HOW TO ADDRESS OBESITY?

Obesity is a defined condition characterized by excessive fat build-up to the point that health and well-being are at risk.

It is a chronic disease and has detrimental effects on health.

DR ASHISH VASHISTHA, BEST BARIATRIC SURGEON IN DELHI Says:-

Obesity can have many co-morbidities-

1) Respiratory  – increased risk of bronchial asthma, COPD

2) Cardiovascular – High blood pressure, coronary artery disease, cardiomyopathy etc.

3) Psychological -social stigmatization and depression

4) Metabolic -type 2 Diabetes and dyslipidemia

5) Gastrointestinal (GI)-Gall bladder stone, fatty liver, reflux esophagitis.

6) Reproductive problems in women -early puberty,  infertility, PCO, Anovulation

7)Reproductive problems in men- hypogonadism

8) Pelvic problems -stress incontinence

9) Obstetrics – Pregnancy-related hypertension, Gestational diabetes, macrosomia, and difficult labor.

10) Malignancies – Endometrial carcinoma  , liver , colon , breast carcinomas, etc

DR ASHISH VASHISTHA, BEST BARIATRIC SURGEON IN DELHI tells about how you diagnose obesity:-

How do you diagnose obesity?

–      Lab tests- like

–      Liver function test

–      Fasting glucose and glycosylated hemoglobin

–      Thyroid  function tests

–      Lipid profile

Evaluation of the degree of fat in the body –

BMI Calculation

For Asian population-

–      Normal weight -18.5-22.9kg/m2  

–      Overweight – 23 kg/m2

–      Obese- 25 kg/m2

DR ASHISH VASHISTHA, BEST BARIATRIC SURGEON IN DELHI says about important Parameters:-

Important Parameters

Waist circumference men >90 and women >80

Waist -hip ratio        men >0.9 and women >0.85

Wrist circumference     in men more than 16.5 cm  and women more than 15.7 cm

Neek circumference    men >35.25 cm and women  >34.25 cm

Body fat percentagemen > 25.1% and women >30%

Body mass indexBMI >  23kg/m2

1. BMI (Body mass index )

It is a screening tool that provides a general look at obesity. It takes into account of person’s height and weight and classifies obesity.

It is calculated as a person’s weight in kilogram divided by the square of their height in meters ( kg / m2)

 Different people of the same BMI may have different body shapes depending on the distribution of body fat and skeletal muscle

A high BMI is a strong parameter for the occurrence of Non-communicable diseases like diabetes, hypertension, high lipid, and many malignancies

2. Waist circumference

 – it is a measure of central /abdominal obesity when is more than 90 cm in men and more than 80 cm in women, they are associated with metabolic problems.

Waist circumference is simple to measure and it avoids any consideration of the hip as it consists of bone and skeletal muscle along with fat- –

The technique for measuring WC is with measuring tape  halfway between the lower rib  and iliac crest

3. Hip circumference (HC)

It is measured at the widest circumference over greater trochanters.

4. Waist –Hip ratio (WHR)

 WHR is obtained by dividing the WC by HC using the same units of measurement for both. WHR is a straightforward indicator of central obesity.

The WHO classifies abdominal obesity in men as WHR >0.9 and in women >0.85

A ratio greater than 1.0 in either sex indicates an increased risk of metabolic complications.

5. Neck circumference (  NC)

NC >35.5cm in men

NC >32cm in women

 is harmful

6. Body fat percentage

Bioelectrical impedance analysis (BIA)is very accurate in diagnosing body fat.

It is more accurate than BMI.

Body impedance analysis (BIA) is a relatively simple quick and noninvasive method to assess body composition.

BIA allows the calculation of fat-free mass and body fat percentage.

Body fat percentage of more than 25% of men and more than 30% of women are considered obese by the Endocrine Society of India.

Imaging

-CT scan

-MRI

Can identify visceral fat and subcutaneous fat.

Visceral fat is responsible for metabolic abnormalities

7. Dual-energy -x-ray absorptiometry (DEXA)

DEXA scanning uses low-level X-rays that pass through different types of tissues at different rates providing estimates of fat mass, fat-free mass, and bone density. This method is widely used to measure bone density and can also accurately measure fat mass. A limitation of most DEXA scanners is the capacity to image extremely obese persons. However, half-body scans have been shown to provide an accurate body compositional analysis. DEXA is relatively simple to perform, less expensive, and more accessible than MRI or CT Scan. Radiation exposure is much less than a CT scan. Although subcutaneous and visceral fat cannot be clearly separated by DEXA, abdominal mass determined by DEXA correlates well with visceral fat as determined by other methods such as CT Scan and MRI Scanning.

DR ASHISH VASHISTHA, BEST BARIATRIC SURGEON IN DELHI Says about the Management of Obesity:-

Management of Obesity

Complete evaluation of all aspects of obesity is a must.

1. History taking-

–      Duration of obesity

–      Is obesity bothering the patient

–      Family history of obesity

–      Is he/ she a worrisome person

–      What is the sleep pattern

–      Detailed dietary history

–      Medical history like – any metabolic disease like diabetes, high blood pressure, PCOS , high lipid , knee pain, etc

–      Social history – smoking,  alcohol, drug abuse

–      Any other compulsion disorders like binge eating , binge drinking, etc

1. Measurement of height, weight, and calculating BMI
2. Abdominal circumference is measured.
3. Hip circumference is measured.
4. W/H ratio calculated
5. Neck circumference noted
6. Look for signs of insulin resistance like acne, acanthosis nigricans, increased hair growth on the face and abdomen, etc.
7. After assessment, talk with the patient and identify his / her goal of weight loss.
8. Lifestyle modification is the first step.
9. A well-balanced diet with sufficient protein and nutrients is formulated with the help of a nutritionist.
10. A well-structured exercise regime consists of aerobics, strength training, and yoga.
11. Anti-obesity drugs are started if BMI is more than 30 or BMI more than 27 with co-morbidities like type 2 diabetes / high blood pressure and the patient is unable to shed weight only on diet and exercise.

Anti-obesity medications When combined with lifestyle and behavior changes, including healthy eating and increased physical activity, can help some people lose weight and maintain weight loss. On average, after 1 year, adults who take anti-obesity medications as part of a lifestyle program lose 3% to 12% more of their starting body weight than people in a lifestyle program who do not take medication.

DR ASHISH VASHISTHA, BEST BARIATRIC SURGEON IN DELHI Says about Orlistrat:-

Orlistat

–      Orlistat is a gastrointestinal and pancreatic lipase that induces weight loss by inhibiting dietary fat absorption.

–      Orlistat should be taken up to 1 hour after taking a fatty meal  .

–      It brings weight loss up to 10 percent and does not depend on systemic absorption.

–      Full dose of 120 mg 3 times a day can give server GI events like flatulence, oily stool , diarrhea, and stool incontinence .

–      -it is advisable to reduce fat content in meals to decrease the side effects of orlistat.

Glucagon-like peptide -1 agonist –

GLP -GLP1agonists have been shown to promote weight loss in patients with or without

Diabetes –

GLP-1 is an appetite regulator.

–      Semaglutide is indicated for chronic weight management along with lifestyle changes like diet and exercise In patients with BMI >27 with obesity-related co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, etc

–      This medicine is also good for risk reduction of major adverse-cardo- vascular events in obese people

–      This is available in 3 , 7, and 14 mg tablets , it promotes insulin secretion and delays gastric emptying .

–      These medications should not be taken by oneself. Always see a doctor, get yourself evaluated, and let a doctor decide which medication is right for you.

1. Metabolic / Bariatric Surgery is the gold standard for sustained weight loss and correction of metabolic side effects of obesity like type 2 diabetes, high blood pressure, high cholesterol, PCOS, etc. According to recent guidelines, particularly from the Obesity and Metabolic Surgery Society of India (OSSI), bariatric surgery in India is recommended for individuals with a BMI exceeding 35 kg/m2, regardless of the presence or severity of co-morbidities; additionally, individuals with a BMI between 30-34.9 kg/m2 and metabolic disease should also be considered for surgery, with special consideration for the Asian population where a BMI above 27.5 kg/m2 may indicate the need for bariatric surgery due to the lower BMI threshold for obesity in Asian populations.