Obesity and Metabolic Surgery – FAQs

Obesity is a medical condition in which there is an abnormal growth of fatty tissue due to enlargement in the size of fat cells or an increase in the number of fat cells or both. It is the fifth leading cause of death in the world. About 2.8 million adults die each year because of being overweight or obese. Moreover, 44% cases of diabetes, 23% cases of Ischemic Heart Disease and 7% to 41% of some cancers can be attributed to over-weight and obesity.

Body Mass Index (BMI) is the most reliable indicator for determining if an individual is obese or not. Other commonly used indicators are Waist Circumference, and Waist to Hip Ratio (WHR). Every individual should attempt to know these parameters for themselves and aim to keep them in the healthy range.The easiest way to find out if your weight is within normal range or not is to calculate your Body Mass Index (BMI). BMI is expressed as an individual’s weight in kilograms divided by the square of height in meters (Kg/m2).BMI = Weight in Kg/ Height in meters2 (Wt. in Kg divided by square of height in meters)According to WHO, a Body Mass Index of 18.5-24.99 is normal and a BMI more than or equal to 25 (23.0 for Indians) means a person is overweight.

• BMI: 25.0-29.9 (Pre-Obese or Overweight)
• BMI: 30.0-34.9 (Obese Class I)
• BMI: 35.0-39.9 (Obese Class II)
• BMI: =40.0 (Obese Class III)

Since Indians have a higher percentage of body fat and a higher tendency to have the “riskier” abdominal fat (fat around the waist), obesity starts at a lower BMI in Indians.

• BMI: 23.0 – 27.5 (Pre-Obese or Overweight)
• BMI: 27.5-32.5 (Obese Class 1)
• BMI: 32.5 – 37.5 (Obese Class II)
• BMI: =37.5 (Obese Class III)

People with distribution of fat predominantly in the abdomen (belly fat) are at higher risk of health hazards than people in whom fat is evenly distributed around the body’s periphery. Sufficient evidence suggests that abdominal obesity plays a big role in the development of diabetes and heart disease.Waist Circumference and Waist Hip Ratio (WHR):Men, whose waist circumference is greater than or equal to 94 cm (90 cm for Indians) and women with a waist circumference of greater than or equal to 80 cm, have a higher risk of metabolic complications. Risk is substantially increased for men with a waist circumference of more than 102 cm and women with a waist circumference of more than 88 cm. Your waistline is truly linked to your lifeline!A Waist Hip Ratio (WHR) of > 0.9 in men and > 0.85 in women is indicative of significant abdominal fat accumulation and substantially increases the risk of metabolic complications.

Obesity is caused by an imbalance between the calories consumed and calories spent. We consume calories in the form of food and drinks and then spend these calories on our day-to-day activities. All over the world, there has been an increase in the intake of calorie-dense food over the past few decades. At the same time, physical activity of people has decreased dramatically because of a sedentary life style, use of domestic appliances and domestic aids, and drastic change in modes of transportation leading to less expenditure of calories. Central heating and air-conditioning have also played a role.Surplus calories (intake minus expenditure) are stored in body as fat. Over a period of time, this leads to an increase in weight and we become overweight (pre-obese) and then obese.

Obesity is the mother of all diseases and accumulation of fat impairs functioning of almost every single organ system in human body. It is a significant risk factor in the development of high blood pressure, diabetes, coronary heart disease, stroke, kidney failure, asthma, chronic obstructive lung disease (COLD), and even certain types of cancers. Obesity also causes osteoarthritis of the hips, knees & lumbar spine, infertility, sleep apnea, gall bladder stones, urinary incontinence, impotency, loss of libido, varicose veins and acid reflux. Depending on the severity of obesity, a person’s lifespan may be reduced by a period ranging from a few years to many decades.Psychological and Social Consequence of ObesityNot only does Obesity have an adverse effect on a person’s appearance, it also reduces their self-confidence and leads to social stigma and isolation. In addition, Obesity decreases a person’s employability and his ability to work hard. Obese people have higher rates of absenteeism from work and that means decreased productivity and increased costs for employers.

Since weight can gradually creep up on us, it is important to keep a close eye on weight and B.M.I. Medical practitioners must use every healthcare contact with people to identify overweight or obese people. A late diagnosis will usually mean that patients will inevitably develop obesity related diseases with serious implications. In early stages, people can often remedy the situation by reducing their calorie intake and spending more calories. In late stages and for those with uncontrolled diabetes, bariatric and metabolic surgery may be the only option.

Suitability for this surgery is determined by a number of factors, which mainly include patient’s BMI and other health conditions like diabetes. Patients must have tried other methods of weight loss and failed to maintain weight loss with them. They must also commit to lifelong dietary and lifestyle changes and regular follow up is required after surgery. Local guidelines state that bariatric/ metabolic surgery should be considered for following patient groups.

• • BMI = 35
  • BMI = 30 with inadequately controlled diabetes or metabolic syndrome

It may also be considered for selected patients with BMI = 27.5 with inadequately controlled diabetes or metabolic syndrome.

This type of surgery is being performed in western countries for more than five decades with exceptional safety. Your surgeon will also inform you about complications/side effects of your chosen surgical procedure. Risk of this surgery is similar to gall bladder surgery.

There are a number of bariatric/metabolic procedures to choose from and no one procedure fits all patients. Our surgeons will recommend the most appropriate procedure for you. If you have a strong opinion regarding the best procedure for yourself, please discuss it with your surgeon. We also offer robotic surgery at our center.

Weight loss immediately prior to surgery is known to improve surgical safety in some patients. Our surgeons will advise you appropriately. We also recommend a liver reducing diet for 10-14 days prior to surgery to improve safety of this surgery.

Please refer to question no. 2. If your BMI is more than 35, you are a suitable candidate for this surgery. If your BMI is between 27.5 and 35, you will only be considered suitable for this surgery if you suffer with inadequately controlled diabetes (type 2 diabetes mellitus). Your physician or endocrinologist will be able to give you appropriate advice.

This surgery has multiple benefits. Not only does it help individuals lose weight, it also improves a range of other medical conditions like diabetes, high blood pressure, renal impairment, asthma, sleep apnea, COPD, acid reflux, infertility, impotency etc. Furthermore, it improves the confidence of the patient and improves work place prospects.

Typically, patients lose approximately 75-85% of their excess weight within the first 12-18 months after surgery (with sleeve gastrectomy and gastric bypass) and maintain most of that in the long term. However, as can be expected, weight loss also depends on individuals’ ability to reform their eating behavior and lifestyle. It is extremely uncommon with current surgical procedures to lose “too much” weight.

This surgery should be considered as an investment in your health and personality with manifold returns in future. It is widely recognized that this surgery pays back for itself in approximately 2 years time through reduced healthcare costs and gain in individual’s economic productivity. It is commonly described as something that adds “years to your life” and “life to your years”.

Patients between 18 and 65 are considered most suitable for this type of surgery but this surgery may also be considered for younger or older patients depending on individual factors. Your surgeon will advise you appropriately.

Patients are admitted to hospital on the day of surgery or day prior to it and are usually discharged 48-72 hours later.

Since this surgery is carried out laparoscopically/robotically in more than 99% of patients, it does not result in too much pain. You will be given appropriate pain-killers as needed. In the early period, patients experience some nausea/vomiting but that is easily controlled with medications.

Patients are allowed to drink water on the first day after surgery and liquid diet is started on the second day. For good healing, it is essential that patients stay on liquid/pureed diet for 4 weeks. After 4 weeks, consistency and texture of food is gradually increased and by 3 months, most patients are able to eat normal, healthy diet off a small plate.

Surgeons will ask you to be up and about as early as 4 hours after surgery. This reduces your risk of chest infection and clots in the legs. After that, patients gradually resume all normal activities within the limits of comfort. After a week, patients are able to manage most activities of daily living completely independently. Gentle exercises like walking, swimming, jogging etc. can be started after 2 weeks but strenuous exercises are best delayed for 3 months.

We screen patients pre-operatively and postoperatively for any deficiencies and supplement vitamins and minerals as and when necessary. Gastric bypass patients are typically recommended routine iron, calcium/vitamin D, and vitamin B12 supplements.

Significant weight loss will inevitably result in some loose skin. Extent of loose skin depends on the amount and distribution of fat in patient’s body and patient’s ability to exercise and tone up. Some patients will need further surgical procedure(s) to remove loose skin.

You can get appointment through following methods:

• Phone:
  • During Office Hours:0091- 11- 29871280, 29871281
  • Outside Office Hours:011-26925801, 011-26925858
• Email: assistance@apollohospitalsdelhi.com