Weight and Metabolic Management

Management of Obesity

Principally we need to achieve and sustain negative energy balance until we reach our goal and then sustain zero balance. Meaning initially we need to consume much less energy than we use forcing our body to use the stored fat to extract energy leading to weight loss, until we reach equilibrium were the energy consumed equal to energy used.
It is very easy to say but extremely difficult to achieve without help, this is mainly due to strength of the hunger signal produced by our brain, it is extremely difficult to resist for long period of time. Most of us crumble in few weeks, some after few month and small number resist it for few years and almost all fail by 2 – 3 years.

Commercial diet industry flourished and every one of these companies advertising and pushing hard to sell their product. Currently we lost the count of how many of them around. All if applied will help you to lose weight but none will help you to sustain your loss, because they don’t address the hunger you suffer with their diet. The more weight you loose the stronger the signal is. Basically it is our survival instinct kicking in to ensure enough energy available to sustain life. Some diet programs caused harm, and yoyo diet leads to eventually increasing weight and weaken the bone density.

Choosing the right food and having good balance of all the major component is very important skill you need to learn and understand. Making sure that enough vitamins and mineral in the diet is very important for proper body function.

Adopting good diet guide is important to prevent slipping into obesity but unfortunately once obese, losing weight and sustaining it by dieting alone is very difficult and patient usually suffering from hunger all the time.

The appeal of losing weight quickly is hard to resist. But do weight-loss pills and products lighten anything but your wallet?

Weight-loss pills — prescription medicines, nonprescription drugs, herbal medicines or other dietary supplements — are all, at best, tools that may help with weight loss. But there is relatively little research about these products, and the best studied of these are prescription weight-loss drugs.

Prescribed medications for the treatment of obesity should be considered for use as an adjunct to lifestyle intervention in patients with a BMI >30 or BMI >27 with obesity related comorbidities. Weight loss medications used in the treatment of obesity can act centrally to increase levels of satiety or act on the gastrointestinal tract to restrict nutrient absorption.

Exercise is very important for health, but it is not a tool alone for weight loss.  Our body is very efficient machine, virtually you could walk over 50 miles with 100 gms of fat, no human made machine could be this efficient. Endurance exercise without after math heavy meal might produce the right signal to our brain to keep our body robust.
Noval approaches

Things like hypnotherapy, acupuncture, mouth wiring, — etc have been used

Endoscopic procedures

Intragastric balloon, basically balloon introduced inside the stomach with help of gastroscope and filled up with saline, simulating large volume food inside your stomach. Could achieve modest weight loss, 10 – 15 % and could only leave it for 6- 12months. Once removed the weight could comes back again and could be associated with severe ongoing vomiting when the balloon blocks the stomach outlet.

Endoscopic bypass, based on hooking long plastic sleeve to the esophagus trying to avoid food passing through the stomach and proximal small bowel by dropping food well into the small bowel, basically virtual bypass without surgery. Now how long this plastic tube will stay, how secure the hooking will be and issues with food sticking to the plastic. It is good thinking but not practical as we could work out how our body dealt in the past with foreign material inserted.

Surgical procedures / Bariatric surgery

Bariatric surgery is a great tool to help you loosing weight. Ideas and types of surgery have changed over the years and decades. At earlier phase surgery was mostly aimed at reducing body ability to absorb nutrient, first operation invented in US 1954, jejunoileal bypass. This procedure led to malabsorption due to bypassing about 90% of small bowel.

Modification of the the above procedure led to developing three principal of surgery

  • Gastric restriction (laparoscopic gastric band, sleeve gastrectomy and vertical banded gastroplasty)
  • Gastric restriction with mild malabsorption (Roux-en Y gastric bypass), developed early 1960’s
  • Mild gastric restriction and Malabsorption (Duodenal switch)

Currently in Australia three surgical approaches used and percentage aged through the years.

  • Laparoscopic gastric band, once was the highest bariatric surgical procedure performed in Australia, was about %85 year 2010, the main attraction was the idea of reversibility ( it is not reversible), adjustability ( needs frequent follow up, and occasionally once deflated patient fails to achieve previous weight loss). While currently is about 1 – 2 % of total surgery performed.
  • Sleeve gastrectomy, currently the commonest surgical procedure performed, used to be about 7% year 2010, while currently is about 80- 90% of total bariatric surgery performed.
  • Laparoscopic gastric bypass surgery, almost steady over the year with mild raise in percentage as some patient with previously failed lap band surgery are not suitable for sleeve gastrectomy.

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