Dr Farooq Ahmad Bhat
Obesity and overweight are defined as the increase in size and amount of fat cells in the body. Obesity and overweight are caused by many factors including behaviours like eating patterns, lack of sleep or lack of physical activity and some medicines, as well as genetics and family history.
Obesity is a chronic health condition that raises the risk for heart disease and is the leading cause of death nowadays, and is linked to many other health problems, including type 2 diabetes and hypertension (High Blood Pressure), Obstructive sleep apnea, certain types of cancers and osteoarthritis. When these patients arrive in our clinics, we use body mass index (BMI) to screen for overweight and obesity. BMI is a measure of body fat based on height and weight and expressed in units Kg (weight)/height squaree. gifa person is 80 kgs body weight & height is 180cm (1.8 meter) BMI= 80/1.8×1.8, 80/3.24, 24.69 . Unhealthy life style habits such as not getting enough physical activity and eating high calorie, low-nutrient foods and beverages, can raise your risk of overweight and obesity. Some medications for high blood pressure or depression, can also sometimes cause an increase of body weight.
BMI categories for adults.
Underweight BMI <18.5
Healthyweight BMI 18.5 – 24.9
Over weight BMI 25- 29.9
Obesity BMI >30 or above
BMI categories for children
For children, height and weight are shown in percentiles. A child’s BMI percentile is calculated by comparing the child’s BMI to growth factors for children who are of the same age and sex.
Obesity prevention requires a complex approach, including interventions at medical, societal, community, family and individual level. Life style changes that can reduce weight include following a heart-healthy eating plan lower in calories and low in unhealthy saturated fats, increasing the intake of dietary fiber and increasing physical activity.
Medications can be used, along with a suitable diet, to reduce appetite or decrease fat absorption.
If diet, exercise and medication are not effective, bariatric surgery is performed. Bariatric surgery, also known as weight loss surgery, is a group of procedures that modify the digestive system to help individuals with obesity loose weight.
Bariatric surgery works by either restricting the amount of food the stomach can hold, altering how food is absorbed, or both.
Commonly used procedures in bariatric surgery:-
a. Sleeve Gastrectomy
b. Gastric Bypass (Ronx-en-y)
c. Adjustable Gastric Band
d. Biliopancreatic diversion with duodenal switch (BPD-DS)
e. Single Anastomosis Duodeno-Ileal Bypass with sleeve gastrectomy (SADI- S)
Gastric surgery (sleeve gastrectomy) may be performed to reduce stomach volume leading to feeling full earlier, or a reduced ability to absorb nutrients from food.
Genetic Factors:
Various genetic studies have shown that obesity is extremely habitable, with numerous genes identified with adiposity and weight gain.
Other causes
Endocrine disorders commonly associated with obesity include Prader- Willi syndrome and less commonly fragile x syndrome, Bardet-Biedl syndrome, Wilson turner syndrome, congenital leptin deficiency and alstrom syndrome.
Obesity has become an epidemic which has worsened for the last 50 years. Obesity is the second most common cause of preventable death after smoking. In 2022, over 1 billion people lived with obesity worldwide.
Obesity can also be estimated by assessing skin thickness in the triceps, biceps, subscapular and suprailiac areas. Dual energy radiographic absorption by (DEXA) scan may also be used to assess fat mass.
How much weight should I lose, is a common question ask by these patients? If you need to loose weight, work with a health care professional to sea weight loss go a land time frame that will work best for you. Loosing excess weight may help lower your chances of developing health problems related to over weight and obesity. If you already have weight-related health problems such as high blood pressure or diabetes, loosing weight may help improve your health. Regular exercises like walking, jogging, swimming etc.., can help you loose weight and maintain lean muscle mass. You should try to get at least 150minutes of moderate-intensity physical activity each weak.
Role of a plastic surgery in the treatment of obesity is divided into 2 parts. First part is before the surgical treatment of obesity and the second part is after bariatric surgery. In the first part, liposuction of areas, which hinder the exercise regime, such as knee, ankles, lower, abdomen is a kick start for these patients. It is to be noted that liposuction is not a weight loss method and does not appear to affect obesity related problems. However as said before obese patients with fat collections around abdomen, knees, ankles feel it very difficult to follow an exercise regime, and therefore liposuction of these are as off at collection gives the psychological boost. The role of a plastic surgeon after bariatric surgery is to address the areas, which become redundant after major weight loss. The areas are 1. Arm 2. Breast 3. Trunk 4. Thighs. So. These patients need brachioplasty for arm redundancy. Abdomino-plasty for abdominal redundancy, breast implants for breast redundancy, and thigh-plasty for thigh redundancy. These procedures are carried out after 18 months to 24 months after bariatric surgery, when the body weight is stable.
Since each of these procedures are major surgeries done under anesthesia, these are staged at intervals of 3-6months. In conclusion approach to an obese patient is a multi-specialty approach, which includes a qualified dietician and exercise trainer, an experienced bariatric surgeon, and a plastic surgeon.
(The author is a senior plastic and cosmetic surgeon at Safa Marwah Hospital, Soura Srinagar)
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