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OBESITY PROBLEMS:

Obesity has already taken an epidemic proportion. Obesity affects all the systems in the body causing various diseases. Obesity and its comorbid disorders are leading causes of morbidity and premature mortality around the world. Obese persons are also vulnerable to low self-esteem and depression because of the psychological and social stigmata that can be associated with obesity. Obesity increases the risk of cancers like oesophagus, endometrium, breast, prostate etc.

CAUSES OF OBESITY:

Obesity is recognized as a chronic condition resulting from an interaction between environmental influences and an individual’s genetic predisposition to weight gain. Studies of populations, families, adoptions, and twins have established a strong genetic role in determining body weight. Estimates of the genetic contribution to the variance of relative body weight and adiposity range from a low of approximately 20% to a high of 90%. [1], over 400 genetic markers have been described in association with obesity-related variables in humans. Epidemiological studies have identified several environmental factors that contribute to the continued weight gain documented over the past several decades in westernised countries. The foremost among these factors are an increasingly sedentary lifestyle (e.g., less physical activity and more time spent watching television) and the availability of energy-dense (high-fat, concentrated-sugar), low-fibre foods. The answer to obesity is “prevention”. This is essential. Meanwhile we need to deal with the people who suffer from obesity.

SURGERY FOR OBESITY:

There are mainly 3 types of procedures for obesity – 1. Restrictive – like Laparoscopic gastric banding, vertical banded gastroplasty and Sleeve gastrectomy 2. Malabsorptive – BPD 3. Combined Restrictive & bypass – Lap gastric bypass (RNY) (more restrictive) and Duodenal switch (more malabsorptive)

EFFICACY OF SURGERY:

Several large-scale studies have demonstrated the efficacy of various bariatric procedures in severely obese patients. One study of gastric bypass reported sustained loss of approximately 50% of baseline body weight (at 5- to 10-year follow-up). [2] In the majority of cases, surgical therapy results in significant, sustained weight loss. With regard to total weight loss and improved disease outcomes, the malabsorptive procedure has the greatest support from published studies, whereas the gastric-banding procedure has the lowest published rates of morbidity (11%) and mortality (0.05%). [3] With the considerable improvements in comorbidity and quality of life that result from this weight loss, bariatric surgery is not only efficacious but also cost-effective [4] in the management of severe obesity. An important benefit of bariatric surgery is that the large weight losses bring improvements in the comorbid conditions that accompany obesity. In addition to these improvements in morbidity, both cohort and population-based studies have demonstrated reduced mortality and use of health care resources in morbidly obese patients who have lost weight after bariatric surgery. Surgery is associated with less morbidity and mortality if it is undertaken by an experienced surgeon with a good backup.

1. Maes HH, Neale MC, Eaves LJ: Genetic and environmental factors in relative body weight and human adiposity. Behav Genet 27:325, 1997
2. Pories WJ, MacDonald KG, Morgan EJ, et al: Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Clin Nutr 55(2 suppl):582S, 1992
3. Buchwald H, Avidor Y, Braunwald E, et al: Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724, 2004

4. Clegg A, Colquitt J, Sidhu M, et al: Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes Relat Metab Disord 27:1167, 2003


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