The world may recover from the deadly COVID-19 pandemic, but the ever-existing pandemic of obesity may not end very soon. World over, including India, the percentage of obese population has increased at an alarming rate. The World Health Organization (WHO) states that the obese population has tripled since 1975, and close to 50% of the world’s population is either overweight or obese.
Obesity also brings along many life-threatening diseases like diabetes, hypertension, high cholesterol, Polycystic Ovarian Disease (PCOD), osteoarthritis, heart disease and cancers. So, what are our options for losing weight and leading a healthier life in 2022?
DIET AND EXERCISE: Treating obesity has been human quest since centuries, and it has been a tough challenge. Various methods of weight-loss have been tried. Appropriate diet is the foremost effective method. There is a long list of formula diets which have been used since many years with limited success. Activity boosters and calorie burners like exercise, yoga, etc. also have a role in achieving and maintenance of weight loss. Diet, exercise, and lifestyle modification will remain an important achievable method for most of us.
MEDICAL THERAPY: People who are unable to achieve adequate long lasting weight loss, or also have co-morbidities like diabetes and have a Body Mass Index (BMI) of up to 30 Kg/m2, can be prescribed medications for weight loss. Drugs for weight loss have been around for more than three decades and many were used off-label initially. One interesting group of formulation is the GLP-1 Analogue. They act like the naturally present Glucagon like Peptide-1 but have a stronger action. They were initially available as daily injections (Liraglutide), later as once weekly injections (Semaglutide), and recently the oral version of the Semaglutide has been launched (Rybelsus by Nova Nordisk). All the drugs which are prescribed for weight loss have a variable effect, and strict diet protocols need to be followed. The drugs need to be stopped if no satisfactory weight loss is observed within two months of the therapy, or if the medication is poorly tolerated. Most of the medications are short term prescription drugs. The introduction of Semaglutide has been deemed as a game changer, but only time will tell.
INTERVENTIONS: Minimally invasive procedures like the Intragastric Balloon have become more attractive with introduction of long-term balloon (Spatz), Swallowable Balloon pill (Obalon) and the self-deflating Intragastric Balloon (Elipse). Newly introduced endoscopic procedure known as ‘Endoscopic Gastric Sleeve’ has also emerged as an attractive option. One should know that all these implants and procedures are expensive, also results are limited and at best temporary, unless followed by lifestyle modifications.
BARIATRIC SURGERY: Bariatric surgery remains the most effective weight loss procedure for the morbidly obese patients (BMI >35). Bariatric surgical procedures like the Laparoscopic Sleeve Gastrectomy, Roux-en-Y Gastric Bypass and the Mini Gastric Bypass remain the more commonly performed bariatric operations. Bariatric surgery not only gives significant weight loss and long-term weight maintenance, but it also cures many co-morbid conditions like type 2 diabetes, dyslipidaemia, Obstructive Sleep Apnea (OSA), fatty liver disease, Polycystic Ovarian Disease (PCOD), and osteoarthritis.
(The writer is a Consultant Robotic, Laparoscopic GI & Bariatric Surgeon at Hiranandani Hospital, Vashi-A Fortis Network Hospital)
