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   home > Obesity Surgery > Overview Of Treatment For Obesity
  Overview Of Treatment Options For Obesity  
 

Taking a proper medical consultation is the first step in your path to control of your obesity !!! Be rest assured you can achieve your goal with an able help of your doctor.

You should read these few pages in order to understand goals and limitations of various treatments available today to treat obesity. This understanding and your consultation with Dr Patankar would form the basis of your knowledge based decision which will help you to lead a healthy life.
Life style modification has always been and still remains a backbone of long-term management of obesity. All the treatment options discussed here are best seen not as an alternative but as an adjuvant to healthy life style. Healthy lifestyle is one which avoids excess of either eating or dieting ! A basic activity like simple brisk walk can help maintain your heart healthy !!

Step 1

Be very certain about objective of your treatment !
Some patients want just a weight loss to ease pressure on their knees or back. Cosmetic appearance of the body is not of any concern for them. Non-surgical treatments may suffice such patients.
While most others would want to loose fat in order to look better. They may or may not be very fat, but want to get rid of bulges and improve contours. Generally these patients need precise surgical body contouring.
Convey your objective of seeking treatment very clearly and honestly !….. This will influence the type of treatment to be selected for you.

Step II

FAT AND WEIGHT ARE NOT THE SAME !!!
FAT LOSS AND WEIGHT LOSS ARE NOT THE SAME !!!
EXCESS FAT IS UNHEALTHY, ABOVE AVERAGE WEIGHT NEED NOT BE !!!
ONE CAN LOOSE FAT WITHOUT LOOSING WEIGHT OR LOOSE WEIGHT WITHOUT LOOSING FAT !!!
YOUR AIM SHOULD BE 'FAT LOSS' AND NOT 'WEIGHT LOSS' !!!

Understand the difference in 'fat' and 'weight'. A very muscular body builder may have a body weight nearing 100 kg, but he would have a very good muscle mass and not excess of fat. As against this, a lady weighing just about 60 kg may have a considerable fat ! You should aim for 'fat loss' without loosing muscle mass. Surgeries like liposuction can remove fat selectively without compromising on muscle mass. Of course you would loose some weight following Liposuction in proportion to the fat being removed. However, it would be pure fat loss and hence even if you loose say just 5 kg on weighing scale, the appearance would change as if you have lost more than 15 kgs !!!

Step III

Both, Surgical and Non-Surgical treatments are available to treat obesity. Let's understand basic differences in them
Let's understand basic differences in them
NON-SURGICAL TREATMENTS SURGICAL TREATMENTS
No injections / anesthesia / surgery Needs anesthesia and surgery
No hospitalization May need hospitalization
No risk. Risk of anesthesia & surgery
Good for high risk, elderly patient Good for medically fit patients
No down time / rest Certain down time / rest
Cheaper than surgery Expensive
Multiple sessions One time treatment
Variable results Predictable assured results
Precise body contouring impossible Precise body sculpting is possible
Good for general fat and weight loss Excellent for precise body contouring
Results need to be maintained Results easier to maintain

Thus, non-surgical treatments are better for high-risk patients with uncontrolled medical problems, seeking general weight loss and who are not very concerned about aesthetic appearance. While young patients seeking precise body shaping are best treated with body sculpting procedure like liposuction.

Let's now understand individual treatments …

NON-SURGICAL LIPOLYSIS

LIPO means fat and LYSIS is 'to melt'. Thus in non-surgical lipolysis, we melt fat without surgery. There are two ways in which it's done…. High Intensity Focalized Ultrasound ( HIFU ) Lipolysis or LASER lipolysis. ( LASER lipolysis is different from LASER liposuction. Please don't confuse between the two ).

In non-surgical treatments, we give HIFU or LASER on the skin. They penetrate under the skin into the fat layer and melt the fat. But this fat is not taken out of the body ( as against in Liposuction in which it is sucked out ). This fat is then drained via certain channels called Lymphatic channels to the liver. Liver uses it for energy production ( metabolism ).

There is a limit as to how much fat can be used by liver in a day or over a week. Hence this treatment has to be done slowly. Patients come every week and treatment session is repeated weekly.

How are the results of these treatments?
How much fat loss is possible in one session?
How much change shall I see in one or in 5 sessions?
How many sessions shall I need to flatten my stomach?
The answer to all these questions is that ' The results of non-surgical treatments are variable!'. Some patients tend to loose fat very fast while some others take longer. The results depend on liver function, body metabolic rate, availability of glucose to liver etc.
Results of LASER lipolysis are deeper, more uniform and faster than HIFU lipolysis. Another advantage of LASER Lipolysis is that it causes better skin shrinkage after fat loss than HIFU lipolysis.
These treatments are very safe and can be administered even in elderly patients with complicated medical conditions. They have side effects whatsoever.
Hence Non-surgical treatments are usually preferred in following set of patients.
  • Patients in whom surgery is not safe because of old age / unstable medical conditions / high risk of anesthesia
  • Patients who have very minimal fat where surgery may not be needed.
  • Patients who are scared of surgery and are unwilling for the same.
  • Patients who seek general weight loss for knee / back problems and not concerned about 'looks'

GASTRIC BALOON

This procedure involves inserting and inflating a balloon in stomach using gastroscopy. The balloon occupies say 90% of capacity of stomach. This keeps the stomach in permanently 'full' state and thus reduces dietary intake of patient. This is a safe procedure done as 'out patient' treatment and doesn't need hospitalization / rest / leave from work.

Patients can loose on an average 10 to 25 kg of weight in 6 months. The balloon needs to be taken out at the end of 6 months. Patients need to control their eating habits after the balloon is removed or else tend to regain all the lost fat.

BARIATRIC SURGERY ?

These surgical procedures are aimed at reducing the capacity of stomach with surgery (We insert a band around stomach, staple part of stomach or cut it off) or prevent food absorption (We bypass majority of small intestine responsible for absorption of food).
Thus patient cannot eat more than say quarter of a chapati (If one tries to eat more, one would tend to belch and voimit) or whatever they eat, is not absorbed. This forces reduced caloric intake and the body weight starts going down.
These procedures are the only ones which can achieve radical weight loss even in the range of 30 to 50 kg.
However, there are significant immediate and long-terzm risks associated with these procedures.
Severe nutritional deficiencies since patient cannot eat / food is not absorbed.
Patient has to take life-long medicines / suppliments.
Very high incidence of osteoporosis and early weakening of bones.
Gastric restrictive procedures may not be permanent since the reduced stomach size starts re-expanding if patient doesn't control eating.
A number of patients experience continuous unpleasant nausea / belching / and restlessness after eating.

As a result, internationally accepted recommendation is to reserve these procedures to treat patients with 'Morbid Obesity' with 'Uncontrolled Co-morbidities'.
Although we routinely perform these surgeries, we prefer to consider them as a last resort in huge patients for whom there is no other safer and easier alternative.

LIPOSUCTION ( ULTRASONINC / VASER / VIBRO / PAL / LASER ) ?

Liposuction is an excellent body sculpting procedure to permanently remove precise quantity of fat from various areas to sculpt the body. The fat thus taken out, can also be re-injected (e.g. in breasts / butts / face etc ) to achieve a perfect body curve and attractive face.

Salient features are…

Done under local / regional / general anesthesia.
Takes 1 to 3 hours
Tumescent fluid is injected in fat to loosen fat cells.
Fat is liquefied with ultrasound / vibrations / LASER
Liquefied fat is immediately sucked out.
Hence instant changes in body contours.
Patient wears pressure garment / belts for 2 weeks to 2 months.
Permanent change since fat cells are taken out
Fat taken out can be re-injected in breasts / butts / face / any other area to achieve a perfect figure and face.

There are various techniques of liposuction like ultrasoninc / vaser / vibro / P.A..L. / LASER liposction.

Ultrasonic liposuction / vaser / vibro liposuction / PAL used much bigger cannulae to melt and remove the fat. This required a bigger cut in the skin with a couple of stitches and a scar. The procedure used to be quite traumatic with lot of blood loss and post-operative pain ( after the surgery ). After the fat was taken out, the skin would turn loose, wrinkled, uneven and sag.

All these problems of older techniques are not seen with Super-selective LASER liposuction.
Super-selective LASER liposuction is THE latest technology. Let us understand in detail how it works and its advantages.
Procedure of Super-selective LASER Liposuction…

Procedure is done under suitable anesthesia. A very thin needle is passed through a 1 mm puncture mark in the skin. An optical fiber is passed through the needle and transmits LASER into the fat layer under skin. LASER causes super-selective lipolysis i.e. melts only the ultra thin walls of fat cells. LASER has no effect on blood

vessels and nerves in the fat. These blood vessels and nerves have a fibrous layer called ‘advantitia’ around them and LASER has no effect on it. Hence these blood vessels are left intact as fat cells are liquefied in a highly selective manner. The liquefied fat is immediately sucked out through the same needle.
Advantages of Super-selective LASER liposuction…

  • Small areas can be done under local anesthesia
  • Blood vessels are minimally damaged during surgery.
            Hence there is very minimal blood loss. This leads to
                 -- Much safer than older techniques.
                 -- No need for blood transfusions
                  -- Much more fat can be removed.
                  -- Multiple body areas can be treated at a time like abdomen, love handles ( waist ), inner / outer part of thighs,                       arms, breasts, face, neck etc.
                 --  Hardly any weakness. Hence patient can go home the same day in evening/night.
                 --  Can start doing all day to day activities from the very next day.
                  --  Can travel and join work within a couple of days.
  • Minimal damage to nerves and hence hardly any pain after surgery
  • LASER causes excellent skin shrinkage. Hence skin doesn’t sag or turn loose. It doesn’t cause any stretch marks or skin wrinkles
  • High precision procedure. Hence used even for extreme fine contouring like that of carving of six packs on abdomen, double chin, neck and face.
  • Less need to wear pressure garments / belts. Much faster recovery.
  • The procedure ruptures and removes fat cells. The cells once removed, cannot regenerate in number. Hence the contour changes and body proportions stay absolutely permanent. Fat cells called

Adipocytes store fat under the skin. When we start diet and exercise regimen, the fat stored within these cells is burnt and they become smaller in size. However their number remains unchanged. Hence the moment we stop dieting and exercising, fat gets re-dposited within these cells once again and we start putting on. Thus effects of diet and exercise are not long lasting and one needs to really struggle to maintain them. As against this, in LASER Liposuction, we destroy and remove certain number of fat cells. A thin layer of fat, necessary for skin and body is left behind and all the extra unwanted fat cells are removed. Thus in LASER Liposuction the number of fat cells reduces. These cells multiply in number in childhood and stop multiplying as we cross puberty. They multiply to some extent during pregnancy but not otherwise. And hence the results of LASER Liposuction are absolutely permanent.

ABDOMINOPLASTY ( TUMMY TUCK ) SURGERY

This procedure involves inserting and inflating a balloon in stomach using gastroscopy. The balloon occupies say 90% of capacity of stomach. This keeps the stomach in permanently 'full' state and thus reduces dietary intake of patient. This is a safe procedure done as 'out patient' treatment and doesn't need hospitalization / rest / leave from work.

Patients can loose on an average 10 to 25 kg of weight in 6 months. The balloon needs to be taken out at the end of 6 months. Patients need to control their eating habits after the balloon is removed or else tend to regain all the lost fat.

This is a surgical procedure to remove excess loose skin and fat from abdomen, especially lower abdomen. A low transverse cut is made in the skin like that of a caesarian section scar. If patient has a scar of previous caesarian surgery, tummy tuck is performed though the same scar. An entire ellipse of skin from navel to pubic area with its stretch marks is removed. Loose abdominal muscles are tightened. If the patient has any hernia on abdomen, it is repaired at the same time. The skin of upper abdomen is pulled down and sutured to make the tummy absolutely flat and taught. An aesthetically pleasing navel is refashioned.

   MOMMY MAKEOVER…

   Pregnancy and delivary can cause fat gain and laxity of skin and muscles. Mommy Makeover aims to reverse these changes in    abdomen, waist, hips, thighs, arms, breasts and genitals.

   Some of the surgeries performed to give a youthful well-toned body with perfect curves are
   -- Breast reduction surgery ( reduction mammoplasty )
   -- Breast lift ( mammopexy )
   -- Increasing breast size ( augmentation mammoplasty ) using fat transfer or silicone breast implants.
   -- Abdominoplasty ( tummy tuck ) surgery.
   -- Super-selective LASER Liposuction for abdomen, love handles, inner and outer thighs, arms etc.
   -- Vaginal tightening procedures to reduce the laxity of female genitalia.
   -- Treatment of stretch marks.

   IMPORTANT NOTE

   Not all, but some of the surgeries may be covered under medical insurance. You may discuss details of your health insurance    policy during your consultation, to check whether it covers the procedures suggested for you.hospitalization / rest / leave from     work.

 
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