Obesity

Obesity

Obesity is defined as having too much body fat, which develops when the intake of fats for the use of energy exceeds its expenditure. It is measured as body mass index (BMI).

Causes of Obesity

A variety of factors contribute to obesity which makes it a complex health issue to address. A combination of any or all of the following is considered:

  • excessive food intake
  • lack of physical activity, and
  • genetic susceptibility

A few cases are caused primarily by genes, endocrine disorders, medications, or mental illness. Evidence to support the view that obese people eat little yet gain weight due to a slow metabolism is not generally supported.

Body Mass Index:

Body Mass Index (BMI) is a method of assessing whether an individual’s weight falls within the healthy range or not. It is a good indicator of body fat. BMI does not differentiate between body fat and muscle mass. Hence, body builders and people with muscle bulk show a high BMI although they are not overweight or obese

Consequences of Obesity

Obesity is associated with many serious physiological, psychological and social consequences, as listed below. 

Physiological consequences of obesity are

  • Type 2 Diabetes
  • High blood pressure
  • Heart disease
  • Gallbladder disease
  • Cancer (breast, uterine and colon cancer)
  • Digestive disorders (gastroesophageal reflux disease or GERD)
  • Breathing problems (asthma)
  • Problems with fertility and pregnancy
  • Urinary incontinence
  • Joint problems (arthritis)
  • Shorter life expectancy

Psychological and social consequences of obesity are

  • Negative self-image
  • Social discrimination and isolation
  • Depression
  • Anxiety

BMI

Classification

Health Risk

Under 18.5

Underweight

Minimal

18.5 - 24.9

Normal Weight

Minimal

25 - 29.9

Overweight

Increased

30 - 34.9

Obese

High

35 - 39.9

Severely Obese

Very High

40 and over

Morbidly Obese

Extremely High

Obesity Treatment Options

Obesity treatment may involve surgical or non-surgical methods.

Non-Surgical Treatment for Obesity

Nutrition

Non-surgical treatment majorly involves nutritional counselling with or without usage of supplements to enhance the weight loss program. Management by nutrition and supplements being the pillars of weight loss and is highly individualistic.

A reasonable goal for weight-loss in the setting of a nutrition-based treatment program is approximately 1.0 -1.5 kg/wk. The concept that the weight-loss goal for each subject must be individualized and cannot be unilaterally based on standard weight-for-height diet norms is becoming increasingly apparent.

Lifestyle Changes

The best way to start your weight loss program is to understand where you are going wrong in your lifestyle activity and alter it so that you start working towards weight loss the right way. Mere starving in the name of diet and gym will not help in long run. They might give you an initial satisfactory weight loss, but after few months you tend to lose energy and become weak rather than losing weight. You really need to be smart to work on your lifestyle and lose weight without much hard work.

Exercise

When it comes to successful and lasting weight loss, eating well is only part of the battle. Physical activity will help you inch closer to your goal by burning calories and building muscle. However, that's not the only reason to make exercise part of your daily life. Exercise also helps prevent many health conditions, decreases stress, and makes you feel better.

Surgical Treatment

Weight-loss surgery has proven to be a successful method for the treatment of morbid obesity. Due to the continuous evolution of surgical principles, today there are multiple options that enable both patients and surgeons to choose the procedure of choice according to their convenience. Some of the surgical procedures performed to treat obesity include:

  • Intragastric balloon
  • Gastric banding
  • Sleeve gastrectomy
  • Roux-en-Y gastric bypass
  • Mini Gastric Bypass
  • Other novel procedures

The use of laparoscopy for performing these procedures is the biggest advancement in bariatric surgery. The laparoscopic procedure is a minimally invasive procedure where the surgery is performed through small incisions. Patients experience minimal discomfort and rapid recovery with the process.

Indications

According to international accepted criteria, the indications for obesity surgery are

  • BMI > 40 kg/m2
  • BMI>35 with pronounced co-morbidities.
  • Failed non-surgical attempts at weight reduction over a period of one year
  • Absence of surgical contraindication or concomitant disease.
  • Age between 18 and 65 years

Contraindications

Bariatric surgery is not recommended in patients with:

  • Inflammatory diseases such as Crohn's disease
  • Severe heart, lung or liver diseases
  • History of auto immune diseases such as scleroderma or systemic lupus erythematous
  • Alcohol or drug addiction
  • Under the age of 18 years
  • Pregnancy
  • Chronic pancreatitis (inflammation of the pancreas)
  • Presence of Infection.

Sleeve Gastrectomy

Sleeve gastrectomy, also referred to as vertical sleeve, gastric sleeve or tube gastrectomy, is a surgical procedure performed for the treatment of obesity. The procedure is a restrictive bariatric surgery to treat extremely obese patients with a high BMI of 40 and above. It encourages weight loss by restricting the stomach size so it holds only a limited amount of food. This helps patients to eat less without hampering the normal digestive process.

Sometimes sleeve gastrectomy is carried out as a first stage of a 2-stage operation in extremely obese patients with a BMI of 60 or more. This is done to achieve a considerable amount of weight loss so it is safer for the patient to undergo a second bariatric surgery if needed.

Sleeve Gastrectomy – Surgery

The procedure is performed under general anaesthesia. The surgeon makes 2 to 5small incisions on your abdomen. A laparoscope, a thin instrument with a light and camera attached, is inserted through one incision, allowing your surgeon to clearly view the internal organs on a monitor.

Additional surgical instruments are inserted through the other incisions. Your surgeon will remove nearly 75-80% of the stomach. A thin sleeve shaped like a banana is created by stapling the remaining part of the stomach. At the end of the procedure, the incisions are closed with sutures. The entire procedure takes about 60 to 90 minutes to complete.

Roux-En-Y Gastric Bypass

Gastric bypass, also known as Roux-en-Y gastric bypass, is a bariatric or weight loss surgery for obese patients who have not been successful losing weight through dieting, exercise and medication.

The surgery uses a combination of restrictive and mal-absorptive techniques to achieve a successful outcome. Staples are used to create a smaller stomach to limit the amount of food intake, and a large portion of the small intestine is bypassed to limit the nutrients and calories absorbed.

Gastric bypass surgery has been shown to help reduce obesity and related illnesses, including heart disease, high blood pressure, and especially type 2 diabetes.

Gastric Bypass – Surgery

Gastric bypass surgery is performed under general anaesthesia. Your surgeon makes several small incisions on your abdomen. A laparoscope, a thin instrument with a light and camera on the end, is inserted through one of the incisions, allowing your surgeon to clearly view the internal organs on a monitor. Small surgical instruments are inserted through the other incisions to perform the surgery.

The first step is to reduce the size of the stomach so that it holds less food. The upper portion of the stomach near the oesophagus is converted into a pouch by stapling.

The second step of the surgery involves the creation of a bypass for food to flow from the new stomach pouch. The small intestine is divided into upper and lower segments.

The lower section of intestine is attached to the opening in the stomach pouch creating what is referred to as the alimentary limb. The upper section of the small intestine which carries digestive juices from the remaining portion of the stomach is attached at the distal end of the roux limb. The roux limb enables food to bypass the lower stomach, duodenum, and a portion of the small intestine. At the end of the procedure, the incisions are closed with sutures

Mini Gastric Bypass

The Mini Gastric Bypass (MGB) is a short, simple, successful, reversible laparoscopic gastric bypass weight loss surgery. It has been recently renamed as One Anastomosis Gastric Bypass.

Mini Gastric Bypass Surgery

Mini Gastric bypass surgery is performed under general anaesthesia. Your surgeon makes several small incisions on your abdomen. A laparoscope, a thin instrument with a light and camera on the end, is inserted through one of the incisions, allowing your surgeon to clearly view the internal organs on a monitor. Small surgical instruments are inserted through the other incisions to perform the surgery.

The first step is to reduce the size of the stomach so that it holds less food. The stomach is converted into a long slender pouch up to the antral part by stapling.

The second step of the surgery involves the creation of a bypass for food to flow from the new stomach pouch. A loop of small intestine preferably between 150 and 250 cms is chosen for anastomosis depending upon the surgeon and the metabolic condition of the patient. The middle section of intestine is attached to the opening in the stomach pouch creating what is referred to as the "omega loop". The loop enables food to bypass the lower stomach, duodenum, and a portion of the small intestine. At the end of the procedure, the incisions are closed with sutures.

Bariatric & Metabolic Surgical Devices

Tissue thickness presents a unique challenge when stapling laparoscopically.      Endocutters are designed to mitigate the forces placed on them during firing based on the tissue thicknesses in order to provide consistent staple formation and transect intended tissues. However, as tissue thickness varies across the body, we need one solution across a broad range of tissue thicknesses, and simplifying the cartridge selection process with optimal compression has been a critical need for many surgeons.

Keeping in mind to eliminate human suffering Meril Endo surgery introduced MIRUS Linear cutter and Mirus Endoscopic Linear cutter with TRIO reloads. The MIRUS Endocutters are intended to use in minimally invasive surgical procedures for the transection, resection of tissues and creation of anastomosis in these procedures.

Mirus Endoscopic linear cutter and TRIO reloads are available in lengths 45mm & 60mm with three rows varied height staples to accommodate varied tissue thicknesses.

Benefits: Mirus Endoscopic linear cutter and TRIO reloads

  • Optimal Compression & Consistent staple formation gives superior hemostasis
  • Ease of handling facilitates better tissue manipulation
  • A new Knife gives a precise and smooth transection
  • Aids better transection, resection and creation of anastomosis

With the development of such different tools few surgeries have become really easy and less painful compared to open surgery such as Bariatric surgeries.

Endoscopic Linear cutters are commonly used to create a GIS anastomosis because of their ability to cut and staple simultaneously. In particular, they are almost indispensable in bariatric, gastric, and pouch surgery, surgeries in which complications lead to a high rate of morbidity and mortality. To minimize the incidence of anastomotic leakage and bleeding along with optimal tissue compression to create safer anastomosis MIRUS Endoscopic Cutter was launched. The new linear cutter provides some advantages to the surgeon. Its Varied Height staple feature accommodates various tissue thicknesses. This accommodation may be helpful in case of the absence of a suitable cartridge for the standard instrument for an operation.

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