Manipal surgeon says obesity a disease, not a lifestyle problem

According to WHO, more than 1.9 billion adults aged over 18 are overweight and over 600 million adults are obese, with at least2.8 million people dying each year as a result of being overweight or obese. Obesity is the new epidemic spread across the globe. Obesity coupled with overweight is linked to more deaths worldwide than underweight. In India, an estimated 10 to 15 percent of the population is obese.

Coupled with a genetic predisposition, consumption of processed food, especially refined carbohydrates, stress, irregular sleep and lack of physical activity contribute to the rise of obesity. With the rapid rise of India's middle class in the last two decades, the lifestyle of unhealthy eating habits has been adopted by many giving rise to obesity. Obesity, in turn, leads to a host of other "metabolic diseases" like diabetes, high cholesterol, sleep apnea and many others.

 

It is the need of the hour for people to realize that obesity is not a lifestyle problem but a disease which requires medical treatment. If a person is overweight or obese, and is unable to lose weight, it is not the person's fault. It is the fault of the disordered internal hormonal balance that causes a person to gain weight and prevents him from losing it. That is the reason why most people cannot lose significant amount of weight by diet and exercise; they are simply fighting their body physiology without changing their internal weight "set point". In the end physiology always wins.

Bariatric surgery, on the other hand, changes the internal hormonal environment in a favorable way so that the body stores less fat and utilizes more. There is a marked reduction in hunger, increase in energy levels and the preference for foods that lead to weight gain is automatically reduced. It changes the weight "set point" to a lower, healthier level. After that the body physiology takes over and the person starts losing weight automatically. It is, therefore, the only effective and durable option to treat severe obesity when a person has not been able to lose enough weight using the other methods.

There are two common types of operations performed; one is called Sleeve Gastrectomy or stomach stapling and the other is calledGastric Bypass. In Sleeve Gastrectomy we make the stomach smaller which decreases hunger hormones and improves satiety. In Gastric Bypass, in addition to making the stomach smaller, we bypass a part of the small intestine which gives additional benefit in controlling diabetes, high cholesterol etc. Both these operations have a favorable effect on the person's metabolism.

Nearly 1/3rd of the overweight people in the world require bariatric surgery. Morbidly obese patients require bariatric surgery to lose weight essentially to prevent all the health complications owing to obesity. In India, there has been a significant increase in the number of bariatric surgeries done each year, with nearly 15,000 surgeries completed the last year. The technology used for bariatric surgery has improved tremendously over the past 10 years, and we have progressed form open bariatric surgeries to laparoscopic method. It has now become much safer and comfortable for the patients. In fact it is as safe as a hernia or a gall bladder operation.

Dr. Sumit Talwar, Chairman - Bariatric Surgery, Manipal Hospitals says, "At Manipal, we have an integrated approach to the problem, we know and we believe that not every patient who is overweight is a candidate for surgery and not every person who comes to us for weight management would be offered surgery. We have a comprehensive Manipal weight management program which involves non-surgical as well as surgical management of obesity."

He also adds, "We have a full-fledged team of experts including dietitians, exercise physicians, and therapists who assess the nutritional status, modify the diet, and give advice on exercise. We filter out patients who have not benefitted from the medical weight management program or who are otherwise unlikely to benefit from the medical weight management program. They are then offered surgery on the basis of their BMI and other problems."

The cost factor associated with the surgery depends on upon the nature of the operation. However, the base price for the surgery is around 3 lakhs and changes depending upon the type of surgery, the associated medical problems and the hospital stay.

With obesity on the rise, Dr. Sumit Talwar believes that there would a two-fold evolution in the treatment of obesity in future. One would be the evolution and development of newer and different types of operations for weight loss. The other significant evolution will be in the non-surgical arena. "There are a lot of exciting things coming up like endoscopic sleeves, pacemakers and I believe that one day we might find a hormone or a pill without the side effects that we have with the current medications that reverses the hormonal imbalance and controls the hunger and will allow the person to lose weight ", says Dr. Sumit Talwar.