Browse Month: October 2017

Women’s & Obesity – Dr Sanjay Patolia – Bariatric Surgeon Ahmedabad

Obesity results from excessive accumulation of fat that exceeds the body’s skeletal and physical standards for age, sex and height. A BMI > 25 is over  weight and > 30 is obese.

Though excessive calorie intake is important factor for the development of obesity, certain hormones regulated by genes are equally important for obesity. Certain hormones regulated by genes are equally important factor for obesity . Excess calorie intake in relation to physical requirement causes obesity. 17% more women are obese , compared to men, having greater health and socio economically implications. Excess fat women’s health by creating the imbalance in sex steroid hormones especially estrogen and androgen. Women suffer from obesity and co-morbid diseases more in comparison with men. Every age group of women has age specific  diseases due to obesity.

Childhood and Puberty (15-20 Yrs)
Obesity affects the ovarian function with an imbalance in estrogen and androgen , causing polycystic ovarian diseases (PCOS) . It manifests with menstrual irregularities and hair growth in male pattern, called hirsutism, obese teens have low self  esteem and poor self confidence, affecting their performance in school and studies.

Child Bearing Age Group ( 21-30 Yrs)
This age group obesity causes major problem of infertility and bad obstetrics history. 15% of infertility problem are linked with obesity . Obesity causes irregular ovulation and poor quality of ovum. Obese women are less likely to respond to infertility days and need hyper doses and prolonged treatment. Even after conception an obese women faces increased risk o f repeated abortions and a pregnancy complicated with diabetes, hypertension , thrombo embolic  events , respiratory disorders like asthama and sleep apnea and vascular infections. Also obesity complicates both the vaginal and caesarean section  deliveries by shoulder dystopia, post partum hemorrhage , uterine rupture and increased risk of anesthesia.

Obesity related adverse outcomes on the fetus include neural tube defects which increases by 7% with every unit increases in BMI . There is a 3 fold in risk of ante partum still birth in morbidly obese women. Also higher incidence of macrosomia , preterm birth and IUGR in PIH are seen. Not only has this but an obese woman passed on the abnormal metabolic molecule to the fetus leading to obesity in her children with early onset metabolic diseases. This affecting the future generation.

Premenopausal Age Group ( >40 Years)
Obesity in this age group leads to poor quality of life, complicated with diabetes , high blood pressure and cholesterol, breathing problems, and sleep apnea, digestive disorders like acid reflux and gall stones. Increased weight leads to osteoarthritis of weight bearing joints like up knee and spine. Breast, uterine and ovarian cancers have higher incidence in obese women. Obesity not only decreases the life span but leads to a very poor quality of life for affected ladies. Their social life is restricted and health compromised.

With rapid rise in obesity in all age groups it is set to become a global epidemic. Life style changes are the need of hence to combat this killer disease. Healthy diet and exercise can help in reversing it.

For those who have advanced beyond, bariatric surgery offers the last ray of hope not only to reduce weight but get rid of associated diseases and a better reproductive outcome.

Article Source – http://asianbariatrics.blogspot.in/2017/09/women-and-obesity.html

Author: Dr. Sanjay Patolia is one of the most experienced and eminent obesity surgeon of India – the recipient of Surgeon of Excellence Award from SRC USA. He is also the co-founder and promoter of Asian Bariatrics, Asia’s largest Bariatrics center.

The Effects of Obesity on Female Reproductive Function – Asian Bariatrics

Reproduction-the enigma and mystery of human race bears the burden of weight like all other system but this is more significant for us as it directly has directly adverse effect on the future generations.

Obesity which has reached epidemic proportions is observed to be higher among women than men. Obesity affects all stages of women life.

The impact of obesity on reproductive function can be attributed primarily to endocrine mechanism. Let us understand how obesity changes the endocrine milieu making it unfavorable for reproduction. Abdominal obesity is associated with high level of insulin. Chronic hyperinsulinemia causes increased ovarian androgen production, increased LH secretion from pituitary and decreased sex hormones biding globulin (SHBG) production leading to increase in free circulating androgen. Fat aromatizes, these androgen to estrogen leading to chronic to chronic hyperestrogenic environment. Increased leptin and other inflammatory factors from adipocytes inhibit follicular development.

The imbalance in the estrogen and androgens cause irregular ovulation or an ovulation. Obesity accounts for 15-20% of all infertile patients. Poor quality of ova even in presence of ovulation leads to sub fertility . Obesity patients require higher doses of drugs and prolonged treatment and still do not respond to fertility treatment satisfactorily.

Even if the obese woman manages to get pregnant, she has a higher chance of abortion due to poor quality of ova. Abnormal hormonal milieu in form of increased insulin, estrogen, triglycerides , uric acid etc results in the increased incidence of congenital anomalies in fetus of obese mother , especially neural tube defects.Other associated medical problems like hypertension, diabetes, breathlessness, thrombosis can also complicate the pregnancy further leading to prematurity , IUGR, macrosomia and even still birth.

Even if she completes her pregnancy uneventfully, maternal obesity causes the infant to have increased degree of adipocytes predisposing the baby for childhood obesity. The abnormal milieu to which the child was exposed to in utero, leads to metabolic disease in children born to obese mothers.Various studies have shown the associated of childhood obesity and earlier onset of diabetes and cardiovascular diseases to maternal obesity.

Stringent anti obesity measures need to be implemented in women, due to detrimental effects of obesity on pregnancy and trans generational out comes. The prevention or treatment of obesity needs to be done before conception.

Even a 5 % decrease in weight, improves fertility in obese PCOS. British fertility society recommends that women who have BMI of 30 or above and less than 35 years of age should defer their infertility treatment. They should first be encouraged to lose weight to achieve a BMI <30 and then be given treatment for fertility to optimize the out come.

Nutritional education and behavioral modification can be tried for weight reduction, In women where these measures have failed bariatric surgery should be considered for women having BMI>35 without co-morbid disease or BMI >33 with disease. It is the only scientific method available today for surgical weight loss and long term management of weight loss.

ACOG (American college of obstetrician and gynecologist) has also endorsed that after bariatric surgery, there is a decrease in the risk preterm delivery along with the reduced risk of labour and delivery complications.

Thus we see that obesity has a profound negative influence on conception pregnancy, labor and even affects the unborn child.Timely correction obesity with conservative means or a bariatric surgery is hence advised before planning a pregnancy for a optional outcome.

Source – http://asianbariatrics.blogspot.in/2017/09/the-effects-of-obesity-on-female.html
Author:
Dr Sanjay Patolia is one of the most experienced and eminent obesity surgeon of India – the receipient of Surgeon of Excellence Award from SRC USA. He is also the co-founder and promoter of Asian Bariatrics, Asia’s largest Bariatrics and Metabolic Surgery Center.

World Obesity Day 2017 – Weight Loss Surgery India – Asian Bariatrics

Eleventh October is observed as the world obesity day every year to raise awareness and address issues related to the epidemic of obesity which is rising at an alarming rate world over. This year the theme is ACT NOW TO AVOID THE CONSEQUENCES LATER.

India has a growing obesity problem with rising middle class income, availability and easy access to processed food and sedentary lifestyle. Today with 20.7% of its females and 18.6% of its male population SUFFERING FROM OBESITY AND OVERWEIGHT, it ranks third in the world only after the US and China in obesity. Obesity as we know is not only about appearance but is responsible for numerous disease including diabetes, high blood pressure, abnormal cholesterol, heart disease, liver malfunction, stoke and paralysis, sleep apnea, hormonal imbalance infertility and pregnancy complications and even certain cancers like the breast, uterus and colon. The genetic predisposition of Indians towards abdominal obesity, diabetes and heart diseases puts them at a higher risk for obesity complications. Treating it timely helps cure or control these complications. Thus treating obesity timely, the slogan ACT NOW, is very important for us.

For a rapidly developing economy like ours which is battling with paradoxical issues of under-nutrition and obesity, preventing the conditions are much more cost-effective than treating their complications. Preventing obesity today would require the following:

(1). Public awareness about obesity and its consequences across all age groups especially among growing children and young adults. The awareness and insistence on healthy choices should be addressed at the school level.
(2). Improve the food environment to ensure that healthier food options become more easily available to public. Increase their awareness about unhealthy food choices, their contents and consequences.
(3). Improve the layout of local living spaces and public places like gardens etc making them support physical activities.
(4). A healthy lifestyle should be marketed, advocated and endorsed by public figures to raise public awareness.

When unable to prevent obesity, its timely treatment becomes essential. So in order to follow this year’s theme of ACT NOW we would require to do the following:

(1). Recognize that obesity is a disease and not just a cosmetic issue. In fact it happens to be the root cause of numerous diseases.
(2). Educate the public about the treatment options available, like conservative means through lifestyle modifications and surgical therapy.
(3). Dedicated centers with multidisciplinary teams to treat people affected with obesity.
(4). Comprehensive follow up services for people on weight loss regime and those who have lost the excess weight to help them maintain the weight loss.
(5). Insurance coverage for obesity treatments. A few companies in India and the CGHS now recognize obesity as a disease and have started covering it in our country but a lot needs to be done.

Obesity is measured by body mass index (BMI). World over, a BMI of over 25kg/m2 is considered overweight but the ministry for health and family welfare along with the Indian Council for Medical Research has lowered it for Indians to 23kg/m2 considering our predisposition to obesity and its complications. As we are a more vulnerable population the theme of the world obesity day to ACT NOW  is a warning bell for us. Healthier choices are available, we need to be wiser. For the treatment part we have numerous qualified professionals for diet and exercise training to help us. India is considered one of the best destination for weight loss surgery with accredited and standardized dedicated centers for obesity surgery here and we have numerous patients coming from all over the world for it. Let us then decide to ACT NOW, prevent it or treat it but get rid of it timely before its too late. Let us all  for once be on time….

Content Source: http://asianbariatrics.blogspot.in/2017/10/world-obesity-day.html

Author:
Dr Sanjay Patolia is one of the most experienced and eminent obesity surgeon of India – the recipient of Surgeon of Excellence Award from SRC USA. He is also the co-founder and promoter of Asian Bariatrics, Asia’s largest dedicated center for Bariatrics & Metabolic Surgery.