The World Health Organization has outlined obesity as an epidemic within developed world and is a significant risk factor for a majority of chronic illnesses. Obesity significantly increases the risk for a broad range of conditions inclusive of diabetes, heart disease, hypertension, stroke, Alzheimer’s disease, infertility, certain cancers such as breast, prostate, and colon cancers, and an enhanced risk of disability. The levels of obesity in the UK have been rising consistently over the last two-three decades. The core determinants for of this increase entail physiological factors, changing eating habits, reduction in physical activity levels fuelled by a sedentary lifestyle, change in lifestyle and psychological influences that manifest at both individual and societal level.
A survey released in 2012 indicated that over a quarter of all adults (close to 26%) in England are obese. Overtime, poor diet and physical inactivity have surged to almost surpass smoking as the principal preventable root of mortality globally. Obesity represents a disease of appetite regulation and energy metabolism influenced by physiology, genetics, and psychosocial, environmental, and cultural factors. Overweight and obesity ultimately stem from a disparity between energy intake and energy output. Some of the risk factors to obesity include living in an industrialized society, overeating, having family members who are obese, not being physically active, consuming a high fat diet, taking certain prescription medications, having a hormone disorder, prenatal exposures such as smoking, and emotional stressed.
One of the easiest modes to determine if one is obese centres on calculating the body mass index (BMI), which represents the ratio between an individual’s weight and height. Adults with a BMI of 25 to 29.9 kg/m2 are perceived as overweight while those with a BMI of ≥30 kg/m2 are considered as obese. Clinical interventions to attain and sustain weight reduction entail behavioural-based interventions to induce lifestyle change (dietary restriction and enhanced physical activity), pharmacotherapy, and surgery.
Solution 1 Gastric Banding
Laparoscopic adjustable gastric banding features one of the most frequently undertaken bariatric procedures for the treatment of morbid obesity. Gastric band surgery is essentially a restrictive procedure that limits the quantity of food possible to be contained in the stomach. This is fashioned at slowing consumption of foods, and consequently the quantity of absorbed food. Since gastric band is a restrictive procedure, the procedure does not impact on the capability of the body to absorb food.
The gastric band operates via a portion control only and does not impact on the foods that the patient can consume. The gastric band is essentially a hollow ring placed around the stomach whereby the ring remains filled with silicon, which applies pressure and contains the amount of room within the stomach. This slows and minimizes the quantity of food that can be consumed at any given time. Thus, the patients feel full even after consuming smaller portions of food. This procedure does not minimize gastric emptying time. The procedure enables the patient to attain a sustained weight loss by adopting healthy food options and minimizing food intake and volume, minimizing appetite, and the movement of food.
The recovery from keyhole surgery is usually much short compared to other extensive surgeries. The surgeon mainly wraps the gastric band around the abdomen to tighten it, and then a tube is attached to the band and a port installed under the skin. The port remains mainly attached to the tube and located just below the patient’s chest through a small incision. This capability to adjust the passageway allows the physician to customize the patient’s weight loss while at the simultaneously cutting adverse side effects.
Implications to Gastric Banding
The ethical issues regarding the procedures hinges on aspects such as patient autonomy, weight related stigma, and discrimination being the motivator for pursuing gastric banding. Some outstanding concerns have been raised regarding the lowering the eligibility criteria for the procedure are that the core driver of the patient’s desire for this may be informed by social consequences of obesity (stigma, rejection, and discrimination) rather than health effects. Based on an analysis of clinical outcomes (effectiveness and safety), as well as cost effectiveness, gastric banding delivers in both the short and medium term on weight loss. As such, the procedure can be termed as cost effective.
Risks of Gastric Banding
Gastric banding is a drastic step and embodies the ordinary pain and risks associated with substantial gastrointestinal surgical operation. Marginally, gastric banding causes both small bowel obstruction and colonic erosion. Gastric banding is not immune to complications that face surgical procedures such as slippage, band erosion, outlet obstruction, and port problems. Medical complications may entail allergic reaction to medications, blood loss, complications from anaesthesia, and bladder infections.
Benefits of Gastric Banding
Some of the advantages of gastric banding surgery relative to other bariatric surgeries include: least invasive surgery requiring less than 45 minutes to complete, besides the procedure is entirely reversible; no stomach cutting, intestinal rerouting; adjustable for nutrition needs of pregnancy; lowest operative complication rate; minimal risk of gall stones; minimal malnutrition risks; and, speedy operation. Gastric banding surgery yields an average of 47% of excess weight loss.
Solution2 Weight Loss Pills
Several medications are presently employed for the management of obesity, inclusive of weight loss and maintenance in line with a minimized calorie diet. Weigh loss pills can be prescribed or purchased over-the-counter. Some of Medications for weight loss pills work by repressing the appetite by influencing the hypothalamus within the brain, which mainly regulates appetite. Other pills influence the lipase enzyme that breaks down fat. Prescription fat-blockers act as lipase inhibitors by removing fat from the body instead of breaking the fat. Other diet pills work by influencing appetite-related hormones. The medications are mainly recommended for obese patients bearing an initial BMI of ≥30kg/m2 or ≥27 kg/m2 with accompanying risk factors such as controlled hypertension and diabetes. Examples of weight loss pills within the market include Alli-OTC, Bitter Orange, Chromium, and Chitosan
Orlistat minimizes fat digestion by restraining pancreatic lipases. Ingested fat is not entirely hydrolyzed, yielding in enhanced faecal fat excretion. Alli represents the reduced strength version of Orlistat (Xenical) (lower dose of about 60 mg that is accessible as an over-the-counter medication) employed to treat obesity. Alli facilitates weight loss by minimizing absorption of fat by the intestines; hence, the amount of calories absorbed is reduced significantly. Lipase represents an enzyme found within the digestive tract and that aids in breaking down of dietary fat into smaller components. Alli works by disabling lipase that thwarts the enzyme from breaking down the fat while within the digestive tract.
The medication is taken with fat-rich meals, up to thrice a day; however, owing to the manner in which the pill works, patients are recommended to eat no more than 15 grams of fat with every meal. The weight loss delivered by Alli is mainly modest such as 2-3 kg above those that would have been lost with diet and exercise. Sympathomimetic drugs mainly obstruct the reuptake of neropinephrine and serotonin into nerve terminals thus yielding an early satiety and minimized food intake. The present approved sympathomimetic drugs such as phentermine and diethylpropion are usually for short-term usage (mainly interpreted as a period of up to 12 weeks). The medications act as appetite suppressants.
Implications to Weight loss Pills
Evidence from various studies point out that individuals quickly regain they had lost after stopping to take the drugs. Amusingly, the weight lost diet and exercise interventions come back, but four times slower, as individuals steadily revert to their old habits. Overall, in terms of cost effectiveness, weigh loss score modestly since they only minimize the rates of obesity-related disease such as type-2 diabetes, heart disease, and osteoarthritis by a small percentage. Serious health risks may result in cases where the privilege of weight loss pill remains abused. In some case, prescription diet pills are potentially addictive.
Risks of Weight Loss Pills
Although weight loss pills are safe to use, the pills can be accompanied by real health risks ranging from nausea and diarrhoea to depression and hypertension. Other side effects include loose stools, frequent, or hard-to-control bowel movements, abdominal pain, gas, insomnia, bloating, and constipation.
Benefits of Weight loss pills
Administration-approved medications for weight loss can be effective in aiding patients to lose weight. The benefits may entail a reduction in body mass index of 5-10% of the entire body weight within a year. Other benefits include reduction in blood pressure, and reduction in blood glucose levels. However, medication should not be perceived as a panacea for weight loss and should be combined with other measures for weight loss. Pills mainly work if the patient combines the medication with a change in lifestyle and exercising. Weight loss pills do not isolate patients from dieting and exercise, but only accelerate the pace with which the benefits derived from dieting and physical exercise can be attained.
Solution 3 Gastric Bypass Surgery
Hybrid techniques combine gastric restriction with the principle of intestinal malabsorption by creating either a bypass or a diversion system. Weigh loss surgeries are mainly utilized for patients whose body mass index is more than 40 or those BMI is more than 35, and manifest obesity-related health problems. Gastric bypass aids patients to lose weight by altering how the stomach and small intestine handle the food that the patient consumes. After the surgery, the patient’s stomach is usually smaller and makes the patient feel full with consumption of little food.
The food that the patient consumes no longer goes into some sections of the stomach and small intestine that mainly breaks down food. As a result, the amount of calories absorbed remains dramatically reduced. Gastric bypass procedures represent a group of equivalent operations that first partitions the stomach, and then re-arranges the small intestine to unite to both. Surgeons have devised varying ways of reconnecting the intestine, hence yielding to a number of gastric bypass procedures names. The resultant weight loss from gastric bypass procedure is characteristically dramatic and noticeably minimizes comorbidities. The long-term mortality rate associated with gastric bypass procedure has been proved to reduce by close to 40%.
The gastric bypass procedure mainly entails the creation of a minute size pouch within the upper stomach, followed by bypass of the remainder of the stomach. This limits the volume of the food that can be consumed. The stomach may merely be partitioned (characteristically by the utilization of surgical staples) or may be entirely partitioned into two parts with staples. The bypass procedure may also entail re-construction of the gastrointestinal tract to allow drainage of the two segments of the stomach.
Gastric bypass, Roux en-Y (proximal)
This is the most dominantly used gastric bypass technique whereby the small intestine is partitioned 45 cm below the lower stomach outlet and is reorganized into a Y-configuration allowing outflow of food through a Roux limb. Other variations of gastric bypass entail procedures such as gastric bypass, Roux en-Y (distal) and mini-gastric bypass (MGB).
Implications to Gastric bypass surgery
In evaluating gastric bypass surgery, attention must be an aid to the extent of informed individual patient choice within the consent process. Access to bariatric surgery for morbidly obese patients may be limited owing to increases in overall costs and an uncertain public health support.
Risks of Gastric bypass surgery
Gastric bypass procedure is a radical surgery accompanied by numerous risks. The risks that accompany any surgery or anaesthesia include risks such as allergic reactions, blood clots, blood loss, heart attack or stroke, and infection. Statistics indicate that close to 15% of the patients experience complications with 0.5% of the patients dying within six months of surgery owing to complications. The complications of abdominal surgery encompass aspects such as infection, haemorrhage, hernia, and bowel obstruction. The complications that may arise from the gastric bypass entail anastomotic leakage, anastomotic stricture, and anastomotic ulcer. The surgery may also lead to nutritional deficiencies owing to insufficient absorption of key nutrients. The resultant malnourishment and anaemia may require lifelong vitamin and mineral supplementation. The surgery has also been associated with doubling the risk to alcohol problems.
Benefits of Gastric bypass Surgery
The core benefit of weight loss surgery is mainly delivering a quick and dramatic weight loss. After the surgery, the patient loses weight for 18-24 months post surgery. Gastric bypass surgery renders an average loss of 61% of excess weight. Similarly, the surgery renders improvements in obesity-related medical conditions including diabetes and hypertension.
Weight loss programmes demand commitment and can be quite challenging; nevertheless, such programmes have been proved to be successful. Obesity can be perceived as not just a mere condition of eating too much, but a chronic disease that is increasingly becoming a worldwide concern. Irrespective of the factors driving the rise in obesity, sustaining a healthy weight eventually hinges on balancing the number of calories consumed, and the number of calories burnt via exercise and everyday activities. Screening for overweight/obesity would be critical, especially in cases where screening would successfully decrease the disease risk. The best mode of preventing weight gain entails eating a healthy diet and exercising regularly. Most health organizations recommend that no more than 30% of the total calorie intake should come from fats.