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Category Archives: Bariatric Surgery

Net Chatting and PS4 Gaming Trigger Obesity In Children

Dr. Arun Prasad

If your child prefers to spend more time sitting at home and chatting on WhatsApp and Facebook or indulging in PS4 gaming rather than playing with his friends in a park or play area, then it is time for you to sit up and become alert. Such a habit of your child is inviting a string of serious diseases, including diabetes, high blood pressure, cancer and heart ailments which are triggered by obesity.

Problem of childhood obesity becomes difficult to control at a later age even through controlled diet, exercise and some other measures to reduce weight. As a result, one has to take recourse to surgical procedures or the bariatric surgery to reduce obesity.

There is a shortage of playgrounds and evening activities for the children in most of Indian cities. At the same time, there is tremendous pressure on children to study more for competitive examinations and attend coaching classes. This effectively consumes their weekends too. The only source for entertainment for the stressed out children is either PS4 gaming or WhatsApp, Facebook and laptops.

Such a situation leads to a mismatch of body metabolism during the most formative years of the person, something that becomes very difficult to reverse at a later age. The individual later finds himself/herself in a difficult situation and has to try out various diet, exercise and weight loss programmes.

Obesity starts during childhood and it is important to educate children and young parents. Health education through media, newspapers and teaching institutions should address this monstrous problem before it gets out of hand.

A chubby child is not ‘healthy’ and cute is the message that we need to give across to the public. Processed foods and shortcut meals are the biggest culprits. This, combined with the lifestyle pressures of a young urban family, makes healthy eating a real challenge.

This is not easy now as the body is already poised at a different level and metabolism is now skewed. Last resort for many individuals is bariatric or weight loss surgery which is now increasingly becoming a surgical specialty of its own.

The increasing menace of obesity is not just for looks and cosmetic reasons. Obesity has its fallouts in terms of health and life span. Obese individuals, especially the morbidly obese (body mass index BMI of more than 32.5), have an increased risk and incidence of various medical diseases like diabetes, blood pressure, cholesterol, liver problems, infertility and sleep apnea. It also reduces the life span of an individual through an increased risk of heart attacks, stroke, kidney and liver failure.

 Is a senior bariatric surgeon at Apollo Hospital, New Delhi. He is the vice president of Obesity & Metabolic Surgery Society of India (OSSI).

 

 

What are the various Gastric Surgery Procedures & when are they required?

Dr. Arun Prasad

Gastric Surgery helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, your stomach will be smaller. You will feel full with less food. The food you eat will no longer go into some parts of your stomach and small intestine that absorb food. Because of this, your body will not get all of the calories from the food you eat. The gastric bypass, in its various forms, accounts for a large majority of the bariatric surgical procedures performed.

various gastric surgery procedures :

RESTRICTIVE PROCEDURES

The stomach size is reduced by applying staplers across it and thereby reducing the amount of food a person can eat at a given time.

  • Gastric Banding is a popular restrictive procedure currently. A band is placed around the upper most part of the stomach. This band divides the stomach into two portions, one small and one larger portion. Because food is regulated, most patients feel full faster. Food digestion occurs through the normal digestive process. Other advantage is that it is EXTERNALLY adjustable ( the band can be tightened or loosened to regulate the amount of food passing ).
  • The Gastric Sleeve Resection removes a great part of the stomach and leads to ‘considerable’ loss of weight. This is useful in those with a BMI between 35 and 40. Also, this procedure is being done in BMI over 60 to downgrade the obesity to a more manageable level of about 50, after which a gastric bypass / duodenal switch can be done.

COMBINED RESTRICTIVE AND MALABSORBTIVE

In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile andpancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat. According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y  gastric bypass is the most frequently performed weight loss surgery in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

The Single Anastomosis Gastric Bypass ( popularly known as ‘mini’ gastric bypass or MGB ) uses a long stomach sleeve tube that is connected to small intestine at a length between 180 and 300 cm based on original weight, eating patterns, presence of diabetes, metabolic disorders etc. The Mini-Gastric Bypass, which uses the loop reconstruction, has been suggested as an alternative to the Roux en-Y procedure, due to the simplicity of its construction, which reduced the challenge of laparascopic surgery. It is claimed that construction of a long tubular gastric pouch reduces the risk of inflammatory complications, and renders it as safe as the RNY technique. Many bariatric surgeons shun the procedure, while those doing the procedure claim to have many satisfied patients.

The other procedure in this group is of Duodenal switch. With this procedure, the surgeon removes approximately 60 percent of the stomach so that it takes the shape of a tube. The small intestine is then divided much further downstream than with gastric bypass so that more intestine is bypassed and two intestinal pathways are created: one for food, and one for the digestive juices, both of which meet to form a common channel. Duodenal switch preserves the pylorus and the outlet muscle that controls emptying of the stomach. It also offers the ability to eat near normal portion sizes and produces reliable weight loss. Since this operation induces a state of decreased absorption, patients typically experience more bowel movements and need to be monitored for vitamin, mineral, and protein levels.

PURE MALABSORBTIVE PROCEDURES

The stomach is joined to the intestine at a point further down to cause malabsorbtion of the consumed food. Jejunoileal bypass (left picture) and bilio-pancreatic bypass (right picture) had serious nutritional complications and are not done commonly.

  • These operations often result in a high degree of patient satisfaction because patients are able to eat larger meals than with a purely restrictive or standard gastric bypass. procedure. These procedures can produce the greatest excess weight loss because they provide the highest levels of malabsorption.

When it is required

You could be a candidate for surgical weight loss if you meet any of the following criteria:

  • You are more than 100 lbs. over your ideal body weight.
  • You have a Body Mass Index (BMI) of over 40.
  • You have a BMI of over 35 and are experiencing severe negative health effects, such as high blood pressure or diabetes, related to being severely overweight.
  • You are unable to achieve a healthy body weight for a sustained period of time, even through medically-supervised dieting.

Is a senior bariatric surgeon at Apollo Hospital, New Delhi. He is the vice president of Obesity & Metabolic Surgery Society of India (OSSI).