Management of Obesity

To manage obesity, one needs to measure it, so that doctors can decide on a patient specific regimen for treating the obesity. BMI (Body Mass Index) is the most accepted obesity measurement tool.  Patients with a BMI between 25 to 29.9, who are considered overweight, will benefit from diet and exercise. But for patients whose BMI is 30 and above, diet and exercise alone will not be helpful and for long term sustained weight loss, such patients will need surgical weight loss methods which are clinically proven and safe.

The biggest challenge that the obese people face is the craving for more food, which is due to a hormone Ghrelin secreted by the stomach. Unfortunately, there are no pills that doctors can prescribe to overcome the effects of this hunger hormone.

The solution is surgery, which has become simple and safe due to the laparoscopic approach. Laparoscopically, the hunger hormone producing area of the stomach can be removed and the size of the stomach can be reduced making it like a tube so that one cannot eat too much following surgery. The procedure is called Vertical Sleeve Gastrectomy and this is a great blessing for the morbidly obese people who have high BMI. This is usually done for those with BMI over 40 or those with BMI over 30 with associated diseases like diabetes, hypertension and others. The weight loss is dramatic and permanent. One loses about 60% of excess weight in a graded fashion over a year or so. In the meantime, it is important to be committed to a healthy way of life eating low calorie diet and doing regular exercises for the rest of one’s life.

Options available

  1. Dietary counselling: Proper counselling helps obese individuals realize that weight loss is a slow and gradual process that requires hard work and commitment. So, one should be strong and patient to follow the right weight loss plan.
    The World Health Organization (WHO) recommends individuals to:
    • Limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and towards the elimination of trans-fatty acids
    • Increase consumption of fruits and vegetables, and whole grains and nuts. Adults should consume at least 500g of fresh fruit and vegetables a day.
    • Limit the intake of free sugars and salt (sodium) consumption from all sources. Recent guidelines recommend eating less than 1,500 mg of sodium per day
    • A dietician will tailor make a diet plan to suit individual tastes and cultural needs
  2. Exercises under supervision
    Because obese individuals are carrying more weight, activities they participate in have the potential to place a significant amount of stress on their ankles, knees, hips and lower back. Engage in activity that puts minimal stress on the joints, such as walking, swimming or water exercises, and cycling. Ease into your workout. Start slowly for the first five minutes to give your body time to adjust to the activity. Work at a comfortable pace that allows you to talk without too much difficulty.
  3. Liposuction
    Liposuction is not a good treatment of obesity. Liposuction is not effective, even as a last resort, for people who are unable to lose weight by dieting and exercise. It is not safe to remove huge amounts of fat by liposuction. It is dangerous to remove more than 8 to 10 pounds of fat by liposuction in a single day.
  4. Weight loss surgery : refer section on Bariatric surgery

 

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