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BMI-Chart for Obesity Measurement

Degree of Obesity Body Mass Index
BMI Chart For Westerners For Asians
Overweight 25.0–29.9 22.5 – 27.5
Obesity 30–34.9 27.5 – 32.5
Severe obesity 35–39.9 32.5 – 37.5
Morbid obesity 40–49.9 37.5 – 47.5
Superobesity >50 >47.5
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what-are-the-adverse-effects-of-obesity?

The more obese you are, the more likely you are to have health problems. You are more likely to develop health problems; such as,

 

  • heart disease

 

  • stroke

 

  • diabetes

 

  • cancer (such as colon cancer, endometrial cancer, and postmenopausal breast cancer)

 

  • gallbladder disease

 

  • sleep apnea (interrupted breathing during sleep)

 

  • osteoarthritis (wearing away of the joints)

 

  • sudden death.
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what-is-the-medical-treatment-of-obesity?

Adequate diet and exercise are the key components. A recommended balanced diet should provide 1200-2000 Calories a day depending upon the person’s lifestyle. A diet restriction of 500Cal/day is expected to cause a wt loss of approx 1lb/week. Many dietary supplements are available. A Low Cal Diet gives 800-1200Cal/day and a Very Low Cal Diet (VLCD) gives 400-800Cal/day. These may partially or completely replace your diet, but usually the weight loss is restricted to the duration of this diet.

A regular exercise pattern is of immense importance. A duration of 30-45 minutes per day, at least 3-5 days/week is recommended by most. Even if you are planning for surgery, an exercise plan is a must.

Medicines for obesity have come and gone because of their undesired effects. At present, the only FDA approved drug is Orlistat. Even this is not free of side effects and causes only upto 10% weight loss in six months, most of which is regained after stopping the drug.

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what-is-the-need-to-undergo-surgical-treatment-of-obesity?

Various studies all over the world have proved that surgery is the most dramatic and durable treatment option for morbid obesity. With the current surgical procedures, a loss of 68-78% excess body weight is lost. The most dramatic loss is in the first six months. The procedures like Roux-en-Y Gastric Bypass and Sleeve gastrectomy reduce food intake because of early filling as well as decreased hunger. This avoids ‘starvation’ to get slimmer.

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Am i a candidate for surgical treatment for obesity?

If you are an Indian/Asian and a weight 100% over your ideal body weight, or a BMI of 37.5 or more, your should strongly consider Obesity Surgery, as it is the only durable option at this stage. If you are a hypertensive or diabetic or have any other obesity related diseases, surgery is recommended at a BMI of 32.5 or more.

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How important is the obesity surgeon and the centre in the outcome of obesity surgery?

The laparoscopic bariatric surgery is a very advanced procedure and the importance of an experienced bariatric surgeon cannot be overemphasized. The Institute of Minimal Access Surgery (IMAS) at Sir Gangaram Hospital is a pioneer in this field. It has a team of experienced advanced Laparoscopic surgeons who are routinely performing the obesity surgical procedures apart from various advanced laparoscopic procedures.

It his highly desirable for a centre, dealing with Obesity and related diseases, to be adequately equipped. IMAS is a centre of healthcare excellence, having the latest bariatric program and a state-of-the-art operation theatre and ICU facilities. IMAS, in liason with an experienced Bariatric Anaesthetic Team, cardiologist, endocrinologist, chest physician, psychologist & nutritionist, form an ideal centre for the treatment of Obesity and related diseases.

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Diabetes and Bariatric Surgery

“Diabetes is looming as one of the greatest public health threats of the 21st century and it has a strong correlation with obesity. ‘Diabesity’, as we may call it is the fastest growing pandemic of the world and the Asian population seems to be the most affected”

 New Delhi:

Obesity is a no longer a laughing matter, it has reached alarming proportions in our urban society and needs serious attention. It is a fact that today the number of overweight people in the world is equal to the underweight population. What is adding fuel to the fire is the fact that this obesity brings with it hoards of other diseases like diabetes, hypertension, dyslipidemia, joint problems, sleep disorders, respiratory insufficiency, infertility, behavioral disorders and social stigma.

The Asian population is more prone to developing the Metabolic Syndrome as compared to their Caucasian counterpart at a lower BMI because:

  •       Higher magnitude of adiposity, abdominal obesity and lower muscle mass.
  • Truncal skin fold thicker meaning more subcutaneous fat.

Interestingly, higher level of hyperinsulinemia and related metabolic derangements has

been recorded in Asian Indian neonates and children as compared to white Caucasian neonates.

PIC

What has given us a jolt is a recent survey of the school going children in Delhi which states that 30% of them are overweight. Shockingly one third of them will develop Diabetes when they become adults.

 

Today diabetes is called the mother of all diseases. Various medicines are now available to control diabetes but still many patients are not adequately benefitted. What needs to be done for Diabesity after lifestyle management and all other medications fail is something more radical.

We have seen in our own clinic at Sir Ganga Ram hospital  that these obese individuals have a poor diabetes control and there insulin requirement keeps on increasing.

 

The only permanent and logical solution for managing obesity & type 2 diabetes endorsed by physicians, endocrinologists, nutritionists is BARIATRIC SURGERY.

 

Over the past few years active research is going on to evaluate the benefits of obesity surgery in curing diabetes. It has been observed over the years that various surgeries like Roux-en Y Gastric Bypass and now Sleeve Gastrectomy have remarkable beneficial effects on diabetes.

According to Dr Francesco Rubino of New York Presbyterian Hospital, USA “Surgery is an excellent approach for treatment of diabetes and metabolic disease”. Similarly The STAMPEDE TRIAL which is being conducted by Dr Philip Schauer et al at Cleveland Clinic, USA shows that surgical treatment of diabetes (with RYGB and Sleeve) was far more effective than insulin or drug treatment.

 

To see the effects of surgical treatment on diabetes, we at the Institute Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi analyzed on our data of more than 200 patients who underwent laparoscopic sleeve gastrectomy. We found 78% resolution of diabetes, 62% resolution of hypertension and over 90% resolution of sleep disorders. The ‘Quality of life’ index improved from 2.7 to 8.2 (on a scale of 1-10). Our patients now have seen and hence agree to the remarkable benefits that surgery had on their diabetes.

 

Conclusion: These initial results are very encouraging, but a longer follow up would be required to substantiate our belief. We are currently in phase one of a clinical trial where a systematic analysis of various gut hormones before and after surgery is being done. World data is now available to suggest more than ever before that diabetes is more a disease of the gut. The management of Diabetes would need a very radical and different approach.

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Know Why You Need to Lose that Flabby Tummy?

An eye-opening article by the Institute of Minimal Access, Metabolic and Bariatric Surgery at Sir Ganga Ram Hospital) reveals the shocking aspects of obesity and how it travels from pre-birth maternal obesity to  to children in our society. It also highlights the most dangerous form of obesity common among Asians especially Indian Asians, namely abdominal or central obesity. The article also offers solutions, by providing appropriate treatment for this dangerous condition.

How Diabetes is Directly linked to Obesity?

There is an increasing belief among medical experts that abdominal or central body obesity is directly linked to the genesis of diabetes and more importantly the rise of cardiovascular disease during adulthood.

Shocking aspect of obesity starting from pre-birth levels:

This problem has its root in nutritional and sedentary behaviour starting from the birth of the child to an unhealthy mother. Maternal obesity and diabetes is now linked to the establishment of adult obesity and diabetes in her children. Sadly, childhood and adolescent obesity has a high chance of resulting in obesity in adulthood.

How Asians are prone to Excess Visceral Fat?

There is now increasing recognition that Asians, especially Indians with obesity have a predisposition for the excess body fat to be largely distributed around the abdomen. Interestingly, a large part of this abdominal fat is visceral or spread around the internal organs contained within the abdomen. Excess visceral fat is dangerous as it produces an excess of substances that have an harmful effect on various systems in the body. The following facts characterise the profile of Asian Indians – 1. A high prevalence of abdominal obesity. 2. Abdominal obesity can occur even in the absence of elevated body mass Index (BMI) and is seen even at a young age.

Indian Asians have even more danger:

Indian Asians have more abdominal visceral fat, higher degree of insulin resistance, hyperinsulinemia, hypertension and diabetes all of which are implicated in the generation of the Metabolic Syndrome and its consequences, especially, premature cardio vascular disease and death among many other morbid and mortal outcomes.

Role of Bariatric surgery and other social aspects in reducing Obesity:

In adults where obesity and especially abdominal obesity is well established, the role of metabolic realignment in the form of bariatric surgery must be considered.

This has immense implications for the promotion of health and the prevention and treatment of obesity. Solutions have to be implemented at the level of larger society as well as the individual. Sharp solutions would have to focus on rendering hopeful mothers non-obese, preventing childhood and adolescent obesity. This largely will come in the form of positive life style choices.

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