Weight loss explained by Dr Pradeep Jain

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

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Weight loss explained by Dr Pradeep Jain

  1. 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. 2. Obesity  Excess body fat leading to deleterious effect on health
  3. 3. BMI ( Body Mass Index )  Weight (kg) / square of height ( meters )
  4. 4. Problem of obesity in India  National health survey (2007) 15% of Indian population fat Out of these 1/3rd are morbidly obese
  5. 5. 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
  6. 6. Obesity – a complex disease
  7. 7. Fat ? So what ? Weight comes with a price  High blood pressure  Diabetes  Heart attack  Sleep Apnea  Arthritis  Infertility  Cancers  Depression  Incontinence
  8. 8. 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
  9. 9. Why should treat obesity at all To increase survival  Improve quality of life  Social acceptability  Decrease medicine intake  Decrease hospital expenses 
  10. 10. AIMS  Sustained weight loss  Good quality of life  Resolution of obesity related diseases  Low risk treatment modality
  11. 11. What to do ? Diet regulation  Exercise  Medicines  Surgery 
  12. 12. 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.
  13. 13. 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
  14. 14. 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 
  15. 15. Schneider BE, Mun EC .Surgical Management of Morbid Obesity. Diabetes care 2005;28(2): 475-80
  16. 16. 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 
  17. 17. Types of surgery Gastric banding  Sleeve gastrectomy  Gastric bypass  Liposuction NO 
  18. 18. Gastric Banding
  19. 19. Roux en y Gastric bypass
  20. 20. Sleeve gastrectomy
  21. 21. 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 
  22. 22. 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?
  23. 23. 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
  24. 24. 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.
  25. 25. Thank you

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