A CURE FOR INCURABLE OBESITY

                 Severe obesity is a chronic condition that is difficult to treat through diet and exercise alone. Bariatric surgery (reducing the size of the stomach) is an option for people who are severely obese and cannot lose weight by traditional means or who suffer from serious obesity-related health problems. The operation promotes weight loss and reduces the risk of type 2 diabetes by restricting food intake and, in some operations, interrupting the digestive process to prevent the absorption of some calories and nutrients. Recent studies suggest that bariatric surgery may even have a favorable impact on mortality (death) rates in severely obese patients. The best results are achieved when bariatric surgery is followed with healthy eating behaviors and regular physical activity.

             You may be a candidate for surgery if you are an adult with:

1. A body mass index (BMI) of 40 or more or a BMI between 35 and 39.9 and a serious   obesity-related health problem such as type 2 diabetes, coronary heart disease, or severe sleep apnea (when breathing stops for short periods during sleep).

     2. Acceptable operative risks.

     3. An ability to participate in treatment and long-term follow-up.

     4. An understanding of the operation and the lifestyle changes you will need to make.

           Normally, as food moves along the digestive tract, digestive juices and enzymes digest and absorb calories and nutrients. After we chew and swallow our food, it moves down the esophagus to the stomach, where a strong acid continues the digestive process. When the stomach contents move to the duodenum, the first segment of the small intestine, bile and pancreatic juice speed up digestion. Most of the iron and calcium in the food we eat is absorbed in the duodenum. The jejunum and ileum, the remaining two segments of the nearly 20 feet of small intestine, complete the absorption of almost all calories and nutrients. The food particles that cannot be digested in the small intestine are stored in the large intestine until eliminated.

Bariatric surgery produces weight loss by restricting food intake and, in some cases, interfering with nutrition through mal-absorption. Patients who undergo bariatric surgery must also commit to a lifetime of healthy eating and regular physical activity. These healthy habits help ensure that the weight loss from surgery is successfully maintained.

There are many types of Bariatric surgery such as adjustable gastric band (AGB), Roux-en-Y gastric bypass (RYGB), etc. Each has its own benefits and risks. To select the option that is best for you, you should consult your physician on each operation’s benefits and risks along with many other factors, including BMI, eating behaviors, obesity-related health conditions, and previous operations.                  Bariatric surgery may be performed through “open” approaches or by laproscopy. Most bariatric surgery today is performed laproscopically because it requires a smaller cut, creates less tissue damage, leads to earlier discharges from the hospital, and has fewer complications, especially postoperative hernias. However, not all patients are suitable for laparoscopy. Patients who are extremely obese, who have had previous abdominal surgery, or have complicating medical problems may require the open approach. But with every advance in science, you get add-on of complications. Early complications of these operations can include bleeding, infection, leaks from the site where the intestines are sewn together, and blood clots in the legs that can progress to the lungs and heart. Complications that may occur later include malnutrition, especially in patients who do not take their prescribed vitamins and minerals. In some cases, if the malnutrition is not addressed promptly, vitamin deficient diseases and malnutrition disorders such as pellagra, Beri- Beri, and kwashiorkor may occur along with permanent damage to the nervous system. Other late complications include strictures (narrowing of the sites where the intestine is joined) and hernias.              Research indicates that about 10 percent of patients who undergo bariatric surgery may have unsatisfactory weight loss or regain much of the weight that they lost. Some behaviors such as frequent snacking on high-calorie foods or lack of exercise can contribute to inadequate weight loss. Technical problems that may occur with the operation, like a stretched pouch or separated stitches, may also contribute to inadequate weight loss. Some patients may also require emotional support to help them through the postoperative changes in body image and personal relationships.                  Rates of obesity among youth are on the rise. Bariatric surgery is sometimes considered as a treatment option for adolescents who have developed extreme obesity. Although it is becoming clear that adolescents can lose weight following bariatric surgery, there are numerous unanswered questions about the long-term effects of these operations on adolescents’ developing bodies and minds.              Experts in pediatric obesity and bariatric surgery recommend that surgical treatment only be considered when adolescents have tried for at least 6 months to lose weight and have not been successful. Candidates should be extremely obese (typically with BMI greater than 40), have reached their adult height (usually 13 or older for girls and 15 or older for boys), and have serious weight-related health problems, such as type 2 diabetes, sleep apnea, heart disease, or significant functional or psychosocial impairment. In addition, potential patients and their parents should be evaluated to see how emotionally prepared they are for the operation and the lifestyle changes they will need to make. Patients should be referred to specialized adolescent bariatric surgery centers with a team of experts qualified to meet their unique needs.              A growing body of research suggests that both weight and health of extremely obese youth can be favorably changed by bariatric surgery. Over the years, gastric bypass surgery has been the predominant operation used to treat adolescent extreme obesity. Even though this surgery is gaining momentum internationally, India also has some successful cases of bariatric surgery to its credit mostly involving obese children.

                      But surgery has its own side effects, so it’s always better to lead a healthy life than to go under the knife.