An “Instant Cure” for Obesity?
Despite vigorous dieting and exercise (or lack of it!), for some, those extra kilos just won’t go away. For the lucky ones who do manage it, the kilos soon come back with the slightest of indulgences. So is there an instant cure (let alone one at all!) for obesity? Well the simple answer is NO!
The calories we burn when we’re sleeping is 2 per minute, having sex is a mere 3 calories per minute (though arguably more for some!), walking is 7 calories per minute and 12 calories per minute for running. In order to burn off a single kilo of body fat, one would have to sleep for 2.5 days, have non-stop sex for 1.5 days, walk for 17 hours or run for 6 hours! Though dieting and exercising work, many scientific studies show that most people cannot maintain their weight loss.
But some of you may ask: what about those magic pills that people take to lose weight or stay slim? For a start, some of those dished out by beauty parlors can carry some harmful side effects. The safe drugs prescribed by doctors still have undesirable side effects.
Surgery - a cure for obesity
Surgery is the closest thing there is to a cure, though not an instant one, for obesity. The US National Institute of Health (NIH) Consensus Conference (1991-1998) concluded that “surgery offers the only means of long term weight control” for the very obese. So who are the ones who need surgery? Obesity is defined by the body mass index (BMI) which is a ratio of one’s weight divided by the square of one’s height (kg/m2). According to the World Health Organization, for Western adults, the normal BMI should be between 18.5 and 24.9. Those with BMI between 25 and 29.9 are considered overweight, between 30 and 34.9 are obese, 35 to 39.9 are severely obese and over 40 morbidly obese. These definitions are based on research findings which showed that individuals in these different BMI categories have increasing risk of early death from obesity related diseases such as heart attack, stroke and even cancer. The ranges for Asians are slightly lower, meaning that the risks are even greater for the same BMI. Surgical procedures for weight reduction can be broadly divided into two types. The first is known as ‘restrictive’ and they reduce the volume of stomach available to contain food, thus making one feel full more easily. The second is known as ‘bypass’ and these work by artificially inducing mal-absorption thus decreasing the food that is absorbed by the body. Occaionally, a combination of these procedures may be required.
The simplest restrictive procedure is the placement of a saline filled balloon in the stomach. The size of this balloon ranges from 400 to 700 cc and is placed under endoscopic guidance. The balloon sits in the stomach and causes it to think that it’s always half full. This creates a sense of satiety after eating just a fraction of the usual amount.
However, those who crave calories can get around it by taking high calorie drinks. It is most suitable for those with BMI in the overweight to the obese range; for those with BMI in the severely and morbidly obese ranges this can act as the first step before going on to definitive surgery. This procedure carries the least discomfort and is easily reversible. The down side is that the balloon can be left in the stomach for no longer than six months after which it must be removed for fear of bursting. Sometimes there is a rebound in body weight after the balloon is taken out.
The amount of food that the stomach is able to hold can also be made less by placing a plastic ring (‘LapBand’) around its upper end. This creates a small pouch above the ring leaving the larger part of the stomach redundant.
The band is inserted by laparoscopic (keyhole) surgery and this is connected to an injection port buried underneath the skin. The amount of food that can be eaten at any one time is related to the rate of passage of food through the ring. This is controlled by the amount of fluid in
the ring that is adjusted by injecting into or drawing from the injection port. This procedure can be used as a first line treatment for those with BMI below 35 or after a balloon. It can achieve a longer term weight control and is reversible.
Another restrictive procedure involves surgically removing a large part of the stomach and is known as sleeve gastrectomy. This procedure not only makes the stomach physically smaller but also removes the part of the stomach (fundus) that secrets the hormone ghrelin which is believed to give rise to the sense of hunger. This procedure can also achieve long term weight loss, but it is not reversible. The bypass procedures cause weight loss by diverting food away from much of the intestine and have been in use since 1950s. Unfortunately, the earliest of these procedures were associated with numerous complications. These were soon replaced by modifications of the original operation but the risk of operating on very large patients remained high, and though successful, these were not popular pocedures. Several generations later, and with the advent of laparoscopic surgery, the bypass procedure finally returned as one of the most effective treatment for the morbidly obese.
Today, management of obesity is a multispeciality discipline in which surgery plays an important role. Many of these patients have co-morbidities such as diabetes and hypercholesterolaemia who are already being looked after by their family physicians or endocrinologists. Before and after their surgery, they would need to be advised by a dietitian on the pattern of food intake. A physiotherapist would be able to help to incorporate appropriate exercises into their weight management programme. Finally, a plastic surgeon’s service may be required for abdominplasty or skin lifting.
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