Am I fat (obese) ? Obesity is usually measured by the term called Body Mass Index(BMI) which is calculated as follows (BMI) = ____ Weight in Kg ____ Body Mass Index (Height in Meters)2 According to the BMI: Overweight BMI 25-29.9 Obesity Class I BMI 30-34.9 Obesity Class II BMI 35-39.9 Obesity Class III BMI 40> So What, if I am fat Obesity usually does not come alone but brings several life threatening medical diseases along with it. They are - Diabetes, hypertension, hyperlipidemia, cardiac disease, respiratory disease, sleep apnea, arthritis, depression, urinary stress incontinence, menstrual irregularities and infertility, It is much more than a cosmetic predicament. At the minimum, it markedly affects the quality it is a matter if like and death. Stroke Depression Diabetes Hernia Breathing Problems High B.P Heart disease Heart burn Joint Pains Arthritis What can I do to reduce? Depending on which class of obesity you fit into and whether or not you have associated co-morbid conditions, the options available are: Diet, Exercise, Medicines, and Surgery Why do I not lose Weight inspite of dieting? The rate of metabolism is different in every person. People whose metabolic rate is low tend to develop obesity. Only dieting will not achieve substantial weight loss. Once you go on a low calories diet, you lose weight initially after which a plateau is reached. Further weight loss is either slow or no more. Frustration sets in, followed by discontinuation of the diet. Now you will gain more weight then before. This is also called the yo-yo Phenomenon. What about medicines? There are few medicines that can help reduce weight, but they are not without side effects. It is observed that 95% of patients resume to their original weight within 2 years after stopping medicines. What is Bariatric surgery? Bariatric surgery is a group of surgeries which are performed to induce long term weight loss along with curing most of the medical problems like diabetes, blood pressure, arthritis etc. Bariatric surgery is often confused with liposuction. Liposuction is a cosmetic surgery where few kilograms of fat is removed by suction. This surgery is mainly used for body contouring or shaping the body where there are few extra kilos of fat like the waistline or thigh. This cosmetic surgery does not help much for morbidly obese patients in controlling their weight or curing associated medical problems. How is it done? Bariatric surgeries can be done through both open and laparoscopic approaches. Laparoscopic surgery is done through small incisions. Hence it has the advantage of being associated with less pain, faster recovery and fewer wound complications. How weight loss surgery helps reduce excess weight? It will restrict or reduce the amount you can eat or it can absorbtion all of the food you eat or the third can be a combination of the first two. How effective is weight loss surgery? Depending on the type of surgery anywhere from 36% to 90% of your excess body weight (EBW) Clinical studies show that, following surgery most patients lose weight rapidly and continue to do soup until 18 to 24 months after the procedure. However you will not wake up from the surgery with any weight loss. Patients may lose 30 to 50% of their excess weight in the first 6 months, and ~77% as early as 12 months after surgery. Another study showed that patients could maintain 50-60% loss of excess weight 10-14 years after surgery. How safe is surgery? Surgery is safe in expert hands and in hospitals with a good infrastructure and equipment. In a surgery of over 10,000 patients, the mortality rate for weight loss surgery was 0.3%. Do I qualify for the surgery? If you are morbidly obese, (BMI > 37.5 or BMI > 32.5 with associated co-morbid medical conditions) and you have failed to lose weight significantly by other methods, and if you are motivated and committed for a life long change in lifestyle, then you qualify for the surgery. Also it is important to make sure that you do not have any metabolic or endocrine disorders causing obesity, have any major psychiatric problem or any severe medical problems, which can make surgery dangerous. For women, it is also necessary to make sure pregnancy is avoided in the near future. Which Procedure is right for you? The most important step in selecting a weight loss surgery is getting all the information you need about the various surgical options. Ultimately your surgeon and other physicians are your best sources for that information. After evaluating you, they can give their best recommendations. The three most common procedures performed are: Roux-en-Y Gastric Bypass Procedure Stapling is used to create a smaller, upper stomach pouch which restricts the amount of food able to be consumed. A portion of small bowel is bypassed thus delaying food from mixing with digestive juices to avoid complete calorie absorption. Sleeve Gastrectomy The stomach is converted into a long thin tube by stapling along its longitudinal axis. The excluded part of the redundant stomach is removed through a small incision. Laparoscopic Adjustable Gastric Banding A band is placed around the upper most part of the stomach separating the stomach into one small and one large portion. Band can be adjusted to increase or decrease restriction. What is the expected hospital stay for the surgery? Most patients stay in the hospital approximately 4 to 5 days after an open procedure and 2 to 3 days after a laparoscopic procedure. You will be discharged when you are able to 1) Take enough liquids and nutrients by mouth to prevent dehydration 2) Have no fever 3) Have adequate pain control with medications by month. How long will I need to recover? If the surgery is done open then it may take bout six weeks, but if it is done laparascopically about 10 days to two weeks. At which time some patients have returned to a desk job. It may take a litter longer if you do heavy manual labor. What are the benefits of Bariatric surgery? Besides significant and sustained weight loss, there are several benefits including freedom from co-morbid conditions: Blood sugar levels for patients which type II diabetes that improve almost immediately and become completely normal within a year after surgery. Blood pressure and cholesterol lower. There is relief of sleep apnea, asthama and acid reflux. Arthritis pain decreases and there is improved mobility. There is improvement in the mood and self esteem. The cosmetic benefits follow after some time when there is significant Weight lose. What are the risks of Gastric Bypass Surgery? Although the operation is considered safe, complications may occur as with any major surgery. However, the risk of remaining obese will eventually outweigh the risks involved with the surgery. Gastric bypass surgery may be associated with loosening of the staple line or anastamotic leak, pulmonary embolism, vomiting due to decreased side of the stomach, wounded infections, blood clots in the legs, scar problems including hernia, developments of gall stones, dumping syndrome leading to loose motions and vitamin deficiencies. When can I have children after the surgery? The surgeons are advising the female patients to wait at least two years after surgery to avoid the stress of a pregnancy during the period of rapid weight loss and allow her weight to stabilize. Please be careful to use birth control methods in the first 18 to 24 months. Will the problems due to my obesity to away after the surgery? Yes some of the complications will resolve and some will improve dramatically, like sleep apnea, asthma, hypertension and high cholesterol. In fact the Type II Diabetes will respond with ~ 85-90% resolution and obesity surgery is now considered the best treatment for that diabetes. Is this procedure considered cosmetic? No, it is considered a medically indicated procedure. Did you know that? “Most people get their diabetes cured before they leave the hospital” “Loosing one Kilo of weight reduces blood pressure by 1mm of mercury” “Gaining one kilo of weight reduces your life by 4 months”