Obesity has been recognised as a worldwide epidemic for the last few decades. A Body Mass Index (BMI) of 25 has been pegged as the landmark, above which is the definition of being overweight. A BMI of above 35 has been classified as being morbidly obese. The obesity societies of Asia has redefined the BMI criteria for Asians as 32.5.
There are many diseases associated with obesity. The long list includes metabolic diseases like Diabetes Mellitus, Hypertension and Hyperlipidemia (and all the complications associated with these diseases), cancers like breast cancer and colorectal cancer, chronic joint diseases like chronic back pain, osteoarthritis of the spine, hips, knees and ankles and other illnesses like skin infections, pancreatitis and much more. There is evidence that those with morbid obesity are more likely to be depressed and have a shortened life-span.
Diet and exercise have been the mainstay of obesity management. However, the chance of weight loss of more than 10% together with keeping that weight down over a sustained period of time, is less than 2% for the morbidly obese. All these statistics, coupled with the complications of obesity that is a huge financial burden to the family and the state, has stimulated the development of obesity management and surgery (Bariatric surgery).
Over the last 40 years, obesity surgery is proven to be the best method to reduce the weight of morbidly obese patients quickly and, more importantly, to sustain that weight loss. In general, there are two main categories of obesity surgery. The restrictive surgeries like the Laparoscopic Adjustable Gastric Band (LAGB) and the Laparoscopic Sleeve Gastrectomy (LSG) have about 80% success in helping the patient lose about 60% of their excess weight within a year or two and this has been shown to be maintained and improved upon for at least 5 to 10 years. The second category is the malabsorptive group of surgeries which is typified by the Laparoscopic Roux en Y Gastric Bypass (LRYGB). This procedure has been shown to not only have a better weight loss profile, but it maintains the weight loss a longer time. With these procedures there is also a reduction or resolution of the complications of obesity by at least 80%.
These procedures, as the name suggests, are done laparoscopically (or keyhole surgery) and there are many advantages of this technique which would include less wound pain and complications, lesser respiratory complications, lesser hospital stay and faster recovery and time to work. The procedures have become very safe as compared to the surgeries done 40 years ago and the current perioperative complications are minimal due to the fact that the surgical techniques used are standard and the anaesthesia care has improved by leaps and bounds.
There will be a group of patients who are below the BMI criteria for Obesity surgery or are too ill to undergo surgery. These patients can be offered the Intragastric Balloon that is inserted into the stomach via gastroscopy under sedation. The balloon insertion is safe and there will be no scars on the abdominal wall. It will then be removed after 6 months and the projected weight loss is about 10%.
Dr Ganesh Ramalingam, Consultant General Surgeon, Panasia Surgery