Weight Loss Surgery : Current Concepts And Future Directions

According to your view and also some of them thinking that obesity is not a leading problem in india. , Do you know this, According to studies, in 1997, it stated that the incidence of obesity in India is 7-9 % , though the number of obesity is less as compared to America and the other countries, but it is also a significant due to the sheer size of the population in India. With this, India would be one of the first nations from the developing countries in Asia to be put on the obesity map.

A pan-India survey by the country’s premier research hospital — the All-India Institute of Medical Sciences (AIIMS) — reinforces that nearly half of India’s 250 million adolescents are overweight and therefore susceptible to type 2 diabetes. Alarmed by reports that India will become the global diabetes capital by 2050, the Health Ministry has reduced the diagnostic cut-offs for body mass index (BMI) to 23 kg/m2 ---- unlike the cut-off limit of 25 kg/m2 earlier and the standard waist circumference to fight the battle against obesity.

I will give u a suitable and simple example, how obesity in india become a leading problem.
A recent survey in Delhi schools was conducted to assess the prevalence of overweight and obesity amongst children in the age group of 5-18 years belonging to low, middle and high income group in National Capital Territory NCT of Delhi. A total of 16,595 children were covered in the present study. It reported the prevalence of obesity as 7.4%. While another study done in school children in Punjab reported prevalence of overweight and obesity to be 11.1% and 14.2% respectively. A study conducted in Pune documented the prevalence of OB 5.7% and OW 19.9%.

Thank you
Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Thank you, ur words are really encouraging and ur wonderful comments are really appreciable.

Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Healing time and long-term success after bariatric surgery depend largely on patient diet and exercise habits after surgery, even it works about life long period If patient follows proper guidelines.

The changes made to gastrointestinal tract will require permanent changes in eating habits that must be followed for successful weight loss in new life after bariatric surgery. Patient’s who undergo any type of bariatric surgery are at increased risk of nutritional deficiencies as a result of drastic changes in food intake, altered digestive anatomy, and possible persistent vomiting. Common deficiencies include those of fat soluble vitamins, folic acid, and thiamine. Patients that undergo gastric bypass surgery are at a much higher risk of these deficiencies when compared to those that undergo gastric banding due to the varying operative procedures. Patients who undergo gastric bypass also suffer more deficiencies of iron, Vitamin B12, and fat soluble vitamins. Though recommendations are somewhat limited, in general, vitamin supplementation in patients undergoing bariatric surgery (more specifically gastric bypass), should include a daily multivitamin (vitamins C, vitamin K, vitamin A, 800 IU vitamin D , E, B vitamins) in either pill or liquid form, monthly injections of vitamin B12 or sublingual B12 1000-2000 mcg daily, daily calcium supplements, iron (if at risk or a deficiency is present), and daily thiamine (if suffering from persistent vomiting). Thease are common long term problems with surgery.

Where as about weight loss, most patients lose weight quickly and continue to lose for 18 to 24 months after the bariatric procedure. With the Roux-en-Y gastric bypass, many patients maintain a weight loss of 60 to 70 percent of their excess weight for 10 years or more.

For weight loss surgery, india is the right place and the target center for somany developed countries. Medical treatment centers for bariatric surgery in India are at Mumbai, Chennai, Hyderabad, Bangalore and Delhi. Low cost bariatric surgery in India is an advanced surgical option to get. The cost of bariatric surgery in India is very less as compared to the cost of same surgery in abroad.

I am herewith attaching the some major hospital link regarding surgery.
www.indiaprofile.com/medical-tourism/surgeries/bariatric-surgeons.html
www.medaccessindia.com/obesity_surgery.htm
http://www.apollohospdelhi.com/our-cliniqs/golf-links.html etc,

Thank you
Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Hi udayasree,

thank you for your nice comment.What information you have got regarding the obsesity causing cancer is the right concept only,I think so the information being provided by me will defintly make you more clear regarding your question,

Obesity is a major preventable cause of cancer
Major studies confirm that being overweight or obese increases your risk of various cancers.1 2 3 4 The World Health Organisation (WHO) says that overweight and obesity are the most important known avoidable causes of cancer after tobacco.5

In the UK, about 13,000 people every year could avoid getting cancer if they maintained a healthy body weight.6 This number is only going to increase in the future since more cancers are being linked to obesity, and the number of people who are overweight is increasing.

Obesity increases the risk of breast cancer in women after menopause
Scientists have estimated that anywhere between 7% and 15% of breast cancer cases in developed countries are caused by obesity.7 8 9 Over a hundred studies show that women who are overweight or obese and have been through the menopause have higher breast cancer risks.3 10

Two large studies funded by Cancer Research UK – the EPIC study and the Million Women Study – have found that obese women have a 30% higher risk of postmenopausal breast cancer than women with a healthy weight.4 10 This means that if the average lifetime risk of breast cancer is one in nine, an obese woman’s lifetime risk is one in seven.

Obesity does not increase the risk of breast cancer in women before their menopause.11 12 However, women who are overweight or obese at this point in their lives often find it hard to lose weight after their menopause.

Putting on weight over time can also increase the risk of breast cancer. Studies have found that after the age of 18:

putting on 25kg increases the risk of breast cancer by 45% 8
putting on 50kg doubles the risk of breast cancer 13
Back to top

Obesity increases the risk of bowel cancer
Obesity is one of the most important causes of bowel cancer.2 5 Some groups have estimated that obesity causes about 11-14% of bowel cancer cases.7 9

Many large studies have found that bowel cancer is more common in overweight or obese people.3 14 15 16 Two of the largest studies so far, including the EPIC study, have found that obese men have about 50% higher risks of bowel cancer than those with a healthy weight.15 16

When BMI is used to measure body fat, studies tend to find that only obese men have a higher risk of bowel cancer. But when researchers use waist circumferences or waist-to-hip ratios, both obese men and women have higher risks of bowel cancer.16 This suggests that for women at least, fat around the stomach is more of a problem than fat elsewhere on the body.17

Obesity increases the risk of womb cancer
A large body weight is one of the most important causes of womb cancer. A study of one million women estimated that up to half of all cases of womb cancer in the UK are caused by being overweight or obese.4

Studies have consistently found that obese people are three to four times more likely to develop womb cancer than people with a healthy bodyweight.4 18 19

Obesity increases the risk of oesophageal cancer
Being overweight or obese increases the risk a type of oesophageal cancer (cancer of the foodpipe) called “oesophageal adenocarcinoma”.

Being overweight doubles the risk of developing this cancer,20 and being obese can triple the risk.1 21 Experts have estimated that in Western countries, it causes about 37% of this type of cancer.9 In fact, the rates of oesophageal adenocarcinoma in white UK men are among the highest in the world and rising. Some studies have suggested that this type of cancer may be becoming more common because of rising levels of obesity.20 21

Obesity increases risk of many other types of cancer
Studies have consistently found that people who are overweight or obese are also more likely to develop pancreatic,22 23 kidney,24 and gallbladder cancers.25 Studies have estimated that having a high body weight accounts for a quarter of kidney and gallbladder cancers.6

And there is more and more evidence that being overweight or obese could increase the risk of many other types of cancer, including:

brain cancer 26
leukaemia 4 27
liver cancer 28
multiple myeloma 4 29
non-Hodgkin lymphoma 4 30
ovarian cancer, before the menopause 31
aggressive prostate cancer 32
thyroid cancer 33

Too much belly fat could increase the risk of cancer
The way that fat is distributed around the body can also affect the risk of cancer. Apple-shaped people who put on weight around their stomach may have higher risks than pear-shaped people who put on weight around their hips.

Scientists measure belly fat using either waist circumference (the length of tape that goes around your waist) or waist-to-hip ratio (how wide your waist is compared to your hips). Studies have found that people with larger waists or waist-to-hip ratios have higher risks of breast cancer,34 bowel cancer,17 kidney cancer,35 and pancreatic cancer.22

Obesity may increase cancer risk by changing hormone levels
Obesity most likely increases the risk of cancer by raising levels of hormones such as oestrogen and insulin.

In early life, oestrogen is mainly produced by a woman’s ovaries, but this stops after menopause. Instead, fat in the body becomes the main source of oestrogen and obese women have up to twice as much oestrogen as women with a healthy weight.36 They also have lower levels of SHBG, or ‘sex hormone binding globulin’, which mops up oestrogen in the body 37. This is almost certainly why obesity increases the risk of breast and womb cancers.37 38 39

Obesity also increases levels of insulin in the body. It’s not clear how this could lead to cancer, although high insulin levels are a common feature of many cancers. High insulin levels could explain why being obese increases the risk of bowel, kidney and pancreatic cancer.40 41 42

Obesity could also cause cancer through other means, including:

increasing the risk of oesophageal cancer by causing ‘gastric acid reflux’, a condition where the stomach’s acids are briefly pushed back into the throat.43 This damages the lining of the oesophagus.
increasing the risk of gallstones, which in turn increase the risk of gallbladder cancer.25
being associated with physical inactivity or unhealthy diets.

thank you if you have further doubts please post a comment.

Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

The bariatric surgery prefers when people suffer with morbid obesity and with unsolved complications, like diabetes, heart problems, sleep apnea, etc.,
this surgery also help to patient by health problems associated with severe obesity, such as hypertension (high blood pressure), sleep apnea, type 2 diabetes, and osteoarthritis.

The most frequent “major” complications for bypass patients were GI leak, GI hemorrhage or bleeding, and small bowel obstruction. Simple restrictive procedures with no bypass were reported to have GI leak and stoma obstruction or stenosis as the most frequent defined major complications.

Yes, it is econamical compared to many major surgeries, But the reason behind the not preference the surgery due to lack of awareness about obesity complications and about this surgery and we always prefer surgeries when life at risk death.

Thank you
Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

good and simple question,

Yes I agree with u, loss of body weight may lead to imbalance, where as after weight loss surgery, patient loss 60 to 70% excess body weight, not regular weight.

Yjhank you
Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Thank u for ur comments,

There are no guarantees for any method, including surgery, to produce rapid weight loss and maintain it. Success with weight loss surgery is possible only with maximum cooperation and commitment to behavioral change and medical follow-up and this cooperation and commitment must be carried out for the rest of your life. Most patients lose weight quickly and continue to lose for 18 to 24 months after the bariatric procedure. With the Roux-en-Y gastric bypass, many patients maintain a weight loss of 60 to 70 percent of their excess weight for 10 years or more.

Healing time and long-term success after bariatric surgery depend largely on patient diet and exercise habits after surgery, even it works about life long period If patient follows proper guidelines.

limitations for surgery, or after surgery, please let me know.

Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Bariatric surgery is the option when non-surgical measures have failed to achieve or maintain clinically beneficial weight loss for at few years. Bariatric surgery prefers mostly in patients have Body Mass Index (BMI) of 40 or greater (about 100 pounds over ideal body weight) or BMI of 35 to 39.9 with a significant obesity-related condition such as diabetes, high blood pressure, heart problems, sleep apnea, or reflux disease.

Healing time and long-term success after bariatric surgery depend largely on patient diet and exercise habits after surgery, even it works about life long period If patient follows proper guidelines.

Thank u for appreciation regarding my PPT.

Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Thanq 4 ur reply! The info was quite useful!

Thank you for ur great appeciation regarding my PPT.

For your first question:
The changes made to gastrointestinal tract will require permanent changes in eating habits that must be followed for successful weight loss in new life after bariatric surgery. Patient’s who undergo any type of bariatric surgery are at increased risk of nutritional deficiencies as a result of drastic changes in food intake, altered digestive anatomy, and possible persistent vomiting. Common deficiencies include those of fat soluble vitamins, folic acid, and thiamine. Patients that undergo gastric bypass surgery are at a much higher risk of these deficiencies when compared to those that undergo gastric banding due to the varying operative procedures. Patients who undergo gastric bypass also suffer more deficiencies of iron, Vitamin B12, and fat soluble vitamins. Though recommendations are somewhat limited, in general, vitamin supplementation in patients undergoing bariatric surgery (more specifically gastric bypass), should include a daily multivitamin (vitamins C, vitamin K, vitamin A, 800 IU vitamin D , E, B vitamins) in either pill or liquid form, monthly injections of vitamin B12 or sublingual B12 1000-2000 mcg daily, daily calcium supplements, iron (if at risk or a deficiency is present), and daily thiamine (if suffering from persistent vomiting).

Hi Jasmine,
The bariatric surgery prefers in patients have Morbid obesity means Body Mass Index (BMI) of 40 or greater or BMI of 35 to 39.9 with a significant obesity-related condition such as diabetes, high blood pressure, heart problems, sleep apnea, or reflux disease and the non-surgical measures have failed to achieve or maintain clinically beneficial weight loss. Congenital obesity sometimes is well restricted by medications, exercise and with strict diet control, if it become morbid then surgery is always the better option.

Thank you
Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Hi gopidalai,

Thank you for your nice comments. The answers to your quries are as follows:

Regarding BMI as i already mentioned it is the BODY MASS INDEX:

Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in metres (kg/m2).
BMI values are age-independent and the same for both sexes. However, BMI may not correspond to the same degree of fatness in different populations due, in part, to different body proportions. The health risks associated with increasing BMI are continuous and the interpretation of BMI gradings in relation to risk may differ for different populations.

In recent years, there was a growing debate on whether there are possible needs for developing different BMI cut-off points for different ethnic groups due to the increasing evidence that the associations between BMI, percentage of body fat, and body fat distribution differ across populations and therefore, the health risks increase below the cut-off point of 25 kg/m2 that defines overweight in the current WHO classification.

Underweight <18.50; Severe thinness<16.00; Moderate thinness:16.00 - 16.99; Mild thinness:17.00 - 18.49;
Normal range:18.50 - 24.99; Overweight ≥25.00; Pre-obese: 25.00 - 29.99; Obese≥30.00; Obese class I: 30.00 - 34-99;
Obese class II:35.00 - 39.99; Obese class III ≥40.00

Regarding the side effects of laproscopic surgery
The main factor making this surgery such popular and used in almost all types of surgeries is that having less side effects and easy recovery . And for your question as we know where ther is some advantage there adds the disadvantage but we just try to decrese the disadvantage to the utmost. The various side effects
include

The most significant risks are from trocar injuries to either blood vessels or small or large bowel. The risk of such injuries is increased in patients who are obese or have a history of prior abdominal surgery. The initial trocar is typically inserted blindly. While these injuries are rare, significant complications can occur. Vascular injuries can result in hemorrhage that may be life threatening. Injuries to the bowel can cause a delayed peritonitis. It is very important that these injuries be recognized as early as possible.[1]

Some patients have sustained electrical burns unseen by surgeons who are working with electrodes that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis.
There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of heated and humidified CO2 may reduce this risk.[2]

Many patients with existing pulmonary disorders may not tolerate pneumoperitoneum (gas in the abdominal cavity), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach.

Not all of the CO2 introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO2 rises in the abdomen, it pushes against the diaphragm (the muscle that separates the abdominal from the thoracic cavities and facilitates breathing), and can exert pressure on the phrenic nerve. This produces a sensation of pain that may extend to the patient's shoulders. For an appendectomy, the right shoulder can be particularly painful. In some cases this can also cause considerable pain when breathing. In all cases, however, the pain is transient, as the body tissues will absorb the CO2 and eliminate it through respiration. [3]

Coagulation disorders and dense adhesions (scar tissue) from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contra-indications for this approach.

Patients can often have trouble walking after surgery for a few days .

Inspite of these side effects most of the people are preferring this surgery , this ahows that this technology has less side effects than the previous ones like open surgeries.

hope so this information is useful to you,
thank you

Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

I am adding some more information regarding Patient selection criteria:

Bariatric surgery prefers in Patients
1)Have morbid obesity means Body Mass Index (BMI) of 40 or greater or BMI of 35 to 39.9 with a significant obesity-related condition such as diabetes, high blood pressure, heart problems, sleep apnea, or reflux disease.

2)Must have made prior attempts at weight loss such as diets, exercise, behavior modification or medications, if non-surgical measures have failed to achieve or maintain clinically beneficial weight loss

3)Need to understand the possible risks, benefits, and side effects of the procedure.
4)Should not have any medical or psychiatric condition in which surgery would be contraindicated.
5)Show commitment and motivation with realistic expectations after surgery.
6)Must be free of any other addictive behaviors such as smoking, drinking, and/or drug abuse.
7)Must undergo both psychological and nutritional evaluation prior to approval.

Thank you
Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

hi sirisha,

Here is the answer to your question,

Yes the selection of the patient is the first and foremost criteria for the surgery . As we know for any type of surgery there is a thorough check up of the patient's condition that whether the patient can with stand the surgery process , this may be of various factors like age, body resistence , HB levels and various others which depend on the type of surgery that is being done to the patient. So coming to our bariatric surgery as it is related to the obesity the various factors that are needed to take into consideration are as follows:

- Age 18-55
BMI > 40
BMI 35-40 if co morbid condition improvable with weight loss
5 years of obesity
Failed conservative therapy
Fit for surgery as deemed by multidisciplinary team
Emotionally stable / lifelong follow up

In this way we select the patient as provided in the presentation also and if you have any more doubts regarding this, like you need some more information please post a comment, i will provide with pleasure.
thank you

Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Thank u for ur reply M.s Shilpa.
All the best

Regards,

""PHARMA TROJANS""
http://www.pharmainfo.net/gangadhar-hari

There are many guidelines from NIH and bariatric foundation regarding diet after bariatric surgery. Infact, Healing time and long-term success after bariatric surgery depend largely on diet and exercise habits.Because, the changes made to gastrointestinal tract will require permanent changes in eating habits that must be followed for successful weight loss in new life after bariatric surgery. Patient’s who undergo any type of bariatric surgery are at increased risk of nutritional deficiencies as a result of drastic changes in food intake, altered digestive anatomy, and possible persistent vomiting. Common deficiencies include those of fat soluble vitamins, folic acid, and thiamine. Patients that undergo gastric bypass surgery are at a much higher risk of these deficiencies when compared to those that undergo gastric banding due to the varying operative procedures. Patients who undergo gastric bypass also suffer more deficiencies of iron, Vitamin B12, and fat soluble vitamins. Though recommendations are somewhat limited, in general, vitamin supplementation in patients undergoing bariatric surgery (more specifically gastric bypass), should include a daily multivitamin (vitamins C, vitamin K, vitamin A, 800 IU vitamin D , E, B vitamins) in either pill or liquid form, monthly injections of vitamin B12 or sublingual B12 1000-2000 mcg daily, daily calcium supplements, iron (if at risk or a deficiency is present), and daily thiamine (if suffering from persistent vomiting).

Thank you for your nice comment about my PPT.
Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Thank u for ur appeciation,

I am little bit confused about your question, there is no tissue removal process usually in bariatric surgeries, which is different from Liposuction, removes pockets of fat from troublesome areas such as the thighs, hips, abdomen, and upper arms. It does not guarantee that you won’t regain some fat.

Where as Weight-loss surgery can be divided into the following categories: restrictive, malabsorptive, and mixed or combination. Restrictive procedures reduce the size of the stomach, limiting the amount of food that can be consumed at once. The goal of malabsorptive surgical procedures is to decrease the effective length of small intestine through which food must pass, thereby reducing the absorption of nutrients and calories and inducing weight loss. Mixed or combination procedures have both a restrictive and malabsorptive component, meaning that they limit food intake while also decreasing absorption of nutrients within the body.

About regain weight,
Most patients lose weight quickly and continue to lose for 18 to 24 months after the bariatric procedure. With the Roux-en-Y gastric bypass, many patients maintain a weight loss of 60 to 70 percent of their excess weight for 10 years or more. After long time, there are several studies reported the the minimal regain also. Healing time and long-term success after bariatric surgery depend largely on your diet and exercise habits.

Thank you
Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

hi juhi mam

The answer to your question is here,

The method of liposuction is entirely different from the weight loss.The Liposuction, also known as lipoplasty ("fat modeling"), liposculpture suction lipectomy or simply lipo ("suction-assisted fat removal") is a cosmetic surgery operation that removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs, buttocks, to the neck, backs of the arms and elsewhere.

Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring with significant attendant risks[1] and is not a weight loss method. The main adverse sie effects are as follows:

Bruising: can be painful in the short term, and should fade after a few weeks.
Swelling: should subside gradually over a month or two.
Scars: will vary in size depending on the particular procedure, and should fade over the weeks. Scarring is an individual thing, partly dependent on heredity. For some, scar healing may take as long as a year.
Pain: should be temporary and controlled by either over-the-counter medication, or by a prescription.
Numbness: sometimes persists for a few weeks.
Limited mobility: will depend on the exact procedure.
There could be various factors limiting movement for a short while, such as:
Wearing a compression garment
Keeping the head elevated
Temporary swelling or pain

The more serious possible complications include:

Allergic reaction to medications or material used during surgery.
Infection: any time the body is incised or punctured, bacteria can get in and cause an infection. During liposuction, multiple small puncture wounds are made for inserting the cannula, that can vary in size depending on the technique.
Damage to the skin: most surgeons work on the deeper levels of fat, so as to avoid wounding the skin any more than they must for the insertion of the cannula.
Sometimes the cannula can damage tissue beneath the skin, which may show up as a spotted appearance on the skin surface.
Skin necrosis (dead skin) is a rare complication, in which the skin falls off in the necrotic area. The problem can vary in degree. The resulting wound then needs to heal typically requiring extended wound care.
Puncture of an internal organ: since the surgeon can't see the cannula, sometimes it damages an internal organ, such as the intestines during abdominal liposuction. Such damage can be corrected surgically, although in rare cases it can be fatal. An experienced cosmetic surgeon is unlikely to puncture any internal organ.
Contour irregularities: sometimes the skin may look bumpy and/or withered, because of uneven fat removal, or poor skin elasticity. Not all patients heal in the same way, and with older patients the healing may be slower and a bit imperfect. Sometimes a small touch-up procedure can help.
Thromboembolism and fat embolisation: although liposuction is a low-risk procedure for thromboembolism including pulmonary embolism, the risk can't be ignored.[9]
Burns: sometimes the cannula movement can cause friction burns to skin or nerves. Also, in UAL, the heat from the ultrasound device can cause injury to the skin or deeper tissue.
Lidocaine toxicity: when the super-wet or tumescent methods are used, too much saline fluid may be injected, or the fluid may contain too high a concentration of lidocaine. Then the lidocaine may become too much for that particular person’s system. Lidocaine poisoning at first causes tingling and numbness and eventually seizures, followed by unconsciousness and respiratory or cardiac arrest.
Fluid imbalance: since fat contains a lot of fluid and is removed in liposuction, and since the surgeon injects fluid for the procedure, even a very large amount of it for tumescent liposuction, there is a danger of the body’s fluid balance being disturbed. This could happen afterwards, after the patient is at home. If too much fluid remains in the body, the heart, lungs and kidneys could be badly affect.

At the same time the recovery time also from several days to the several weeks with a lot of uneasiness in movement and drastic changes in the shape of part undergone to surgery .

So this is what is the liposuction ,last but not the least the fat once removed from the body has no guarantee that it would not return relating to various factors that lead to obesity. There fore it is better to under go a permanent weight loss process either surgeryor other form rather than the liposuction.

hope so your doubt has been cleared.thank you

Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

India didn't have the 40 years of record either in surgical procedure or even in obesity, According to studies, in 1997, it stated that the incidence of obesity in India is 7-9 % , though the number of obesity is less as compared to America and the other countries, but it is also a significant due to the sheer size of the population in India. With this, India would be one of the first nations from the developing countries in Asia to be put on the obesity map.

A pan-India survey by the country’s premier research hospital — the All-India Institute of Medical Sciences (AIIMS) — reinforces that nearly half of India’s 250 million adolescents are overweight and therefore susceptible to type 2 diabetes.Alarmed by reports that India will become the global diabetes capital by 2050, the Health Ministry has reduced the diagnostic cut-offs for body mass index (BMI) to 23 kg/m2 ---- unlike the cut-off limit of 25 kg/m2 earlier and the standard waist circumference to fight the battle against obesity.

Regarding surgical procedures in India,

Medical treatment centers for bariatric surgery in India are at Mumbai, Chennai, Hyderabad, Bangalore and Delhi. Weight loss surgery in India is undertaken by obesity patients from USA, Canada, UK and other global destinations as the natives of these countries are often uninsured or face difficulties in meeting the high medical treatment expenditures concerning weight loss and obesity surgeons in India provide fine treatment quality with adequate medical cost reduction. Low cost bariatric surgery in India is an advanced surgical option to get. The cost of bariatric surgery in India is very less as compared to the cost of same surgery in abroad.
The major reasons behind the Indian obese people not prefer to treat obesity due to
(1) Overweight/obesity is not considered as a specific disease in India.
(2) Lack of awareness in people about obesity and its co-morbidity implications and their inability to control it on their own.

Regarding the selection criteria,

Bariatric surgery prefers in patients
1) who have morbid obesity means Body Mass Index (BMI) of 40 or greater or BMI of 35 to 39.9 with a significant obesity-related condition such as diabetes, high blood pressure, heart problems, sleep apnea, or reflux disease.
2) Must have made prior attempts at weight loss such as diets, exercise, behavior modification or medications, if non-sugical procedures fails to control or weight loss
3) Need to understand the possible risks, benefits, and side effects of the procedure.
4) Should not have any medical or psychiatric condition in which surgery would be contraindicated.
5) Show commitment and motivation with realistic expectations after surgery.
6) Must be free of any other addictive behaviors such as smoking, drinking, and/or drug abuse.
7)Must undergo both psychological and nutritional evaluation prior to approval.

Thank u for ur comments

Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Thank u very much for ur wonderful comments.

In 1997, it stated that the incidence of obesity in India is 7-9 % , though the number of obesity is less as compared to America and the other countries, but it is also a significant due to the sheer size of the population in India. With this, India would be one of the first nations from the developing countries in Asia to be put on the obesity map.

A pan-India survey by the country’s premier research hospital — the All-India Institute of Medical Sciences (AIIMS) — reinforces that nearly half of India’s 250 million adolescents are overweight and therefore susceptible to type 2 diabetes.

Alarmed by reports that India will become the global diabetes capital by 2050, the Health Ministry has reduced the diagnostic cut-offs for body mass index (BMI) to 23 kg/m2 ---- unlike the cut-off limit of 25 kg/m2 earlier and the standard waist circumference to fight the battle against obesity.

Recently, the standards have been set for the first time in the Ministry's consensus guidelines for Prevention and Management of Obesity and Metabolic Syndrome for the country. The guidelines were released jointly by the Health Ministry, the Diabetes Foundation of India, the All-India Institute of Medical Science (Aiims), Indian Council of Medical Research, the National Institute of Nutrition and 20 other health organisations.

Studies say that India will become the global diabetes capital by 2050 if the abdominal and lower limb obesity and metabolic syndrome are not arrested.

Regarding the Prevelance, I will give u the best example about recent survey in Delhi schools. A recent study was conducted to assess the prevalence of overweight and obesity amongst children in the age group of 5-18 years belonging to low, middle and high income group in National Capital Territory NCT of Delhi. A total of 16,595 children were covered in the present study. It reported the prevalence of obesity as 7.4%. While another study done in school children in Punjab reported prevalence of overweight and obesity to be 11.1% and 14.2% respectively. A study conducted in Pune documented the prevalence of OB 5.7% and OW 19.9%.

So this is the time to increase the awareness about obesity in people, because TB can treated within six months completely, where as if obesity occurs, it leads to so many life threaten and unprevented diseases like, diabetes, heart diseases.

Regarding bariatric surgeries,
India is the Destination for Obesity Cure for so many countries and Obesity surgeries in India have seen a phenomenal Growth during recent past. Most patients from countries like USA and UK travel to developing countries such as India for treatment, few main reasons while choosing India at first choice are because India offers wide range of cheapest pricing options of treatment.

Due to lack of awareness about obesity and its comorbidities, indian obese people not paying much attention, but the day will come definitly.

Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India

Thank u for u r appreciation.

Regarding Efficacy:
Most patients lose weight quickly and continue to lose for 18 to 24 months after the bariatric procedure. With the Roux-en-Y gastric bypass, many patients maintain a weight loss of 60 to 70 percent of their excess weight for 10 years or more. With BPD/DS, most studies report an average weight loss of 75 to 80 percent of excess weight. Because combined operations result in greater weight loss than restrictive operations, they may also be more effective in improving the health problems associated with severe obesity, such as hypertension (high blood pressure), sleep apnea, type 2 diabetes, and osteoarthritis.

There are no guarantees for any method, including surgery, to produce rapid weight loss and maintain it. Success with weight loss surgery is possible only with maximum cooperation and commitment to behavioral change and medical follow-up and this cooperation and commitment must be carried out for the rest of your life.

Regarding safety:
The total number of bariatric surgeries raised nine fold from 13,386 operations in 1998 to 1,41,055 procedures in 2004 and in 2007 it is 2,05,000 in only United States. As Asian levels of obesity are catching up with the West, more and more people in the region choose to undergo weight-loss surgery. Anti-obesity surgery also is a growing trend in other Asian countries - mainly in Taiwan, Malaysia, Japan, Hong Kong and South Korea.

According to the recent survey indicated that “No complication” within 30-days of the primary operation was reported for 86.42% for patients with bypass procedures, 89.36 % for restrictive procedures with no bypass. The most frequent “major” complications for bypass patients were GI leak (0.73%), GI hemorrhage or bleeding (0.44%), and small bowel obstruction (0.40%). Simple restrictive procedures with no bypass were reported to have GI leak (0.47%) and stoma obstruction or stenosis (0.35%) as the most frequent defined major complications.

Once again thank u for ur comments

Shilpa.sambana
St ann's college of pharmacy
Vizianagaram
Andhra pradesh, India