Managing weight in a healthy way

The increased use of social media has made people more conscious of their health and their looks. Of late, they are even opting for various ways to lose weight and gain health, along with looks. When all efforts fail , they opt for liposuction and bariatric surgeries to improve their health and looks, and at the same time, keep themselves fit.

 Welthi spoke to Dr T. Lakshmikanth, consultant bariatritic surgeon, Star Hospitals, Hyderabad, to understand how health and appearance depend on each other.

When can you say a person is overweight or obese?

Dr Laksmikanth: Weight can basically be categorised into underweight, normal weight, overweight, obese and morbid obese.  This can be determined by Body Mass Index (BMI) which is calculated with the help of height and weight of a person.

A BMI of less than 25 is treated as normal weight and 25-30 as overweight. Beyond a BMI of 35, it is considered as moderate obese and a BMI of 40 and above as severe obesity.

What are the risks associated with overweight  and obesity ?

Obesity occurs due to various reasons from genetic conditions, hormonal and environment and poor lifestyle. These lead to various health issues and long time disorders in the body. The disorders are called co-morbidities and they include diabetes, hypertension, severe sleep apnea, metabolic syndrome, back pain, high levels of cholesterol and triglycerides.

In case of women, obesity can also cause PCOD, menstrual irregularities, infertility and pregnancy-related complications.

 What is the difference between liposuction and bariatric surgery?

Liposuction and bariatric surgery are two different surgeries done for different situations. Lipo is a cosmetic procedure done to improve the appearance   while bariatric surgery deals with weight loss and correction of metabolic and medical problems.

 Persons with less than 30 BMI and without any co-morbidities (health complications) can go for liposuction for cosmetic reasons and any correction of abnormal fat deposition. Weight loss occurs only to a small extent in the process of body contouring.

People wanting to look good and remain in shape can go for lipo or body sculpting as fat would be removed from various parts of the body. People can lose up to 1-7 kg through lipo. Sometimes, even more fat is removed through lipo but the person gains back all that within a year as the weight loss is temporary if proper lifestyle is not followed.

For any person, losing even 2 kg is a big task and if an obese individual has to lose something beyond 25 kg, it is almost impossible and that is when surgical intervention is needed.

Persons with BMI 37.5 or 32.5 with severe obesity-related health conditions (co-morbidities), are advised to undergo bariatric surgery as losing weight with health complications is a tough task.  Bariatric surgery will also help resolve co-morbidities.

How are lipo and bariatric surgeries performed?

In liposuction, small holes are made in the skin and the fat deposited between the skin and the rectus sheath is sucked out with high-power suction equipment or through lasers.  However, only parietal fat can be removed through this process.

The fat inside the abdomen, called as visceral fat, cannot be removed through liposuction.  It gets dissolved when bariatric surgery is done.

One thing that should be understood is that lipo cannot be done if the abdominal wall is thin. In men, the abdominal wall and the muscle near the abdomen are usually thin and so lipo cannot be done in most cases. They require abdominoplasty.

Males have apple-shape obesity while females have pear-shaped obesity.  In women, fat can be removed from abdomen and thighs and hence, lipo will have an impact.

What are the different types of bariatric surgeries?

 There are three types of bariatric surgeries—Sleeve gastrectomy, gastric bypass and MGB or single-loop bypass.

All the three surgeries have two components – restrictive and metabolic.

In sleeve gastrectomy, the major component is restrictive wherein the release of hormones gets modified through the surgery and the person gets a feeling of satiety and fullness in the stomach even if they have restricted intake of food, which will ensure maintenance of weight loss successfully.

 Malabsorption of nutrients is the least in this type of surgery, compared to the other two.

In Gastric bypass surgery, both the components, restrictive and malabsorption exist. In this surgery, a large portion of the stomach is bypassed. This leaves a small pouch of stomach to hold food, restricting the amount that can be eaten at one time. The small intestine is cut below the duodenum and reattached to the new stomach pouch leaving a shortened path for food to travel through causing malabsorption.  

People who have a sweet tooth and alcoholics can also be checked through bariatric surgery. After the surgery, the person will start feeling inconvenient if he eats sweets or consumes alcohol, thereby leading to giving up the habit and also aiding the process of weight loss.

The single-loop gastric bypass or mini gastric bypass is a procedure that relies more on the malabsorption factor. However, this will give good results for both short term and long term weight loss.

How do you address the problem of malabsorption?

The person undergoing the surgery should get the nutrient content checked regularly. Those who had undergone the sleeve gastrectomy can go for nutrient examination after a year of the surgery while those opting for the single loop gastric bypass should go for the nutrient test every three months.

How long do the bariatric surgeries last?

Usually, weight loss through bariatric surgery will last for a longer time than that in liposuction, if the person undergoing the surgery, follows a healthy lifestyle. Gastric bypass can last for a lifetime. Constant follow-up is needed to keep oneself healthy.

What are the side effects of bariatric surgery? Do they prove fatal?

Compared to the advantages of the surgery, the side effects are negligible. Complications arise only in 0.3-0.6 per cent of those undergoing the surgery.

Usually, obesity is associated with respiratory problems. The lungs cannot pump in the required oxygenated blood to the body of the obese person. Usually, we take all the precautions to avoid problems.

Overweight is associated with co-morbidities which can prove harmful to a person’s health. This health condition needs to be weighed against the complications involved in the surgery which is usually, very less.

Through bariatric surgery, we try to increase the life span of a person by addressing the co-morbidities like diabetes, hypertension, sleep apnea , etc.

We also try to prepare a person for the surgery by making him move and do minimum breathing exercises so as to improve his health condition.

Please tell us about your experiences in performing bariatric surgeries?

I started doing surgeries in 2004 and had operated on more than 4,000 people. So far, there were no complications and all of the surgeries had been successful.

In India, the chance of weight regain after surgery is 10-19 per cent which is very less compared to other parts of the world.

Balanced diet and exercising, apart from behavioural changes, help a person maintain the reduced weight and at the same time, keep oneself healthy.

Book Appointment: Dr T. Lakshmikanth, consultant bariatritic surgeon, Star Hospitals, Hyderabad