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Dr Pradeep Jain, Fortis Hospital explains about weight loss and what are the factors that contribute to weight gain.
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Why, who, when and what of weight loss surgery
Dr Pradeep jain, M.Ch
DirectorDept of GI Cancer and Bariatric Surgery Fortis Hospital Shalimar Bagh &Namokar Gastro Clinic IA 46 A Ashok Vihar Phase 1 Opp Mont Fort School
Obesity
Excess body fat leading to deleterious effect on health
BMI ( Body Mass Index )Weight (kg) / square of height
( meters )
Problem of obesity in IndiaNational health survey (2007)
15% of Indian population fat
Out of these 1/3rd are morbidly obese
WHY ARE WE SO OVERWEIGHT??• Consumption of foods high in
calories (excessive sugar and fat)• Consumption of too much
food (large portions)• Not enough
exercise/sedentary lifestyle• Inheriting “fat genes” from
our parents/relatives
Obesity – a complex disease
Fat ? So what ? Weight comes with a price
High blood pressure Diabetes Heart attack Sleep Apnea Arthritis InfertilityCancers Depression Incontinence
Impact of BMI on Longevity
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Impact of Obesity on Mortality and Years of Life Lost
Graph represents years of life lost for white men.Fontaine KR, Redden DT, et al. Years of life lost due to obesity. JAMA 2003;289:187.
Why should treat obesity at all To increase survival Improve quality of life Social acceptability Decrease medicine intake Decrease hospital expenses
AIMSSustained weight loss
Good quality of life
Resolution of obesity related diseases
Low risk treatment modality
What to do ?Diet regulationExercise Medicines Surgery
Disadvantages of medical treatment
• Most patients (95-97%) regain most or all of the weight that was lost within 2-5 years following diet or drug treatment
• The average amount of weight loss is
relatively small – 5-10 kg • Drug therapy may be associated
with severe complications.
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Medical vs Surgical Therapy for Obesity
Medical (lifestyle changes and pharmacotherapy) vs Surgical Therapy for Obesity
-25
-20
-15
-10
-5
0
5
0 6 12 18 24
Months
Per
cen
t E
xces
s W
eigh
t L
oss
SurgicalMedical
Source: O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program. Ann Intern Med. 2006;144:625-633.
Weight
(lbs.)
Why Surgery ?Only known method for sustained
weight loss Risks are far less than risk of
continuing with morbid obesity and associated problems
Lead to hormonal changes leading to resolution of co morbidities
Decrease satiety
Schneider BE, Mun EC .Surgical Management of Morbid Obesity. Diabetes care 2005;28(2): 475-80
Contraindication for bariatric surgeryHistory of substance abuse,
eating disorder,or major psychiatric problem
which isuntreated and/or unresolved Patients who are too ill or too
high a risk for surgeryWomen who may become
pregnant soon
Types of surgeryGastric banding Sleeve gastrectomy Gastric bypass Liposuction NO
Gastric Banding
Roux en y Gastric bypass
Sleeve gastrectomy
What is the postoperative diet Liquid diet for 2-3 weeks Puree diet for 1-2 wksSoft diet for 1-2 wks Normal diet after that Avoid sweets, aerated drinks ,
drinking water with meals Regular supplements
Concerns after surgeryIs it safe ?What are the side effects or complications ?Will I continue to loose weight and become
below normal ?What will be my diet after surgery ? Will I require medicines through out life? Will there be any problem in getting pregnant ?Will there be regain of weight after some time? How much time it will take to reduce weight ?Will my tissues and skin get loose after
surgery ?Is it reversible?
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Bariatric Surgery Has a Low Incidence of Mortality
1Mortality rate when performed at a Bariatric Surgery Center of Excellence; Bariatric Surgery: DeMaria EJ, Pate V, Warthen M et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database, Surgery for Obesity and Related Diseases. Article in Press.2Dolan JP, Diggs BS, Sheppard BC et al. The National Mortality Burden and Significant Factors Associated with Open and Laparoscopic Cholecystectomy: 1997–2006. J Gastrointest Surg. 2009; 13:2292-23013Lie SA, Engesaeter LB, Havelin LI et al. Early postoperative mortality after 67,548 total hip replacements. Acta Orthopaedica 2002; 73(4):392-399 4Ricciardi R; Virnig BA, Ogilvie Jr. JW. Volume-Outcome Relationship for Coronary Artery Bypass Grafting in an Era of Decreasing Volume. Arch Surg. 2008;143[4]:338-344
Bariatric Surgery Lap Chole Hip Replacement CABG0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
0.13%
0.52%
0.93%
3.30%
Mortality Rates (%)
1 2 3 4
Medical Co-Morbidities Resolved after Bariatric Surgery
Type 2 Diabetes 95%
Hypertension 92%
Osteoarthritis 82%
Cardiac Function Improvement
95%
Stress Incontinence 87%
GERD 98%
Cholesterol 97%
Sleep Apnea 75%
Wittgrove AC,Clark GW. Laparoscopic Gastric bypass roux-n-y-500 patients. Obes Surg 2000. And others.
Thank you