Treatment

Treatment
Treatment

Obesity is now being considered as a disease which can lead to hypertension, diabetes, stroke, ischemic heart disease, myocardial infarction [heart attack], cancer to name some of them .Obesity affects people of all age groups and both sexes, it has no particular affinity for any particular race, in other words it is a universal problem and it we who have to deal with it.

 

Management of obesity should be done in a programmed way so as to not only help the individual lose weight but he or she must be able to maintain the loss. There are six factors in the management and treatment of obesity.

 

While treating obesity the co morbidities should also be taken into account and managed at the same time.

Diet

After working out the BMI and measuring the waist circumference the individual should be in a position to assess that if they are overweight or not, and if they are then after working out their daily calorie requirement can plan a diet which will suit them and they can enjoy it and at the same time loose the unwanted extra weight they are carrying.

Activity

This is a major player in not only achieving weight loss but helping to maintain the loss in future .An active lifestyle helps in increasing cardiac capacity and improves the function of the lungs .Activity is of three types :Mild , Moderate and strenuous . To choose one of them it is advisable to consult your doctor first. Depending on your present medical conditions prevailing, you will be advised accordingly.

Motivation

To achieve weight loss with diet and activity programme the individual needs to be motivated and if there be need be during the course of treatment he or she might benefit from a Behavioural therapist.

Medical Treatment

There are many drugs available in the market to help reduce obesity .It is very important to find out their mode of action i.e. how they are going to act on your system, what do they do to help you lose weight, and what are the side effects short term and long term .Medical treatment should only be tried if Diet Activity and Motivation have failed.

Bariatric Surgery

Should all the above measures have failed to achieve the target weight of the individual and obesity is a threat to his life then only bariatric surgery should be considered.

Eligibility for Bariatric Surgery – NICE Guidelines (NICE = National Institute for Health and Clinical Excellence)

The patent must have exhausted all other methods of sustained weight loss (i.e. diet, lifestyle change and medication) and fulfil one of the following BMI criteria:

 

Either:

 

  1. a BMI greater that 40 kg/m2 or
  2. a BMI greater that 35 plus an obesity related co-morbidities

 

Obesity related co-morbidities are generally agreed to be any medical condition which would be expected to be improved by the patient losing weight.

These include:

 

  • Type 2 diabetes
  • Obstructive Sleep apnoea
  • Hypertension
  • Orthopaedic problems such as osteoarthritis, but only if the patient is awaiting an orthopaedic operation (such as a hip or knee replacement) and has been told by the orthopaedic surgeon that he/she need to lose weight before they can have the operation. Just having osteoarthritis does not count
  • Polycystic Ovary Disease

 

Please note – The following are not considered obesity-related co-morbidities for this assessment:

 

  • Depression
  • Anxiety
  • General poor mobility
  • Lower back pain
  • Shortness of breath when walking

 

Bariatric procedures

The 2 most commonly performed bariatric procedures are Laparoscopic Gastric Banding and Roux-en-Y Gastric bypass

 

Laparoscopic gastric band

Patients are routinely put on a 2 week low carbohydrate diet immediately before sugary to reduce the size of the liver. The liver is full if carbohydrate. A low carbohydrate diet uses this, making the liver smaller. A smaller liver makes the operation easier.

 

The standard post operative diet is:

 

  • Weeks 0-4 – Liquid only
  • Weeks 4-8 – sloppy, pureed food
  • After week 8 – solid food

 

Note – The long term diet is small amounts of well-chewed solid food. This may not be considered ‘normal food’ by some patients

 

Advantages

Short duration surgical procedure. In other words, it doesn’t take long to do It usually takes less than one hour and requires just an overnight stay in hospital, The patient is largely fully recovered after 2-3 weeks.

 

The operation is potentially reversible

 

Disadvantages

Requires to keeping to a very restrictive diet long term after the operation

 

The Laparoscopic gastric band is not as powerful as a gastric bypass, so its success rate is lower and the amount of weigh tlost not as great.

 

Roux-en-Y Gastric Bypass

 

Patients are routinely put on a 2 week low carbohydrate diet immediately before sugary to reduce the size of the liver. The liver is full if carbohydrate. A low carbohydrate diet uses this, making the liver smaller. A smaller liver makes the operation easier.

 

The standard post operative diet is:

  • Weeks 0-4 – Liquid only
  • Weeks 4-8 – sloppy, pureed food
  • After week 8 – normal food (Some foods are notoriously difficult at first, such as bread, rice, chicken and meat. However, with time most patients achieve a return to being able to eat normal food, just less of it)

 

Disadavantages

 

Longer, more major surgical procedures than Laparoscopic Gastric Bypass, with longer recovery time (3-4 weeks)

 

Should be considered to irreversible

 

Has been associated with malabsorption problems and diarrhoea in past. However, recent audits have shown that with regular follow-up by a Hospital Specialist experienced in the medical follow-up of gastric bypass patients, the risk of malabsoption problems is small. It is recommend that patients be followed up every 3 4 months post op (with monitoring blood test) for at least 2 years. In additions, recent audits suggest that diarrhoea is very rate following this surgery. Most patients experience no long term change in their regularity. With approximately 20 per cent having a mild constipation whci is usually easily treatable/

Patients are required to take vitamins supplements long-term (usually 2 A-Z multivitamins plus a calcium/vitamins supplement)

 

Advantages

 

A very powerful operation with a very high success rate in terms of weight lost.

 

The average weight lost is morew that is usually achieved by a Laparoscopic gastric band

 

Patients usually rate it high on Quality of Life scores, usually because they are able to return to a normal but healthier diet while still being able to lose weight.

 

Please note: Roux-en-Y Gastric bypasses can now be performed laporoscopically (that is, by ‘key-hole’)

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