) but was identified as a global pandemic in 1997. Obesity is generally measured as Body Mass Index [ratio of weight (in kg) and height (in metres square)]. Normal BMI is 18-25kg/m2 with 25-30 BMI being overweight.
Anyone with BMI greater than 30 (27.5 for Asians; i.e; 2.5 points less) is Obese and those with BMI greater than 35, 40, 50 & 60 are respectively labelled with Class 2, Class 3, Class 4 & Class 5 Obesity. The cut off is kept 2.5 points less for Asians and Indians because of more prevalence of Central Obesity & Diabetes.
Q2) How is Obesity related to Diabetes & other lifestyle disorders like High BP, Heart disease, Breathing difficulties, Fatty liver etc.?
Obesity is a lifestyle disorder like Diabetes but it has genetic predisposition as well. The excess fat tissue in obesity leads to insulin resistance and release of certain other pro inflammatory hormones which leads to Diabetes. Moreover, high cholesterol levels or dyslipidemia predispose these patients to problems like Hypertension, Heart disease and Fatty Liver which may progress to Liver failure. The excessive abdominal and thoracic fat leads to higher airway pressures causing obstructive sleep apnea (OSA), which decreases the blood oxygen levels and can further aggravate coronary heart disease.
Q3) Does Obesity increase the risk of cancer?
Yes Obesity does increase the Cancer risk of around 13 different types in females and 11 types in males by 1-8 times. It has beem recognised as the 2nd most preventable cause of Cancer after smoking or tobacco. Moreover, the diagnosis of Cancer in Obese patients gets delayed due to poor sensitivity of certain investigations in presence of excessive abdominal fat besides additional technical challenges of performing Oncosurgery in such patients and dosing of chemotherapeutic agents and their access.
Q4) What is the role of lifestyle modifications & are there any medicines or drugs available for the management of Obesity?
Yes lifestyle modifications like dieting and regular exercises do help in achieving a weight loss of 5-10% and this can be further improved to around 15% with addition of certain medications but the concern is that this weight loss is persistent only till the person is following it. And more importantly long term safety of the weight loss medicines is yet to be established.
Q5) Is there a role of Surgery in management of Obesity & Is it true that Diabetes can be cured by this Surgery?
Yes in severe or class 3 Obesity or class 2 obesity with comorbidities like Diabetes, Hypertension or OSA, Surgery plays a wonderful role of achieving a sustained weight loss for years. Very importantly, this surgery can cure diabetes in a majority of the patients while improving the blood sugar levels in others thereby decreasing the requirement for insulin or other anti diabetic medications. That is why this surgery is now also called as Diabetes Surgery.
Q6) How is this surgery performed, how safe it is & are there any short or long term complications with this surgery?
This surgery is performed by keyhole or Laparoscopic approach requiring 4-5 stitches at different places on the abdomen and patient is up and walking on the same day of surgery and can go home on day 2nd of Surgery. This surgery is very safe in expert hands and it’s safety can be compared to the safety of routine Laparoscopic Gall bladder surgery. There are literally no short term complications except for the requirements in dietary adjustments as per the type of surgery, while in long term, these patients may require routine multivitamins, again depending upon the type of surgery, which is of least concern comparing the numerous benefits this surgery offers to our patients like weight improvement to near normal, improvement or cure of diabetes, near 100% resolution of Obstructive Sleep Apnea (OSA), less risk of heart disease and the cancer.
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