Dealing with morbid obesity

The World Health Organization (WHO) recognises morbid obesity as a public health problem. The obesity pandemic has been growing at an alarming rate and has been a serious issue of discussion among healthcare providers, globally.

Awareness of the ill effects of obesity is widespread and it has been estimated that a morbidly obese individual has more than a decade of reduction in life expectancy, secondary health problems such as diabetes, coronary heart disease, hypertension, etc. There is however, a lack of proper understanding among patients and general practitioners alike, of available options that can be tailored to the needs of a given patient with morbid obesity.  

The severity of obesity is stratified based on ‘body mass index’ (BMI) which is calculated as weight of the individual in kilograms, divided by the square of height in metres. BMI between 18 and 25 is considered normal, BMI 25-30 is overweight and a BMI above 30 defines obesity and above 40 is morbid obesity.

Obesity has been on the rise globally and is a cause of early death in many of these unfortunate individuals because of associated medical problems such as hypertension, diabetes and heart disease. They also suffer from joint problems, breathing disorders, sleep disorders and social stigma. Changing trends in eating habits and the invasion of fast food into our lives have resulted in an alarming increase in childhood and adolescent obesity too.

Weight losing measures generally adopted are dieting, exercise and medications. The vast majority of people who are overweight would benefit from these measures alone. There is no substitute for regular exercise and a balanced diet for optimal health. However, in the morbidly obese, consistent weight loss cannot be achieved by these measures alone.

Bariatric surgery has been shown to result in loss of up to 80 per cent of the excess weight in a year and half to two.

Patients who have a BMI of more than 40 and those with BMI >35 with co-morbid conditions such as hypertension and diabetes are ideal candidates for bariatric surgery after a multidisciplinary team  of endocrinology, pulmonology, cardiology, plastic surgery and a bariatric surgeon evaluate a patient.

For the Asian population, the criteria for offering bariatric surgery have been modified because of their different body habits, higher body fat percentage and a higher prevalence of comorbidities. When other medically treatable causes of overweight have been excluded, patients are counselled on this surgical option.

The three types of bariatric procedures commonly performed are the laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy and laparoscopic gastric bypass procedure. As these procedures are now done as ‘key-hole surgeries’, it typically requires hospitalisation of just 3-4 days.

The goals of these procedures are weight loss, improvement of hypertension, resolution/ significant improvement in diabetes (Type 2), improvement in arthritis and resolution of sleep apnea among the many benefits. A better appearance is a bonus and not the primary goal of doing this procedure. However, bariatric surgery in not a “shoppers stop” for every patient suffering from obesity.

(The contributor is chief surgical gastroenterologist, BGS Global Hospitals.)