Bariatric

What is Obesity?

• Obesity is the condition of having excess amount of body fat that can be dangerous to health.

What is Morbid Obesity?

• When serious medical problems starts
• When excess weight is 50 kg or more

Causes

• Excessive food energy intake
• Lack of physical activity
• Genetic susceptibility
• Endocrine disorders
• Medications
• Psychiatric illness
• Pregnancy
• Lack of sleep
• Medical problems - e.g. Prader-Willi syndrome, Cushing"s syndrome, arthritis - can lead to decreased activity

Different Ways to measure Obesity

Body Mass Index (BMI)
Waist Circumference
Waist-to-Hip Ratio (WHR)
Skinfold Thickness

• Predicts development of disease and death in Obese people
• The most basic method, and the most common, is the Body Mass Index (BMI)

BMI

BMI is Body Mass Index – the formula helps to calculate the approximate required weight in proportion to height.

Formula: Weight (kg) / Height2 (m2)

BMI (kg/m2) Classification

< 18.5           Underweight
18.5 – 22.9   Normal weight
23.0 – 24.9   Overweight
25.0 – 29.9   Class I Obesity
30.0 – 34.9   Class II Obesity
≥ 35              Class III Obesity

Waist Circumference

• It’s the circumference of the abdomen
• Can be measured at
      - the natural waist (in between the lowest rib and the top of the hip bone)
      - the umbilicus (belly button)
      - the narrowest point of the midsection

Strengths
• Measures “abdominal obesity”—the extra fat found around the middle that is an important factor in health, even independent of BMI

Limitations
• Measurement procedure has not been standardized
• Lack of good comparison standards (reference data) for waist circumference in children
• May be difficult to measure and less accurate in individuals with a BMI of 35 or higher

Waist-to-Hip Ratio

• It measures abdominal obesity - the widest diameter of the buttocks and then dividing the waist measurement by the hip measurement

Strengths
• Good correlation with body fat

Limitations
• More prone to measurement error because it requires two measurements
• More difficult to measure hip than it is to measure waist
• More complex to interpret than waist circumference, since increased waist-to-hip ratio can be caused by increased abdominal fat or decrease in lean muscle mass around the hips
• Turning the measurements into a ratio leads to a loss of information: Two people with very different BMIs could have the same WHR
• May be difficult to measure and less accurate in individuals with a BMI of 35 or higher

Skinfold Thickness

• A special caliper to measure the thickness of a “pinch” of skin and the fat beneath it in specific areas of the body - the trunk, the thighs, front and back of the upper arm, and under the shoulder blade
• Equations are used to predict body fat percentage based on these measurements

Strengths
• Portable
• Fast and easy (except in individuals with a BMI of 35 or higher)

Limitations
• Not as accurate or reproducible as other methods
• Very hard to measure in individuals with a BMI of 35 or higher

Co-morbidities – Obesity impacts patient’s health and quality of life

Heart - High Blood Pressure, Heart Attacks, Stroke, Congestive Heart Failure
Lungs– Obstructive Sleep Apnoea, Obesity Hypoventilation Syndrome, Asthma/ Reactive Airway Disease
Abdomen– Gallbladder Disease, GERD (recurrent heartburn), Recurrent Ventral Hernias, Fatty Liver Disease
Urinary– Frequent Urinary Tract Infection (UTI’s), Stress, Urinary Incontinence, Menstrual Irregularity or Infertility
Bones– Degeneration of Knees on Hips, Disc Herniation, Chronic non-surgical low back pain
Skin– Multiple disorders, most relate to Diabetes and Yeast Infections between skin folds
Cancer– Breast, Uterine, Prostate, Renal, Colon and Pancreatic
Blood– Hyperlipidemia, Atheresclerosis, Hypercholestremia
Endocrinal– Diabetes Mellitus, Hirsutism

Management of Obesity

• Lifestyle changes
• Diet
• Physical activity
• Daily habits
• Pharmacotherapy (occasional)
• Bariatric Surgery

How the Bariatric Surgery is the solution?

• Bariatric Surgery is the most viable option to be considered in Morbid Obesity when nothing works (diet, physical activity etc.).

Eligibility Criteria of Bariatric Surgery

IFSO-APC consensus statements 2011 for Bariatric / GI Metabolic Surgery:
• BMI ≥ 35 kg/m2
• BMI ≥ 30 kg/m2 and T2DM or Metabolic Syndrome (for patients who are inadequately controlled by lifestyle alterations or medical treatment)
• BMI ≥ 27.5 kg/m2 and T2DM or Metabolic Syndrome (as a non primary alternative for patients who are inadequately controlled)

Asian Pacific Metabolic and Bariatric Surgery Society (APMBSS)(Consensus in Asia-Pacific 2005)
• BMI ≥ 37 kg/m2
• BMI ≥ 32 kg/m2 and the presence of Diabetes or 2 significant obesity-related co-morbidities
• Failed attempts at weight loss by dietary or medical measures
• Age 18 to 65

Types of Bariatric Surgery

• Gastric Bypass
• Sleeve
• Mini Gastric Bypass

Benefits

• It has been observed that patients who are more committed towards eating healthy diet, taking the required additional food supplement, physical activities will have the Best Long Term Result
• Significant sustained weight loss
• High Cholesterol
• High Blood Pressure
• Obstructive Sleep apnoea
• Hypertension
• Type 2 Diabetes
• Cardiovascular Diseases
• Endocrinologic Diseases
• Dyslipidemia