首頁資訊 Bariatric Clinic

Bariatric Clinic

來源：泰然健康網(wǎng) 時間：2024年12月03日 15:25

What is Obesity

Obesity is a disease. People with obesity often have issues with energy regulation, leading to the accumulation of excess fat and an increase in body size. Obesity is not simply a matter of appearance: According to the World Health Organization (WHO), in 2008, more than 1.4 billion adults were overweight and more than 500 million were obese. Every year, at least 2.8 million deaths can be attributed to being overweight or obese. Between 1980 and 2008, the number of obese patients has nearly doubled. In 2014, more than 1.9 billion adults aged 18 and over were overweight (39%), and more than 600 million people were obese (13%). In 2014, 41 million children under 5 were overweight or obese.

How to define obesity:

Overweight and obesity are defined as abnormal or excessive fat accumulation that can damage your overall health statues. Body mass index (BMI) is a simple index of ratio of weight to height, and is usually used to categorize overweight and obesity for adults.
Body mass index (BMI) = weight (kg) / height (m2)

Adiposis Universalis Asian Westerners Normal BMI 18-22.9 kg/m 2 BMI 18.5-24.9kg/m 2 Overweight BMI 23-24.9 kg/m 2 BMI 25-29.9 kg/m 2 Obese BMI ≥ 25 kg/m 2 BMI ≥ 30 kg/ 2 Abdominal Obesity Male WC* > 90 cm WC > 102 cm Female WC >80 cm WC > 88cm

* Waist measurement is the length of the circumference from the lower end of the ribs to the middle of the hip bone

Cause of Obesity

If the body consumes more calories than it needs to function, the excess calories will be stored in the body as fat. There are many causes of obesity, including genes, environment, and behavior. Sometimes endocrine or metabolic diseases can lead to obesity as well. There may be many obese people in one family, as patients carrying genes for obesity are more likely to accumulate fat in the body. The eating habits of family members (such as eating high-calorie foods regularly) can also cause obesity. Other causes include addiction to snacks, a sedentary lifestyle, taking steroids or anti-depressants, etc. If you have depression, bulimia nervosa, obesity bulimia, hypothyroidism, Cushing’s syndrome or other diseases at the same time, you will also be more susceptible to obesity-related diseases.

Obesity related diseases

The risk of obesity patients having severe diseases are high.

Obesity and overweight has a serious impact on health. Over accumulation of fat can lead to various serious health consequences, such as hypertension, hyperlipidemia, coronary artery disease, sleep apnea, diabetes, gallstones, gastroesophageal reflux disease, urinary incontinence, infertility, premature birth, joint degeneration, stroke, anxiety, depression; In addition, obesity will increase the risk of endometrial, prostate, esophagus, ovarian, kidney, large intestine, breast, liver, pancreas cancers and others; Obese people life expectancy maybe 5 to 20 years shorter than normal with the effect of possible severe diseases.

Metabolic syndrome
Metabolic syndrome is defined as factors that increase the risk of a series of diseases such as ischemic heart disease, stroke and diabetes and causing the shortening of life expectancy.

The International Diabetes Federation (IDF) recently redefined metabolic syndrome as meeting at least three followings:

Central Obesity (waist): Asian (except Japanese): ≥ 90cm (male)﹔≥ 80cm (female)

? Triglyceride ≥1.7mmol/L (150mg/dL)

? HDL cholesterol <1.03mmol/L (40mg/dL) (male); <1.29 (50mg/dl) (female)

? Blood pressure ≥130/85 or under treatment

? Fasting blood glucose ≥ 5.6mmol/L (100mg/dL) or diagnosed with Type II diabetes

Coping with obesity

Suffering from obesity? Obesity can be improved by changing diet and daily living habits, exercising, medication and surgical treatment.

Diet, exercise and living habits

For people with severe obesity, the effect of adjusting daily living habits is very limited: large study samples indicated that only 5-10 percent of patients can keep ideal weight a few years later. Jiahui dietitian and physical therapists are dedicated to offer individualized living habits adjustment plans to help our clients reducing weight effectively. With the guidance and supervising of our professionals, better weight loss goal will be achieved.

Medication treatment
Medications can be treated as one of alternative methods for obesity and overweight clients, but diet and living habit adjustment cannot be replaced. Comparing to living habit adjustment only, taking medications plus living habit change usually can reduce extra 3-9 percent weight for clients. However, medication treatment is not for everyone: children, elderly people over 70 (especially elder adults with multiple illnesses) and pregnant women are not for medication treatment. Moreover, medications have side effects, and weight might regain after terminating medications also needs to be noticed when selecting this treatment option.

Surgical treatment plan for obesity, Type 2 Diabetes and metabolic syndromes

1.Laparoscopic Sleeve Gastrectomy

Sleeve gastrectomy is the most common surgical weight loss option worldwide. The surgery is relatively simple, safe, and the chances of developing long-term complications is low. This surgery limits the volume of the stomach in order to achieve weight loss, removing 60-70% of the greater curvature of the stomach, and reducing the patient's food intake. Sleeve gastrectomy also removes the fundus of the stomach that secretes appetite-stimulating hormones, which makes the patient less hungry and reduces cravings for food.

2.Laparoscopic Roux-EN-Y gastric bypass

Roux-en-Y gastric bypass surgery not only limits the patient's food intake, but also reduces the effectiveness of nutrients absorption in the stomach and intestines. This surgery reduces the size of your upper stomach to a small 60-100ml pouch. The surgeon does this by stapling off the upper section of the stomach, reducing the amount of food you can eat. The surgeon then attaches this pouch directly to part of the small intestine called the Roux limb. This forms a "Y" shape. The food you eat then bypasses the rest of the stomach and the upper part of your small intestine, reducing the amount of fat and calories you absorb from the foods you eat. This surgery is more complex than a sleeve gastrectomy, and the possibility of developing post-surgery complications will be slightly higher.
The best results can be seen about a year after surgery, and the surgery can be especially helpful for patients with diabetes or metabolic syndrome. About 80% of morbidly obese patients with diabetes fully recover after the bypass surgery, and no longer need to take blood sugar medications.

Skin and Plastic Surgery

Refers to abdominoplasty and other treatments used to solve the skin problem after weight loss.

Do I need weight loss/ metabolic surgery

Eligibility of the surgery depend on the following three conditions:

1. Body Mass Index (BMI)

Body mass index (BMI) = weight (kg) / height (m2)

2. Whether you have type 2 diabetes (T2DM)

3. Whether you have metabolic syndrome

The following group may consider weight loss/metabolic surgery:

1.Age ≥ 18 and < 65 years

2.Patients with a BMI ≥40 kg/m2 (32.5 kg/m2 for Asian population) without coexisting medical problems and for whom bariatric procedures would not be associated with excessive risk

3.Patients with a BMI ≥ 35 kg/m2 (27.5 kg/m2 for Asian population) and ≥ 1 severe ORC (Obesity Related Complication) remediable by weight loss, including T2D ( Type 2 Diabetes Mellitus ), high risk for T2D (insulin resistance, prediabetes, and/or MetS), poorly controlled HTN, NAFLD/nonalcoholic steatohepatitis (NASH), obstructive sleep apnea (OSA), osteoarthritis of the knee or hip, and urinary stress incontinence, can consider a bariatric procedure

4.Patients with BMI 30 to 34.9 kg/m2 (25 to 27.4 kg/m2 for Asian population) and T2D with inadequate glycemic control despite optimal lifestyle and medical therapy