Dr Pradeep Jain, Fortis Hospital explains about weight loss and what are the factors that contribute to weight gain.

1. Why, who, when and what of
weight loss surgery
Dr Pradeep jain, M.Ch
Director
Dept of GI Cancer and Bariatric Surgery
Fortis Hospital Shalimar Bagh
&
Namokar Gastro Clinic
IA 46 A Ashok Vihar Phase 1 Opp Mont Fort School

2. Obesity

Excess body fat leading to deleterious
effect on health

3. BMI ( Body Mass Index )

Weight (kg) / square of height ( meters
)

7. Problem of obesity in India

National health survey (2007)
15% of Indian population fat
Out of these 1/3rd are morbidly
obese

8. WHY ARE WE SO
OVERWEIGHT??
• Consumption of foods high in
calories
(excessive sugar and fat)
• Consumption of too much food
(large portions)
• Not enough exercise/sedentary
lifestyle
• Inheriting “fat genes” from our
parents/relatives

9. Obesity – a complex disease

10. Fat ? So what ?
Weight comes with a price
 High blood pressure
 Diabetes
 Heart attack
 Sleep Apnea
 Arthritis
 Infertility
 Cancers
 Depression
 Incontinence

11. Impact of BMI on Longevity
Impact of Obesity on Mortality and Years of Life Lost
Graph represents years of life lost for white men.
Fontaine KR, Redden DT, et al. Years of life lost due to obesity. JAMA 2003;289:187.
www.infinitysurgery.com

12. Why should treat obesity at all
To increase survival
 Improve quality of life
 Social acceptability
 Decrease medicine intake
 Decrease hospital expenses


13. AIMS

Sustained weight loss

Good quality of life

Resolution of obesity related diseases

Low risk treatment modality

14. What to do ?
Diet regulation
 Exercise
 Medicines
 Surgery


15. Disadvantages of medical
treatment
• Most patients (95-97%) regain most or
all of the weight that was lost within
2-5 years following diet or drug
treatment
• The average amount of weight loss is
relatively small – 5-10 kg
• Drug therapy may be associated with
severe complications.

16. Medical vs Surgical Therapy for
Obesity
Medical (lifestyle changes and pharmacotherapy) vs
Surgical Therapy for Obesity
Months
Weight
(lbs.)
Percent Excess Weight Loss
5
0
0
6
12
18
24
-5
-10
-15
-20
Surgical
Medical
-25
Source: O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive
medical program. Ann Intern Med. 2006;144:625-633.
www.infinitysurgery.com

17. Why Surgery ?
Only known method for sustained
weight loss
 Risks are far less than risk of
continuing with morbid obesity and
associated problems
 Lead to hormonal changes leading to
resolution of co morbidities
 Decrease satiety


18. Schneider BE, Mun EC .Surgical Management of Morbid Obesity. Diabetes care 2005;28(2): 475-80

19. Contraindication for bariatric
surgery
History of substance abuse, eating
disorder,
 or major psychiatric problem which is
 untreated and/or unresolved
 Patients who are too ill or too high a
risk for surgery
 Women who may become pregnant
soon


20. Types of surgery
Gastric banding
 Sleeve gastrectomy
 Gastric bypass
 Liposuction NO


21. Gastric Banding

22. Roux en y Gastric bypass

23. Sleeve gastrectomy

24. What is the postoperative diet
Liquid diet for 2-3 weeks
 Puree diet for 1-2 wks
 Soft diet for 1-2 wks
 Normal diet after that
 Avoid sweets, aerated drinks , drinking
water with meals
 Regular supplements


25. Concerns after surgery










Is it safe ?
What are the side effects or complications ?
Will I continue to loose weight and become
below normal ?
What will be my diet after surgery ?
Will I require medicines through out life?
Will there be any problem in getting pregnant
?
Will there be regain of weight after some
time?
How much time it will take to reduce weight ?
Will my tissues and skin get loose after
surgery ?
Is it reversible?

26. Bariatric Surgery Has a Low Incidence of Mortality
Mortality Rates (%)
3.50%
3.30%
3.00%
2.50%
2.00%
1.50%
0.93%
1.00%
0.52%
0.50%
0.13%
0.00%
1
Bariatric Surgery
2
Lap Chole
3
Hip Replacement
CABG
4
1Mortality
rate when performed at a Bariatric Surgery Center of Excellence; Bariatric Surgery: DeMaria EJ, Pate V, Warthen M et al. Baseline data from American
Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database, Surgery for
Obesity and Related Diseases. Article in Press.
2Dolan JP, Diggs BS, Sheppard BC et al. The National Mortality Burden and Significant Factors Associated with Open and Laparoscopic Cholecystectomy: 1997–
2006. J Gastrointest Surg. 2009; 13:2292-2301
3Lie SA, Engesaeter LB, Havelin LI et al. Early postoperative mortality after 67,548 total hip replacements. Acta Orthopaedica 2002; 73(4):392-399
4Ricciardi R; Virnig BA, Ogilvie Jr. JW. Volume-Outcome Relationship for Coronary Artery Bypass Grafting in an Era of Decreasing Volume. Arch Surg.
2008;143[4]:338-344
www.infinitysurgery.com

27. Medical Co-Morbidities Resolved
Bariatric Surgery
after
Type 2 Diabetes
95%
Cholesterol
97%
Hypertension
92%
GERD
98%
Cardiac Function
Improvement
95%
Stress Incontinence
87%
Osteoarthritis
82%
Sleep Apnea
75%
Wittgrove AC,Clark GW. Laparoscopic Gastric bypass roux-n-y-500 patients. Obes Surg 2000. And others.

28. Thank
you