Bariatric/ Metabolic surgery is
Obesity is accumulation of excess body fat. Over eating of unhealthy, processed, refined foods and reduced physical activity are mainly responsible for this problem. Endocrine, genetic problems also contribute to obesity.
Body mass index is most commonly used parameter to define obesity. BMI = Body weight (in kilograms)/ square of height (in meters) = kg/ m2. BMI ≥ 25 kg/m2 indicates obesity in Indians/ Asians. Waist circumference (WC – F > 80 cm, M > 90 cm) and waist to hip ratio (WHR – F > 0.8, M > 0.9) also indicates obesity in Indians/ Asians. These are more specific parameters than BMI to define obesity in Indians/ Asians.
Obesity is not just a cosmetic problem but it is a disease. It can lead to more than 65 other medical problems like type 2 diabetes, hypertension, high blood cholesterol, heart attack, stroke, osteoarthritis, obstructive sleep apnea, cancers etc. Obese females may have irregular periods, higher incidence of abortions and difficult labor. Obesity increases life risk by 50 to 100% and reduces life span by 5 to 20 years.
Healthy diet and regular exercise are necessary to maintain fitness and prevent obesity. But these alone are not sufficient to reduce weight permanently in obese individuals especially if BMI is ≥ 30 kg/m2. There is a “set point for fat storage” that decides the amount of fat to be stored in the body. This fat set point is abnormally high in obese individuals. Effect of healthy diet and exercise on this set point is minimal. When dieting and exercise are initiated this high fat set point induces counter hormonal changes resulting in weight regain. So even though there is initial weight loss, all the lost weight and sometimes extra weight is regained over a period of 6 months to 5 years. Even the commercially available very low calorie diet (VLCD) products and nature cure methods can’t change the fat set point. So their effect on weight loss is temporary.
Anti obesity medicines are useful to increase weight loss only in those individuals who are already losing weight by diet restriction and exercise. They can’t result in effective weight loss. Moreover weight is lost as long as these medicines are taken. Once discontinued, all the lost weight is regained within two years, again due to the effect of fat set point. These medicines have several side effects.
Liposuction and cool sculpting are cosmetic procedures designed for body shaping. These are not weight loss procedures. In these procedures fat is removed from certain areas to improve cosmetic appearance. These methods cannot alter body fat set point. Compensatory mechanisms are initiated by this set point immediately after these procedures and individuals regain lost weight over a period of time. Liposuction and cool sculpting are not needed for those who can reduce weight by healthy diet and exercise. Those who can’t reduce weight by healthy diet and exercise, will not reduce weight permanently even after liposuction and cool sculpting.
Laparoscopic bariatric surgeries are performed on stomach and small intestine. Weight loss after bariatric surgery is not due to food restriction and/or mal-absorption. Sleeve Gastrectomy and diversion procedures like Gastric Bypass, Sleeve with Loop DJB, SADI – S and Duodenal Switch lower the body fat set point by altering several hormones that control body fat and energy expenditure. As a result gradual weight loss is achieved towards ideal body weight. Bariatric surgery is the only scientifically proven method for sustained long term weight loss.