Obesity and overweight are defined as the increase in size and amount of fatcells in the body. Obesity and overweight are caused by many factors includingbehaviours like eating patterns, lack of sleep or lack of physical activity and somemedicines, as well as genetics and family history.
Obesity is a chronic healthcondition that raises the risk for heart disease and in the leading cause of deathnowadays, and is linked to many other health problems, including type 2 diabetesand hypertension (High Blood Pressure), Obstructive sleep apnea certain types ofcancer and osteoarthritis.
When these patients arrive in our clinics, we use body massindex (BMI) to screen for overweight and obesity. BMI is a measure of body fatbased on height and weight and expressed in units Kg(weight)/height square e.g. if aperson is 80kgs 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 physicalactivity and eating high calorie, low-nutrient foods and beverages, can raise yourrisk of overweight and obesity. Some medications for high blood pressure ordepression, can also sometimes cause an increase of body weight.
BMI categories for adults:
- Underweight BMI <18.5
- Healthy weight BMI 18.5 – 24.9
- Overweight 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 percentileis calculated by comparing the child’s BMI to growth factors for children who arethe same age and sex.
Obesity prevention requires a complex approach, including interventions atmedical, societal, community, family and individual level. Life style changes that can reduce weight include following a heart-healthy eating plan lower in caloriesand low in unhealthy saturated fats increasing the intake of dietary fiber fats andincreasing physical activity.Medications can be used, along with a suitable diet, to reduce appetite or decreasefat 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 thatmodify the digestive system to help individuals with obesity loose weight.Bariatric surgery works by either restricting the amount of food the stomach canhold, altering how food is absorbed, or both.
Commonly used procedures in bariatric surgery:
- Sleeve Gastrectomy
- Gastric Bypass (Ronx-en-y)
- Adjustable Gastric Band
- Biliopaucreaticsiversion with duolenal switch (BPD-DS)
- Single Anastomosis Duodeno-Rlecl Bypass with sleeve gastrectomy (SADI-S)
Gastric surgery (sleeve gastrectomy) may be performed to reduce stomach volumeor length of the intestines, leading to feeling full earlier, or a reduced ability to absorbnutrients from food.
Genetic Factors
Various genetic studies have shown that obesity is extremely habitable, withnumerous genes identified with adiposity and weight gain.
Other causes
Endocrine disorders commonly syndromes 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. In2022, over 1 billion people lived with obesity worldwide. Obesity can also beestimated by assessing skin thickness in the triceps, biceps, subscapular and suprailiac areas. Dual energy radiographic absorption by (DEXA) scan may also be usedto 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 set a weight lossgoal and time frame that will work best for you. Loosing excess weight may helplower your chances of developing health problems related to overweight and obesity.
If you already have weight-related health problems such as high blood pressure ordiabetes,loosing weight may help improve your health. Regular exercises likewalking, jogging, swimming can help you loose weight and maintain lean musclemass. You should try to get at least 150minutes of moderate-intensity physicalactivity 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 afterbariatric surgery. In the first part, liposuction of areas, which hinder the exerciseregime, such as knee, ankles, lower, abdomen is a kick start for these patients. It isto be noted that liposuction is not a weight loss method and does not appear to affectobesity related problems.
However as said before obese patients with fat collectionsaround abdomen, knees, ankles feel it very difficult to follow an exercise regime,and therefore liposuction of these areas of fat collection gives them a psychologicalboost. 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. These patients need brachioplasty for arm redundancy.
Abdomino-plasty for abdominal redundancy, breast implants for breast redundancy,and thighplasty for thigh redundancy. These procedures are carried out after 18months to 24 months after bariatric surgery, when the body weight is stable.
Sinceeach of these procedures are major surgeries done under anesthesia, these arestagged at intervals of 3 – 6 months. In conclusion approach to an obese patient is amulti-specialty approach, which includes a qualified dietician and exercise trainer,an experienced bariatric surgeon, and a plastic surgeon.
(Author is a senior plastic and cosmetic surgeon at Safa Marwah Hospital, SouraSrinagar.E-mail: [email protected])
