Morbid Obesity

Obesity Clinic

Fat is deposited on our bodies when the energy (kilojoules) we consume from food and drink is greater than the energy used in activities and at rest. Small imbalances over long periods of time can cause you to become overweight or obese. Overweight and obesity are defined by the World Health Organization using the body mass index (BMI). BMI is a measure of body size and is used to indicate level of risk for morbidity (disease risk) and mortality (death rates) at the population level. People with a BMI of 25 or more are classified as overweight. People with a BMI of 30 or greater are classified as obese.
Obesity is not just a cosmetic consideration; it is a dire dilemma directly harmful to one’s health. In the United States, roughly 300,000 deaths per year are directly related to obesity, and more than 80% of these deaths are in patients with a BMI over 30. For patients with a BMI over 40, life expectancy is reduces significantly (as much as 20 years for men and five years for women). Obesity also increases the risk of developing a number of chronic diseases, including the following: Insulin resistance, Type 2 (adult-onset) diabetes, High blood pressure (hypertension), High cholesterol, Stroke, Heart attack, etc.
Regarding this Issue, an equipped clinic with multidisciplinary doctors could provide treatment and reducing the symptoms of obesity. In Obesity Clinic contribution of Bariatric Surgeons, Cosmetic Surgeons, Nutritionists, Physical Therapist, Gastroenterologists, Radiologist and Psychiatrist will be required for a complete course of treatment for obese patients.

Diet Therapy

Diets to promote weight loss are generally divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie. A meta-analysis of six randomized controlled trials found no difference between three of the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilogram (4.4–8.8 lb) weight loss in all studies. At two years these three methods resulted in similar weight loss irrespective of the macronutrients emphasized.
Very low calorie diets provide 200–800 kcal/day, maintaining protein intake but limiting calories from both fat and carbohydrates. They subject the body to starvation and produce an average weekly weight loss of 1.5–2.5 kilograms (3.3–5.5 lb). These diets are not recommended for general use as they are associated with adverse side effects such as loss of lean muscle mass, increased risks of gout, and electrolyte imbalances. People attempting these diets must be monitored closely by a physician to prevent complications.

Exercise

With use, muscles consume energy derived from both fat and glycogen. Due to the large size of leg muscles, walking, running, and cycling are the most effective means of exercise to reduce body fat. Exercise affects macronutrient balance. During moderate exercise, equivalent to a brisk walk, there is a shift to greater use of fat as a fuel. To maintain health the American Heart Association recommends a minimum of 30 minutes of moderate exercise at least 5 days a week.
A meta-analysis of 43 randomized controlled trials by the Cochrane Collaboration found that exercising alone led to limited weight loss. In combination with diet, however, it resulted in a 1 kilogram weight loss over dieting alone. A 1.5 kilogram (3.3 lb) loss was observed with a greater degree of exercise. Even though exercise as carried out in the general population has only modest effects, a dose response curve is found, and very intense exercise can lead to substantial weight loss. During 20 weeks of basic military training with no dietary restriction, obese military recruits lost 12.5 kg (27.6 lb). High levels of physical activity seem to be necessary to maintain weight loss. A pedometer appears useful for motivation. Over an average of 18-weeks of use physical activity increased by 27% resulting in a 0.38 decreased in BMI.
Signs that encourage the use of stairs as well as community campaigns have been shown to be effective in increasing exercise in a population. The city of Bogota, Colombia for example blocks off 113 kilometers (70 mi) of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These pedestrian zones are part of an effort to combat chronic diseases, including obesity.

Prescription weight-loss medication

Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. If you don’t make these other changes in your life, medication is unlikely to work.
Your doctor may recommend weight-loss medication if other methods of weight loss haven’t worked for you and you meet one of the following criteria:

  • Other methods of weight loss haven’t worked for you
  • Your body mass index (BMI) is 30 or greater
  • Your body mass index (BMI) is greater than 27 and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea

Obesity is not a single disorder but a heterogeneous group of conditions with multiple causes. Although genetic differences are undoubtedly important, the marked rise in the prevalence of obesity is best explained by behavioural and environmental changes that have resulted from technological advances. In such circumstances, it is appropriate to consider pharmacological treatment as an adjunct to the other treatment modalities.
Current drug treatment of obesity is directed at reducing energy/food intake either by an action on the gastrointestinal system or via an action through the central nervous system control of appetite and feeding. Before prescribing a drug, a clinician must firstly assess whether the patient understands the purpose of the drug treatment (in combination with lifestyle change to improve health status) and how it works, and secondly, assess the likely outcome of treatment. The clinician should ensure that there are no medical or psychiatric contraindications to drug therapy. This requires an appropriate documented clinical assessment of the patient.
It is important that doctors who prescribe such drugs are fully familiar with either the primary literature or an authoritative summary, such as this report.

Bariateric Surgery

In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery offers the best chance of losing the most weight, but it can pose serious risks. Weight-loss surgery limits the amount of food you’re able to comfortably eat or decreases the absorption of food and calories, or both.
Weight-loss surgery for obesity may be considered if:

  • You have extreme obesity, with a body mass index (BMI) of 40 or higher
  • Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure
  • You’re committed to making the lifestyle changes that are necessary for surgery to work

Weight-loss surgery can often help you lose as much as 50 percent or more of your excess body weight. But weight-loss surgery isn’t a miracle obesity cure. It doesn’t guarantee that you’ll lose all of your excess weight or that you’ll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits.
Common weight-loss surgeries include:

  • Gastric bypass surgery: This is the favored weight-loss surgery in the United States because it has shown relatively good long-term results. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach.
  • Laparoscopic adjustable gastric banding (LAGB): In this procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. LAGB is popular because it is less invasive, generally causes slow, steady weight loss and the band can be adjusted if needed. However, as with other procedures, this won’t work without changes in your behavior. Results are usually not as good as with other procedures. The LAP-BAND gastric banding device has also been approved for use in people who have a BMI of 30 to 34 and have an additional health condition related to their obesity.
  • Gastric sleeve: In this procedure, part of the stomach is removed, creating a smaller reservoir for food. There are ongoing studies evaluating this procedure.
  • Biliopancreatic diversion with duodenal switch: In this procedure, most of your stomach is surgically removed. This weight-loss surgery offers sustained weight loss, but it poses a greater risk of malnutrition and vitamin deficiencies, and you require close monitoring for health problems. It’s generally used for people who have a body mass index of 50 or more.