Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese.
Symptoms of Obesity:
Obesity is an excess of body fat and body weight. The person’s weight is usually disproportionate to his height. Other symptoms that are common in obese people are acne, striae, buffalo hump, fat pad distribution, acanthosis nigricans, gynecomastia, abdominal pannus, hernias, skin tags, hypoventilation, hirsutism, pedal edema, varicoceles, irregular rhythms, stasis dermatitis, and gait abnormalities are common obesity focus findings
When is a patient labeled overweight and obese?
The measurement of body mass index is a typical screening tool for obesity (BMI). BMI is computed by dividing weight in kilograms by height in meters squared. Obesity is divided into three categories based on BMI:
- Underweight: less than 18.5 kg/m²
- Normal range: 18.5 kg/m² to 24.9 kg/m²
- Overweight: 25 kg/m² to 29.9 kg/m²
- Obese, Class I: 30 kg/m² to 34.9 kg/m²
- Obese, Class II: 35 kg/m² to 39.9 kg/m²
- Obese, Class III: more than 40 kg/m²
A waist-to-hip ratio of greater than 1:1 in men and more than 0:8 in women is regarded as noteworthy.
Skinfold thickness, bioelectric impedance analysis, CT, MRI, DEXA, water displacement, and air densitometry studies can all be done as part of the evaluation process.
Complete blood count, basic metabolic panel, renal function, liver function study, lipid profile, HbA1C, TSH, vitamin D levels, urinalysis, CRP, and additional investigations such as ECG and sleep studies can all be done in the laboratory to assess associated medical issues.
Complications of Obesity:
Obese people are more likely than those who are normal or healthy weight to have a variety of significant diseases and health issues, including the following. Obese people are more likely than those who are normal or healthy weight to have a variety of significant diseases and health issues, including the following:
- Low quality of life
- High blood pressure (Hypertension)
- High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
- Type 2 diabetes
- Coronary heart disease
- Mental illness such as clinical depression, anxiety, and other mental disorders
- Sleep apnea and breathing problems
- Many types of cancer
- Gallbladder disease
- Body pain and difficulty with physical functioning
- All causes of death (mortality)
Treatment of Obesity:
Obesity generates a slew of comorbid and chronic medical issues, so physicians should take a multifaceted approach to obesity management. Individualize treatment, treat underlying secondary causes of obesity, and concentrate on managing or treating associated comorbid diseases, according to experts. Dietary changes, behavioral therapies, drugs, and, if necessary, surgical intervention should all be part of the treatment plan.
Dietary changes should be tailored to the person, with regular weight reduction being closely monitored. Diets low in calories are advised. Carbohydrate or fat restriction could be considered low calorie. When compared to a low-fat diet, a low-carbohydrate diet can result in faster weight loss in the first few months. The importance of the patient’s nutrition should be highlighted constantly.
- Obese patients should be referred for intensive behavior therapy, according to the USPSTF. Motivational interviewing, cognitive behavior therapy, dialectical behavior therapy, and interpersonal psychotherapy are among the psychotherapeutic therapies available. When behavioral therapies are paired with diet and exercise, they are more successful.
Medications for weight loss:
- Antiobesity drugs can be utilized if your BMI is greater than or equal to 30 or if you have comorbidities and your BMI is greater than or equal to 27. Medications can be used in conjunction with dietary, exercise, and behavioral changes.
- Phentermine, orlistat, lorcaserin, liraglutide, diethylpropion, phentermine/topiramate, naltrexone/bupropion, and phendimetrazine are some of the FDA-approved antiobesity drugs.
- All of the compounds are used to help people lose weight over time. Because of its limited absorption, orlistat is usually the first choice because of its lack of systemic effects. Because of the danger of serotonin syndrome, lorcaserin should not be taken with other serotonergic drugs. In the first three months, high responders typically lose more than 5% of their body weight.
- The recent so-called “game-changer” drug Semaglutide is associated with up to 15% body weight loss. It is a novel GLP-1 analog-like liraglutide (Victoza, Saxenda), however, it is administered once-weekly and is more effective than Liraglutide. It has been studied in patients with or without diabetes.
Bariatric Surgery or Cardiometabolic Surgery:
Bariatric and metabolic surgery are terms used to describe weight loss surgery. These phrases are used to describe the effect of these surgeries on the weight and health of patients’ metabolisms (breakdown of food into energy).
These operations are particularly helpful in treating diabetes, high blood pressure, sleep apnea, and high cholesterol, among many other disorders, in addition to obesity. These procedures can also help to prevent future health issues. Patients with obesity who opt to receive therapy might expect a higher quality of life and a longer lifespan as a result of the benefits.
Metabolic and bariatric procedures have been perfected over many decades and are among the most thoroughly researched treatments in modern medicine. They are conducted utilizing minimally invasive surgical procedures and tiny incisions (laparoscopic and robotic surgery).
These developments enable patients to have a better overall experience, with less pain, fewer problems, shorter hospital stays, and faster recovery times. These procedures are exceedingly safe, with lower complication rates than typical procedures including gallbladder removal, hysterectomy, and hip replacement.
The purpose of these procedures is to alter the stomach and intestines in order to treat obesity and other disorders. The operations may cause the stomach to shrink and a part of the intestine to be bypassed. This leads to a decrease in food intake and a shift in how the body absorbs food for energy, resulting in reduced hunger and more fullness. These treatments boost the body’s ability to maintain a healthy weight.
All patients who undergo a cardiometabolic or bariatric surgery should be assessed before, during, and after the surgery for extra nutritional requirements such as fluids and vitamin B-12.
Bariatric Surgery Types, Advantages, and Disadvantages of Various Procedures:
The Laparoscopic Sleeve Gastrectomy, sometimes known as the “sleeve,” involves removing around 80% of the stomach using laparoscopic surgery. The stomach that remains is about the size and shape of a banana.
Advantages of Sleeve Gastrectomy:
- Surgery is technically straightforward and takes less time.
- In some patients with high-risk medical problems, this procedure is possible.
- For people with severe obesity, this could be the initial step
- It’s possible to utilize it as a stopgap between gastric bypass and SADI-S surgeries.
- Weight loss that works and improvements in obesity-related issues
Disadvantages of Sleeve Gastrectomy:
- A procedure that cannot be reversed
- Reflux and heartburn may become worse or appear for the first time.
- When compared to bypass surgeries, there is a lower influence on metabolism.
Roux-en-Y Gastric Bypass (RYGB) Surgery:
The Roux-en-Y Gastric Bypass, sometimes known as the “gastric bypass,” has been conducted for over 50 years, with the laparoscopic method perfected since 1993. It is one of the most popular operations for treating obesity and obesity-related disorders, and it is quite effective. The name comes from a French phrase that means “in the shape of a Y.”
Advantages of Rou-en-Y Gastric Bypass Surgery:
- Weight loss that is consistent and long-lasting
- Obesity-related disorders can be cured with this treatment.
- A technique that has been refined and standardized
Disadvantages of Roun-en-Y Gastric Bypass Surgery:
- When compared to a sleeve gastrectomy or a gastric band, this procedure is more technically challenging.
- More vitamin and mineral deficits than gastric banding or sleeve gastrectomy
- Small bowel blockage and complications are a possibility.
- Ulcers are a possibility, especially if you use NSAIDs or smoke.
- May create “dumping syndrome,” which is a sense of being unwell after eating or drinking something sugary.
Adjustable Gastric Band (AGB)
The Adjustable Gastric Band is a silicone band that is wrapped around the top of the stomach to restrict how much food a person can eat. Since 2001, it has been sold in the United States. Other methods have a lower impact on obesity-related disorders and long-term weight loss. As a result, its use has decreased during the last decade.
Advantages of Adjustable Gastric Band:
- Early following surgery, there is the lowest risk of complications.
- There is no stomach or intestinal division.
- On the day of operation, patients are free to go home.
- If necessary, the band can be removed.
- The patient is the least likely to suffer from vitamin and mineral deficiencies.
Disadvantages of the adjustable gastric band:
- During the first year, the band may require multiple changes and monthly office visits.
- Weight reduction is slower and less than with other surgical treatments.
- Over time, there is a risk of band movement (slippage) or stomach injury (erosion)
- Requires a foreign implant to remain in the body
- Has a high re-operation rate
- Swallowing difficulties and esophageal enlargement are possible side effects.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS):
The Biliopancreatic Diversion with Duodenal Switch, or BPD-DS, is a procedure that starts with the creation of a tube-shaped stomach pouch, similar to a sleeve gastrectomy. It’s similar to a gastric bypass in that a larger portion of the small intestine is bypassed.
Advantages of biliopancreatic diversion with duodenal switch:
- Among the most promising results for improving obesity
- Reduces hunger and increases fullness after eating by affecting gut hormones.
- It is the most efficient method of treating type 2 diabetes.
Disadvantages of biliopancreatic diversion with duodenal switch:
- Complication rates are slightly greater than for other operations.
- Highest levels of malabsorption and a higher risk of vitamin and micronutrient deficiencies
- Heartburn and reflux can develop or worsen.
- There’s a chance you’ll have looser, more frequent bowel movements.
- More complicated surgery requiring more time in the operating room.
Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S)
The SADI-S, or Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy, is the newest treatment to be approved by the American Society for Metabolic and Bariatric Surgery. While the SADI-S is comparable to the BPD-DS, it is easier to execute and takes less time because there is only one surgical bowel connection.
Advantages of SADI-S:
- Long-term weight loss and type 2 diabetes remission are both highly effective with this treatment.
- Gastric bypass or BPD-DS is more complicated and time-consuming to operate (one intestinal connection).
- An excellent option for someone who has already had a sleeve gastrectomy and wants to lose more weight.
Disadvantages of SADI-S:
- Vitamins and minerals are not absorbed as well as they are with a gastric band or a sleeve gastrectomy.
- This is a newer surgery with only short-term results.
- There’s a chance that your reflux will get worse or you develop new-onset reflux
- There’s a chance you’ll have looser, more frequent bowel movements.
The field of Bariatric Surgery, now commonly termed “Cardiometabolic Surgery” is still evolving. Compared to weight loss medications, these procedures can result in a lot of weight loss and may reverse diabetes, hypertension, and other high-risk metabolic conditions.