Excel Hospital
  • What is Obesity?

    • Obesity is the condition of having excess amount of body fat that can be dangerous to health.

  • What is Morbid Obesity?

    • When serious medical problems starts
    • When excess weight is 50 kg or more

  • Causes

    • Excessive food energy intake
    • Lack of physical activity
    • Genetic susceptibility
    • Endocrine disorders
    • Medications
    • Psychiatric illness
    • Pregnancy
    • Lack of sleep
    • Medical problems - e.g. Prader-Willi syndrome, Cushing"s syndrome, arthritis - can lead to decreased activity

  • Different Ways to measure Obesity

    Body Mass Index (BMI)
    Waist Circumference
    Waist-to-Hip Ratio (WHR)
    Skinfold Thickness

    • Predicts development of disease and death in Obese people
    • The most basic method, and the most common, is the Body Mass Index (BMI)

  • BMI

    BMI is Body Mass Index – the formula helps to calculate the approximate required weight in proportion to height.

    Formula: Weight (kg) / Height2 (m2)

    BMI (kg/m2) Classification

    < 18.5           Underweight
    18.5 – 22.9   Normal weight
    23.0 – 24.9   Overweight
    25.0 – 29.9   Class I Obesity
    30.0 – 34.9   Class II Obesity
    ≥ 35              Class III Obesity

  • Waist Circumference

    • It’s the circumference of the abdomen
    • Can be measured at
          - the natural waist (in between the lowest rib and the top of the hip bone)
          - the umbilicus (belly button)
          - the narrowest point of the midsection

    Strengths
    • Measures “abdominal obesity”—the extra fat found around the middle that is an important factor in health, even independent of BMI

    Limitations
    • Measurement procedure has not been standardized
    • Lack of good comparison standards (reference data) for waist circumference in children
    • May be difficult to measure and less accurate in individuals with a BMI of 35 or higher

  • Waist-to-Hip Ratio

    • It measures abdominal obesity - the widest diameter of the buttocks and then dividing the waist measurement by the hip measurement

    Strengths
    • Good correlation with body fat

    Limitations
    • More prone to measurement error because it requires two measurements
    • More difficult to measure hip than it is to measure waist
    • More complex to interpret than waist circumference, since increased waist-to-hip ratio can be caused by increased abdominal fat or decrease in lean muscle mass around the hips
    • Turning the measurements into a ratio leads to a loss of information: Two people with very different BMIs could have the same WHR
    • May be difficult to measure and less accurate in individuals with a BMI of 35 or higher

  • Skinfold Thickness

    • A special caliper to measure the thickness of a “pinch” of skin and the fat beneath it in specific areas of the body - the trunk, the thighs, front and back of the upper arm, and under the shoulder blade
    • Equations are used to predict body fat percentage based on these measurements

    Strengths
    • Portable
    • Fast and easy (except in individuals with a BMI of 35 or higher)

    Limitations
    • Not as accurate or reproducible as other methods
    • Very hard to measure in individuals with a BMI of 35 or higher

  • Co-morbidities – Obesity impacts patient’s health and quality of life

    Heart - High Blood Pressure, Heart Attacks, Stroke, Congestive Heart Failure
    Lungs – Obstructive Sleep Apnoea, Obesity Hypoventilation Syndrome, Asthma/ Reactive Airway Disease
    Abdomen – Gallbladder Disease, GERD (recurrent heartburn), Recurrent Ventral Hernias, Fatty Liver Disease
    Urinary – Frequent Urinary Tract Infection (UTI’s), Stress, Urinary Incontinence, Menstrual Irregularity or Infertility
    Bones – Degeneration of Knees on Hips, Disc Herniation, Chronic non-surgical low back pain
    Skin – Multiple disorders, most relate to Diabetes and Yeast Infections between skin folds
    Cancer – Breast, Uterine, Prostate, Renal, Colon and Pancreatic
    Blood – Hyperlipidemia, Atheresclerosis, Hypercholestremia
    Endocrinal – Diabetes Mellitus, Hirsutism

  • Management of Obesity

    • Lifestyle changes
    • Diet
    • Physical activity
    • Daily habits
    • Pharmacotherapy (occasional)
    • Bariatric Surgery

  • How the Bariatric Surgery is the solution?

    • Bariatric Surgery is the most viable option to be considered in Morbid Obesity when nothing works (diet, physical activity etc.).

  • Eligibility Criteria of Bariatric Surgery

    IFSO-APC consensus statements 2011 for Bariatric / GI Metabolic Surgery:
    • BMI ≥ 35 kg/m2
    • BMI ≥ 30 kg/m2 and T2DM or Metabolic Syndrome (for patients who are inadequately controlled by lifestyle alterations or medical treatment)
    • BMI ≥ 27.5 kg/m2 and T2DM or Metabolic Syndrome (as a non primary alternative for patients who are inadequately controlled)

    Asian Pacific Metabolic and Bariatric Surgery Society (APMBSS)(Consensus in Asia-Pacific 2005)
    • BMI ≥ 37 kg/m2
    • BMI ≥ 32 kg/m2 and the presence of Diabetes or 2 significant obesity-related co-morbidities
    • Failed attempts at weight loss by dietary or medical measures
    • Age 18 to 65

  • Types of Bariatric Surgery

    • Gastric Bypass
    • Sleeve
    • Mini Gastric Bypass

  • Benefits

    • It has been observed that patients who are more committed towards eating healthy diet, taking the required additional food supplement, physical activities will have the Best Long Term Result
    • Significant sustained weight loss
    • High Cholesterol
    • High Blood Pressure
    • Obstructive Sleep apnoea
    • Hypertension
    • Type 2 Diabetes
    • Cardiovascular Diseases
    • Endocrinologic Diseases
    • Dyslipidemia

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