Obesity is defined as a chronic disease of excess fat storage to the extent that health is impaired. It has reached epidemic proportions worldwide and is a major health concern of 21st century. Diabesity, the combination of Obesity and Diabetes is commonly seen today, as are other associated diseases such as Hypertension, Joint Pains, Obstructive Sleep Apnea, Dyslipidemia, PCOD, Infertility, Depression, Skin infections, Psychosocial problems with poor Quality of Life.
Obesity is a precursor to many life-threatening conditions such as Coronary Artery Disease, Stroke, Obesity Hypoventilation Syndrome, Cancers and is the leading preventable cause of death worldwide. Globally the prevalence of obesity has doubled between 1980 and 2014. 1.9 billion adults are overweight (38% of men and 40% women). 600 million (13%) are obese. 41 million children under the age of 5 were overweight or obese in 2014.
Even in India overweight and obesity increased from 21% in 2005 to 39.3% in 2015. The incidence of Diabetes (20.3%) and Hypertension (22.2%) is on the rise. Due to the preferential central accumulation of fat, the Asian population is particularly at higher risk of insulin resistance and atherogenesis at comparatively lower BMIs and hence the cut off for surgical intervention is lower.
A bariatric procedure is recommended to the person with BMI > 37.5 without related diseases and also when associated diseases are already present at BMI > 32.5. Body mass index is calculated by dividing weight in kilograms with height in meter square. Lower BMI patients have advised lifestyle modifications, diet, and regular exercise to reduce weight.
Bariatric Procedure is proven procedure of choice to lose excess weight, obesity treatment and for maintenance of weight loss in long-term. One may expect to loose up to 80% of excess weight at one year. All related diseases either completely resolve or there occurs significant improvement leading to much better quality of life. Obesity surgery increases overall life expectancy and reduces deaths from complications.
Types of Bariatric Procedures
These are either restrictive or malabsorptive or a combination of both. The kind of procedure performed depends on the age, BMI, co-morbid conditions, pre-operative workup results and also the intraoperative findings.