The perils of obesity
How putting on weight puts your health at risk
The rise of obesity has been meteoric. The rate of obesity in both developed and especially developing countries, in the last 30 years, have eclipsed any other epidemic in the world. The effects are far reaching, encompassing not only the well-known multiple negative medical aspects but it also has extensive social and economic drawbacks.
There are many diseases associated with obesity. They include:
- Metabolic diseases such as diabetes mellitus ( and all the complications associated with these diseases)
- Cancers such as breast cancer and colorectal cancer
- Chronic joint diseases such as chronic back pain
- Osteoarthritis of the spine, hip, knees and ankles
- Other illness such as skin infections, pancreatitis and much more
1 – TYPE 2 Diabetes Mellitus
Research have shown that people with BMI 30 are more than ten times as prone to suffer from diabetes. It is believed that increased body fat decreases the bodys sensitivity to insulin, a hormone produced in response to high sugar levels after a meal. Left uncorrected , the body is unable to utilise the sugar in the blood appropriately and this eventually results in the development of diabetes. Diabetes brings about its own list of health harms to the other organs, including the kidneys, eyes and nerves. In a review of studies on weight loss surgery for morbid obesity where 80% of 135000 patients were women,78% were reported to be in remission for diabetes and 86% showed improvement in glycemic (blood glucose) control after surgery
2 – Heart Disease
Research has shown that women with BMI of > 35kg /m are up to three times as likely to suffer from high blood pressure. A pooled analysis of 22000 patients of which 72% were reported 70% improvement in hyperlipidemia (high lipid levels) and 78% improvement in high blood pressure after weight loss surgery
3 – Cancer
Recent research has shown that obesity is a major risk factor for developing cancer of the breast and reproductive system ( e.g endometrium ,cervix and ovarian ) in women. There is a strong link between obesity and development of breast cancer. Prolonged high levels of blood oestrogens predispose obese women to development of breast cancer. Overweight women going for breast surgery also tend to face complications such as higher wound infection rates which may prolong recovery time
The management of obesity has been scrutinised and researched thoroughly in the last 2 decades. The magic pill is still diet and exercise. However, surgery has been the most effective way to control the epidemic effectively and in a sustained manner for a larger group of people. This fact has also been widely studied and, despite the numerous other weight loss methods available in the market, has stood the test of time thus far.
These procedures are done laparoscopically ( or keyhole surgery ) .There are many advantages of this technique, including less wound pain and complications, shorter hospital stay and faster recovery .The procedures have become very safe as compared to the surgeries done 40 years ago. The standardisation of surgical techniques used and the tremendous improvement in anaesthesia care has resulted in complications being minimised
In the Singapore context, the Ministry of Health guidelines on obesity state that a Body Mass Index (BMI) above 32.5 for Asians, qualify for the surgery. The surgery is mainly done keyhole or laparoscopically, and the options will include the adjustable gastric band, the sleeve gastrectomy and the Roux en Y gastric bypass. The intra-gastric balloon is another non operative way to aid in weight loss, via a gastroscopy only.
Management of obesity has to be multidisciplinary. Other than the surgeons, the team will include the Dietician, Physiotherapist, Endocrinologist, Respiratory Physician, Anaesthetist, Bariatric nurses and Psychiatrists. Its a holistic approach to tackle the objective of a better and longer life without obesity.
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