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adolescents are increasingly affected. Worldwide, 33% of
populations – a staggering 2.36 billion people are estimated
to be overweight or obese - PANDEMIC.
Body Mass Index is used to measure and quantify Obesity
in adults. It is a simple calculation of dividing weight in
centimeters by height in meters 2 . Moreover we have a
typical pattern of fat distribution around the waist which
makes us prone to development of insulin resistance and
type 2 Diabetes at much lower BMIs.
After quantification, management of Obesity becomes
easier where mild to moderately Obese are managed by
encouraging lifestyle modifications, supervised diets and
regular physical exercise. Severely Obese i.e. BMI > 37.5
are advised a Bariatric Procedure. When two or more co
morbidities have already set in such as Diabetes,
Hypertension, OSA, PCOS etc. surgery is advised at a
lower BMI of > 32.5.
Bariatric procedures have undergone tremendous
innovations, the most significant being the performance of
these Laparoscopically compared to when these were first
started more than 50 years ago. Laparoscopy has its
inherent benefits of being safer, less painful, decreasing
hospital stay, providing early return to work and superior
cosmesis across all procedures but biggest benefit is reaped
by Obese patient when early ambulation is started just a few
hours after the surgery, preventing many serious
complications in these otherwise susceptible obese subjects.
Common Bariatric Procedures suitable to Asian diet are:
Lap Sleeve Gastrectomy
Laparoscopic Sleeve Gastrectomy removes a part of
stomach along the greater curvature, thus reducing the
size of the stomach substantially. It is the most
commonly performed procedure worldwide today.It is
mainly a restrictive procedure with hormonal alterations.
There is a decrease in levels of hormone Ghrelin which
produces hunger.
Lap Roux – En –Y Gastric Bypass
In this procedure a very small, micro pouch of stomach is
created to which small bowel loop is attached. Intestinal
rerouting is done to create a Roux-en-Y configuration
which prevents reflux of bile into the micro pouch and also
provides a very small degree of malabsorption.
10 | March 2019 |