Obesity is a problem which is often labelled as a disease of “Lifestyle.” It is defined as Body mass index (BMI) > 30Kg/M2 . Obesity is a risk factor for many diseases such as diabetes, Hyperlipedmia, Hypertension. It predisposes to many GI diseases like Fatty Liver, Gastroesophageal reflux disease. Obesity is associated with many cancers like Adenocarcinoma of esophagus, Ovarian and breast cancer and pancreatic cancer. Conditions like Sleep apnea and Osteoarthritis are directly related to excess weight.
Treatment of obesity is complex and is guided by BMI and associated conditions mentioned above. Dietary control and exercise form the mainstay of treatment. To achieve weight loss caloric restriction is of paramount importance. It should be 750 Calories below the recommended for the weight. Recommended exercise is 30 minutes per day 0r 150 minutes per week. It should be a combination of both isotonic and isometric exercise. People who are unable to lose weight even after dietary and exercise control or those with BMI > 32.5 and associated illness or BMI above 40 are the ones who can benefit from weight loss interventions. Bariatric surgery is one of the most definitive ways of weight loss. Many different types of surgeries are available but the most common is Sleeve Gastrectomy. There are many alternatives of surgeries which are now available which can be performed endoscopically. These procedures are cheaper and can be performed on day care basis. Two most common procedures are
1.Gastric Balloon Placement
2.Endoscopic Sleeve Gastroplasty (ESG)
In Gastric Balloon Placement a specially designed balloon is placed endoscopically in stomach. It is filled with 500-750 ml of water or Normal Saline. The Balloon is intended to be kept in place for about one year. It can lead to a weight loss of upto 10-15% of baseline weight. Side effects include feeling of nausea, vomiting mild pain, In < 1% there may be need of removal of balloon due to intolerance. The most important point is to maintain dietary and exercise regimen because there might be regain of weight after removal balloon.
ESG is a novel technique whereby the capacity of stomach can be reduced in the same way as in Sleeve Gastrectomy. It leads to a weight loss to the tune of 20-25 % and this is likely to be maintained over long term. ESG is now available at select centers including Sir Ganga Ram hospital, New Delhi. These procedures are to be undertaken only after due consultation with experts and understanding of consequences and alternatives. It should be for strict medical reasons rather than cosmetic purpose.
