Metabolic and Bariatric Surgery Center

Obesity is one of the most common diseases. It is not just a cosmetic concern it is a health problem that can have a very negative impact on a person's health and physical and mental wellbeing and needs to be addressed.

 

What is the definition of obesity and how is it diagnosed?

Obesity is an epidemic chronic disease that has a significant detrimental impact on health, life expectancy markedly and increased morbidity and mortality.

The diagnosis is done by calculating the Body Mass Index (BMI) through dividing a person's weight in kilograms by their height in meters squared. If the calculated number is:

BMI: Classification /category

• Below 18.5 kg/m2 – Underweight
• Between 18.5 and 24.9 kg/m2 –healthy weight range
• Between 25 and 29.9 kg/m2 –overweight
• Between 30 and 34.9 kg/m2 –obesity class 1
• Between 35 and 39.9 kg/m2 –obesity class 2
• Above 40 kg/m2 –obesity class 3( severe Obesity)

 

Another method of measuring obesity and its risks for diseases is measuring waist circumference.

• For men,
  • Low risk: below 94 cm
  • High risk: 94–102 cm
  • Very high: more than 102 cm
• For women,
  • Low risk: below 80 cm
  • High risk: 80–88 cm
  • Very high: more than 88 cm.

 

What are some of the health problems associated with obesity?

People with obesity are more likely to develop several potentially serious health problems, including metabolic syndrome (type 2 diabetes, high blood pressure, high cholesterol levels), and also heart and vascular diseases, obstructive sleep apnea, obesity hypoventilation syndrome, Asthma, heartburn, Gastrointestinal reflux disease, osteoarthritis, Joint degenerative disorders, fatty liver, non-alcoholic fatty liver disease(NAFLD)and non-Alcoholic steatohepatitis (NASH), and other liver problems, gallbladder disease, Psychosocial disturbances, Pseudotumor cerebri, sexual problems, erectile dysfunction, Poly cystic ovary syndrome and infertility, urinary incontinence, and Chronic kidney disease. Obesity is associated with an elevated risk of certain types of cancers, including esophagus, stomach, colorectal, liver, gallbladder, pancreas, kidney, breast, endometrial, and ovary.

 

What are the causes of obesity?

The causes of obesity are complex and most of the time they are intertwined.

• There are genetic and hereditary factors that play a great role in obesity. The genes one inherits from their parents affect the amount of fat body stores, and where that fat is distributed. It also affects how efficiently the body converts food into energy, and how the body regulates appetite.
• Another reason for obesity is poor lifestyle choices. This includes unhealthy eating habits, such as consuming foods that are very high in calories and eating oversized portions.
• Lack of exercise and sedentary lifestyle.
• 4-There are some medical conditions that can cause obesity, such as underactive thyroid, high cortisol levels in the body, Prader-Willi syndrome, and arthritis. Also, some medications can cause weight gain if a person is taking them, such as cortisone, steroids, some antidepressants, and some epilepsy drugs.
• Aging. As the person ages, the amount of muscle in the body decreases and the rate of metabolism decreases. This makes the body more prone to accumulate fat and gain weight.
• Other factors, such as pregnancy, psychological stress and diseases, sleep disorders, quitting smoking and others can also lead to obesity.

 

Investigations and clinical evaluation of Patients with Obesity

The clinical evaluation of obesity requires a medical examination and several tests.

• Fasting blood glucose
• HbA1c
• Complete blood count
• Electrolytes, uric acid and renal blood testing (eGFR)
• Liver function tests
• Lipid profile
• Thyroid function tests
• Vitamin D levels
• Iron and vitamin B12 status
• Urine for albuminuria
• Cardiovascular assessment
• Gastroenterologist assessment
• Sleep studies (where clinically indicated)
• Other specific tests as indicated by clinical findings.

 

Non-surgical treatment for obesity

There are three main routes to treating obesity, and these are often complementary: lifestyle changes, medical treatment, and surgical treatment.

 

Lifestyle changes

The cornerstone of obesity treatment is making lifestyle modifications, including adopting a healthy diet that is rich in vegetables, fruits, and fibers. Avoiding foods that are high in calories or saturated fats. Also limiting sweets and alcohol intake. It is advised to quit smoking, exercise about half an hour a day, monitor weight regularly, and ensure adequate amount of sleep every night. Changes in lifestyle are necessary to maintain weight loss even when medical or surgical treatment is also pursued.

 

Cognitive Behavior Therapy (CBT)

In the form of behavioral modification techniques and psychological eating patterns

 

Medical treatment of obesity:

Antiobesity medications (AOMs) that are commonly used to treat obesity include:

• Appetite suppressants, which reduce feelings of hunger like GLP-I receptor agonists (liraglutide; Semaglutide, tirzepatide)
• Medications that increase metabolism and appetite suppressants, Phentermine, Phentermine combined with Topiramate (Qsymia; VIVUS), Naltrexone combined with Bupropion (Contrave; Currax Pharmaceuticals)
• Medications that block the absorption of fat (Orlistat).

Antiobesity Medications (AOMs) are indicated as an adjunct to caloric restriction and physical activity in adults with a BMI ≥30 kg/m² or BMI 27 to 29.9 kg/m² with at least 1 weight-related comorbidity such as diabetes, hypertension, hyperlipidemia, obstructive sleep apnea, nonalcoholic fatty liver disease, or osteoarthritis.

Most of the international medical societies propose that weight loss goals for most individuals with obesity should be ≥10% which lead to greater and more clinically meaningful improvements in weight-related comorbidities, including greater relative risk reduction for diabetes and cardiovascular events, improvements in fatty liver, decreased disease activity in patients with inflammatory rheumatic disease, and improvements in osteoarthritis, obstructive sleep apnea, and cancer risk.

While these medications can be effective in weight loss, they are not recommended for short term use but rather for long term use.

They also have side effects and should only be used under the guidance of a healthcare provider. Note that calorie restricted healthy diets and increased physical activity should always be a part of your treatment plan with antiobesity medications.

 

Endoscopic treatment includes the following:

• Intragastric balloon: Based on current evidence, balloon therapy is FDA approved as an endoscopic, temporary tool for the management of obesity.
• Endoscopic sleeve gastroplasty: This is a minimally invasive procedure that does not require surgery. It is done through endoscopy under anesthesia. It involves placing stitches in the stomach to reduce the amount of food and liquid the stomach can hold at one time. Endoscopic sleeve gastroplasty leads to significant weight loss.

 

Internationally approved -Programmed Balloon (Smart Capsule): The patient should be evaluated and made sure that there is nothing to prevent its use. It aims to reduce weight for patients who are overweight or the onset of obesity of the first class.

 

We recommend against the use of other commercial remedies for obesity that are not FDA approved such as fat burner supplements, Botox injections, or other commercially available treatments that have not been studied in randomized controlled studies for obesity.

 

Surgical treatment for metabolic diseases and obesity

A surgical intervention may be recommended for obese patients in the following cases:

• MBS is recommended for individuals with BMI 35 kg/m2, regardless of presence, absence, or severity of comorbidities.
• MBS is recommended in patients with T2D and BMI 30 kg/m2.
• MBS should be considered in individuals with BMI of 30–34.9 kg/m2 who do not achieve substantial or durable weight loss or co-morbidity improvement using nonsurgical methods.
• There is no upper patient-age limit to MBS. Older individuals who could benefit from MBS should be considered for surgery after careful assessment of co-morbidities and frailty.
• Children and adolescents with BMI 120% of the 95^th percentile and a major co-morbidity, or a BMI 140% of the 95th percentile, should be considered for MBS after evaluation by a multidisciplinary team in a specialty center.

 

Metabolic and Bariatric Surgery (MBS) Procedures

Bariatric surgeon determines which kind of operation is recommended depending on the patient’s case and condition, however the final decision is made by the patients after options have been given.

The most common Bariatric Surgeries are:

• Laparoscopic sleeve gastrectomy (LSG): In this procedure, A large part of the stomach is removed, creating a smaller reservoir for food, and the part of the stomach responsible for secreting ghrelin (the hormone that regulates appetite) is removed.

• Laparoscopic RNY Gastric bypass surgery (LRNYGB): by making a small pouch of the stomach and then making two anastomoses, the first between the stomach pouch and the jejunum, and the second is a jejuno-jejunostomy.
• Laparoscopic Single Anastomosis Gastric bypass (LSAGBP): by making a long pouch of the stomach and then performing an anastomosis between the gastric pouch and the jejunum.

 

Laparoscopic Revision or Conversion Bariatric Surgeries:

• Laparoscopy re-sleeve or converting it to other operations.
• Removal of Gastric Banding and conversion it to other operations.
• Conversion of Vertical Banded Gastroplasty (VBG) to other operations.
• Revision of gastric bypass.
• And other internationally approved operations.

 

Other Surgeries are performed for selected patients:

• Single Incision Laparoscopic Sleeve Gastrectomy (SILS)
• Laparoscopic Sleeve Gastrectomy with band (Banded-Sleeve)
• Laparoscopic Nissen fundoplication with sleeve gastrectomy (N-Sleeve)
• Laparoscopic Banded Bypass
• Laparoscopic Single Anastomosis Duodenal Ileal Bypass with sleeve gastrectomy (SADI-S)
• Laparoscopic Biliopancreatic diversion with duodenal switch off (BPD-DS ) 
• Laparoscopic Esophageal reflux surgeries and hiatal hernia repair after bariatric surgeries
• Laparoscopic reversal of Bypass (UNDO)

 

When you should see a doctor?

If a person is overweight or obese, it is recommended that they visit a specialist doctor specialized in weight loss. The doctor will take a detailed history, perform a thorough physical examination including body measurements, and BMI calculation as well as checking for other health problems. They also might order some blood tests.

Through this, the doctor will evaluate the cause of the obesity, and make sure there are no medical illnesses, like hypothyroidism, that are contributing to the weight gain. They will identify complications or illnesses related to obesity that need to be treated. They will also decide on the treatment plan, and whether medications or surgery is most appropriate option depending on the case.

 

Quality Measures

Metabolic and Bariatric Surgery Center at Abdali Hospital follow best evidence-based guidelines. We have multidisciplinary healthcare professional team with experience in bariatric patient management. The team consists of licensed Bariatric surgeons, anaesthesiologist, nurses, psychologists, gastroenterologist, clinical dieticians, Interventional radiologist, cardiologist, pulmonologist, endocrinologist, obesity medicine physician or internist, physiotherapist and bariatric surgery coordinator.