Diabetic Surgery

The world wide cases of Type 2 diabetes are rising dramatically, secondary to increasing sedentary behaviour and easier access to attractive calorie-dense foods. The most recent global predictions by the International Diabetes Federation (IDF) suggest that there are 285 million people with diabetes currently worldwide. This is set to escalate to 438 million by 2030, with a further half billion at high risk.

The classification of diabetes includes four clinical classes:

  1. Type 1 diabetes (results from B-cell destruction, usually leading to absolute insulin deficiency)
  2. Type 2 diabetes (results from a progressive insulin secretary defect on the background of insulin resistance)
  3. Gestational diabetes mellitus (diabetes diagnosed during pregnancy)
  4. Specific types of diabetes due to other causes, e.g., genetic defects in B-cell function, genetic defects in insulin action, diseases of the exocrine pan-creas (such as cystic fibrosis), and drug-or chemical-induced (such as in the treatment of AIDS or after organ trans-plantation)

Type 2 diabetes is a risk factor for vascular damage affecting small blood vessels (eye; kidney and nerve) and large blood vessels (premature and more extensive heart, brain and limb blood vessels). Early death and damage to organs in diabetes result from such complications. The disease results from inadequate insulin (hormone that keeps sugar under control) production and action and results in hyperglycaemia (high sugar in blood). In addition, obesity, by itself, generates similar cardio-metabolic dysfunction. 

A weight loss and Diabetes Surgery centre, helps to reduce the excess weight and nearly normalise the uncontrolled blood sugar after all initial modalities fails. Our Centre has experienced and super-specialist laparoscopic Gastrointestinal surgeon along with team of physician, diabetologists, intensivist, dietician and specialized physiotherapist to take care of all & high-risk obese person. The centre is equipped with all latest facilities to deliver world class treatment.

HOW IT is DONE

Established Procedure

1. Roux-en-Y Gastric Bypass: A Surgical stapler to create a small and vertically oriented gastric pouch and its volume is usually<30 cc. The upper pouch is completely divided from the gastric remnant and is anastomosed to the jejunum (30“75 cm from the ligament of Treitz) through a narrow gastro-jejunal anastomosis. Bowel continuity is restored by an entero-entero anastomosis between the excluded bil-iopancreatic limb and the alimentary limb. This anastomosis is usually performed 75-100 cm distal to the gastro-jejunostomy. although it has also been performed at 100-250 cm in patients with BMI>50 kg/m2. As this is a restrictive as well as malabsorpative procedure, diabetes control is moderate and acepatable and easily manageable mal-absorption related deficiencies.

2. Laparoscopic Adjustable Gastric Banding: Laparoscopic adjustable gastric banding (LAGB) is a restrictive procedure that involves encircling the upper part of the stom-ach with a band-like, saline-filled tube. The band is wrapped around the superior portion of the stomach, just distal to the gastroesophageal junction. The amount of restriction can be adjusted by injecting or withdrawing saline solution from the hollow core of the band through a subcutaneous port. Being a purely restrictive procedure, diabetes control correlates with corresponding weight loss. As it does not affect gastro-intestinal hormonal milieu, diabetes control is mild.

3. Biliopancreatic Diversion: The operation consists of a distal, horizontal gastrectomy that leaves behind upper stomach 200-500 ml in size. This remnant stomach is anastomosed to the distal 250 cm of small intestine (alimen-tary limb). The excluded small intestine (including the duodenum, the jejunum, and part of the proximal ileum) carries bile and pancreatic secretions (biliopancreatic limb), and it is connected to the alimentary channel 50 cm proximal to the ileocecal valve. The 50-cm common limb is the only segment of small bowel where digestive secretions and nutrients mix.

4. Biliopancreatic Diversion with Duodenal Switch: The biliopancreatic diversion with duodenal switch (BPD-DS) includes a sleeve vertical gastrectomy (rather than a horizontal version, as in Scopinaro™s original procedure), which leaves a 150“200-ml gastric reservoir. The duodenum is closedˆ¼2 cm distal to the pylorus, and a duodeno-ileal anastomosis is performed. Bowel continuity is restored, as in BPD; however, the entero-entero anastomosis is performed more proximally on the alimentary limb, leaving a longer common channel of ˆ¼100 cm, as opposed to 50 cm in Scopinaro™s original procedure. As this is also restrictive as well as mal-absorptive procedure, but it induced greatest mal-absorption. Thus diabetes control is greatest with this procedure and also associated with maximum deficiency of nutrients. 

Novel Procedure

1. Sleeve gastrectomy (SG): To shorten the duration of the laparoscopic BPD-DS in high-risk patients, the originator of this operation, proposed a two-stage approach in which SG is performed first, with the duodeno-ileostomy and ileo-ileostomy as a second stage a few months later. This approach resulted in reduced surgical morbidity and mortality compared to the traditional one-stage approach in super-superobese patients (BMI>60 kg/m2). Unexpectedly, patients achieved re-markable weight loss after the first stage of this approach,

2. Duodenal-Jejunal Bypass (DJB): DJB is a stomach-sparing bypass of a short portion of proximal intestine, comparable to the segment excluded in a standard RYGB (Figure 2a). Variants of this experimental procedure include techniques that preserve the pylorus (duodeno-jejunal anastomosis) or do not (gastro-jejunal anasto-mosis).

3. Ileal Interposition (IT): This operation involves the surgical insertion of a small segment of ileum, with its neurovascular supply intact, into the proximal intestine, increasing its exposure to ingested nutrients that leads to increased level of glucagon-like peptide-1 (GLP-1) and peptide-YY. These hormonal changes, in the absence of gastric restriction or malabsorption, are associated with reductions in food intake and body weight & improvement in glucose levels. This procedure, alone or in combination with SG, has been used in lean diabetic patients. The short term results are encouraging. The late metabolic sequalae are therefore unknown, and long-term safety is still to be evaluated.

4. Endoluminal duodenal-jejunal sleeve (ELS): The ELS is a flexible plastic sleeve, placed in stomach using endoscope. This sleeve extends for distal stomach to duodenum and proximal jejunum, thus disrupting absorption of nutrients. Studies to determine the safety and efficacy of long-term ELS placement in humans are under way.

Risk Factor

Obesity is considered the primary risk factor for diabetes. It has been estimated that the risk of developing Type 2 diabetes is increased 93-fold in women and 42-fold in men who are severely obese rather than of healthy weight.

Need for Surgery

Limitation of Medical treatment in Obese

Though lifestyle interventions along with medical treatment options are initial line of treatment for any diabetic patient, but they have very limited success in controlling blood glucose levels amongst the severely obese, with many of these patients not achieving targets.

There is strong evidence that significant weight loss achieved by using lifestyle and medical methods by obese, particularly severely obese, people is modest and rarely sustained, particularly in the severely obese.

A number of these medications used for treating Type 2 diabetes, including insulin, themselves can result in weight gain.

There are now few medications approved for weight loss with recent withdrawals associated with adverse events.

Diabetic Surgery has sustainable effect on sugar control

Almost all severely obese patients are unsuccessful in their efforts to achieve sustained and significant weight loss and there is evidence that weight loss induced by Gastro-intestinal (bariatric) surgery can lead to remission of high blood sugar in the majority of patients with diabetes. Earlier treatment increases the likelihood of remission. In the remaining patients, residual hyper-glycaemia is easier to manage following surgery. It can therefore be suggested that Gastro-intestinal (bariatric) surgery for the morbidly (severely) obese with Type 2 diabetes should be considered early as an option for eligible patients, rather than being held back as a last resort.

Decrease the risk of death by diabetes and related complications:

In addition to weight loss by Gastro-intestinal (Bariatric) surgery, has been shown to substantially improve hypertension, high cholesterol and sleep apnoea and several reports have documented an improvement of overall survival and specific reduction in diabetes-related mortality.

Recommendation for Children

Long-term whole-of-family lifestyle change, with high-quality medical management, is the mainstay of paediatric obesity treatment. However, the growing prevalence of severe obesity in children and adolescents demonstrates a need for additional therapy.

Bariatric surgery is only considered suitable for adolescents of developmental and physical maturity.

Australian and New Zealand Colleges for paediatric physicians and surgeons and the Obesity Surgery Society of Australia and New Zealand has recommended that surgery be considered

  1. If adolescents had BMI > 40 kg,m2
  2. > 35 kg,m2with severe co-morbidities (including Type 2 diabetes)
  3. Aged 15 years or more
  4. Tanner pubertal stage 4 or 5 and skeletal maturity
  5. Can give informed consent
  6. Potential candidates should have failed a multidisciplinary programme of lifestyle & pharmacotherapy for 6 months
  7. Patient & his family must be motivated and understand the need to participate in post-surgical therapy and follow-up

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don't have excess body fat.

Result

Most studies show prevention, improvement or remission of type 2 diabetes after surgery with a relatively low rate of risk in appropriate patients. The extent of remission of Type 2 diabetes is influenced by the extent of weight loss, weight regain, duration of diabetes, the pre-surgery hypoglycaemic therapy requirements, and the choice of gastro-intestinal procedure. In addition, each patient's commitment to modifying their diet and levels of exercise within a framework of ongoing multidisciplinary care will influence outcomes.

Supportive Evidence:

1.2004: According to a landmark study published in the Journal of the American Medical Association (JAMA) in 2004, Gastro-intestinal (bariatric) surgery patients showed improvements in the following metabolic conditions:

  1. Type 2 diabetes remission in 76.8% and significantly improved in 86% of patients
  2. Hypertension eliminated in 61.7% and significantly improved in 78.5% of patients
  3. High cholesterol reduced in more than 70% of patients
  4. Sleep apnea was eliminated 85.7% of patient™s.
  5. Joint disease, asthma and infertility were also dramatically improved or resolved.
  6. The study showed that surgery patients lost between 62 and 75 percent of excess weight.

2009: The Swedish Obese Subjects study clearly demonstrated the prevention and sustained remission of Type 2 diabetes in a group of 2037 severely obese patients electing to have bariatric surgery when compared with well-matched controls at 2 and 10 years follow-up (Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C,Carlsson Bet al.Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351: 2683-2693)

2008: There is a well designed prospective randomized control trial (RCT) that compared bariatric surgery (compared laparoscopic adjustable gastric banding) to conventional diabetes therapy with a focus on weight loss by diet and exercise. After 2 years, remission of diabetes was significantly more common in those who had received surgery (73 vs. 13%) (Dixon JB et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. J Am Med Assoc 2008;299: 316-323)

2009: Cochrane review including patients with and without diabetes concluded that bariatric surgery resulted in greater weight loss than conventional treatment in obese class I (BMI>30kg m2) as well as severe obesity, accompanied by improvements in co-morbidities such as Type 2 diabetes, hypertension and improvements in health-related quality of life. (Colquitt JL et al. Surgery for obesity. Cochrane Database Syst Rev2009; CD003641)

2009: A systematic review and meta-analysis of 621 studies which included approximately 135 000 patients identified 103 studies reporting on the remission of the clinical and or laboratory manifestations of diabetes. Overall, 78.1% of patients had ˜remission™ of diabetes following surgery. Among patients with diabetes at baseline, 62% remained in remission more than 2 years after surgery. (Buchwald H et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009;122: 248-256)

Prevention

Whether you're at risk of obesity, currently overweight or at a healthy weight, you can take steps to prevent unhealthy weight gain and related health problems. Not surprisingly, the steps to prevent weight gain are the same as the steps to lose weight: daily exercise, a healthy diet, and a long-term commitment to watch what you eat and drink.

  • Exercise regularly.
  • Follow a healthy-eating plan
  • Know and avoid the food traps that cause you to eat.
  • Monitor your weight regularly
  • Be consistent

Benefits

Untreated Obesity & Diabetes increase the chances of early death:

Severe obesity is associated with a large number of health problems in addition to Type 2 diabetes. A review of more than 1.4 million participants in prospective studies largely from North America, Europe and Australia show a consistent progressive rise in the mortality hazard ratios with increasing BMI.(Berrington de et al. Body mass index and mortality among 1.46 million white adults. N Engl J Med 2010; 363:2211-2219)

A similar analysis by the Prospective Studies Collaboration found the risk of diabetes-related death was quadrupled for morbidly obese individuals (Whitlock G et al. Body mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009;373: 1083-1096)

Obesity & Diabetes Surgery prolong overall survival:

Follow-up of participants in the Swedish Obese Subjects Study after an average of 11 years found thatbariatric surgery was associated with a 29% reduction in all-cause mortality after accounting for sex, age and risk factors in this severely obese group. (Sjostrom L et al. Effects of bariatric surgery on mortality in Swedish obese subjects.N Engl J Med2007;357: 741-752)

Another study also has confirmed this mortality advantage when compared with community matched control subjects. (Adams TD et al. Long-term mortality after gastric bypass surgery. N Engl J Med2007;357: 753-761)

Specific mortality reductions in the operated group were 56% for coronary artery disease, 92% for diabetes and 60% for cancer when compared with matched controls. Bariatric surgery also led to a specific reduction in cancer incidence in women. (Sjostrom L et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden. Swedish Obese Subjects Study. Prospective, controlled intervention trial. Lancet Oncol 2009; 10:653-662)

Surgery improves overall quality of life:

Many studies have demonstrated major improvements in health-related quality of life following surgery using both generic and obesity-specific quality-of-life instruments. (Kolotkin RL. Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls. Surg Obes Relat Dis2009;5: 250-256)

Risk of surgery

There are risks that go with any type of medical procedure and surgery is no longer an exception. Success of surgery depends upon 3 factors: type of disease/surgery, experience of surgeon and overall health of patients. The risks of each procedure need to be considered in the light of potential reductions in mortality, morbidity or co-morbidity, quality of life and productivity.

  1. The most common complications of Gastro-intestinal (bariatric) surgery include anastomotic and staple-line leaks (3.1%), wound infections (2.3%), pulmonary events (2.2%) and haemorrhage (1.7%). Morbidity rates are lower after laparoscopic procedures, which constitute a steadily increasing proportion of bariatric operations. (Nguyen NT et al. Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers.J Am Coll Surg2007;205: 248-255).
  2. Early post-operative morbidity and mortality are related to the complexity of the surgery. The US Bariatric Outcomes Longitudinal Database (BOLD) reviewed over 57 000 consecutive procedures and reported one or more complication at 1-year rates of 4.6, 10.8, 14.9 and 25.7% following laparoscopic adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass and bilio-pancreatic diversion, respectively. (DeMaria EJ. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Out-comes Longitudinal Database.Surg Obes Relat Dis2010;6: 347-355)
  3. The 30-day mortality associated with Gastro-intestinal (bariatric) surgery is estimated at 0.1-0.3%, a rate lower / similar to that for laparoscopic cholecystectomy & described as a ˜low". Thirty-day post-surgical mortality is 0.1% for laparoscopic adjustable gastric band, 0.5% for Roux-en-Y gastric bypass and 1.1 for bilio-pancreatic diversion. (Buchwald H et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 2007;142: 621-632).
  4. Long-term concerns, especially with Roux-en-Y gastric bypass and bilio-pancreatic diversion, include vitamin and mineral deficiencies, osteoporosis and, rarely, Wernicke's encephalopathy and severe hypoglycaemia from insulin hypersecretion.

Cost effective treatment

The costs of Type 2 diabetes are substantial: In the USA, the lifetime cost has been estimated at $US 172 000 for a person diagnosed at the age of 50 years and $US 305 000 if diagnosed at the age of 30 years. The estimate included both the direct medical costs of diabetes and its complications and indirect costs caused by work absence, reduced productivity at work, disability and premature death. Over 60% of the medical cost was incurred within 10 years of diagnosis. (Zhuo X. Life-time cost of type 2 diabetes in the US. Presented at the American Diabetes Association meeting, 25–29 June 2010, Orlando, FL, USA. Abstract 0434-PP)

Diabetic Surgery & Weight loss Surgery is the cost saving tool: Surgery for severe obesity, regardless of diabetes status, has been assessed as cost-effective and, in some analyses, cost saving.

  1. Picot J et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation.Health Technol Assess 2009.
  2. Salem L, Devlin A, Sullivan SD, Flum DR. Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions. Surg Obes Related Dis 2008.
  3. Cremieux PY et al. A study on the economic impact of bariatric surgery. Am J Manag Care 2008.
  4. Ackroyd R, Mouiel J, Chevallier JM, Daoud F. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg 2006.
  5. van Mastrigt GA. One-year cost-effectiveness of surgical treatment of morbid obesity: vertical banded gastroplasty versus Lap-Band.[erratum appears in Obes Surg. 2006 May;16(5):682]. Obes Surg 2006.

When to see a doctor

If you're concerned about weight-related health problems, you have come at the right place Request a Callback to discuss about obesity management. We can evaluate your health risks and discuss your weight-loss options.

Obesity is a complex disease involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It is a medical problem that increases your risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.

There are many reasons why some people have difficulty avoiding obesity. Usually, obesity results from a combination of inherited factors, combined with the environment and personal diet and exercise choices.

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. Dietary changes, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss procedures are additional options for treating obesity.

Causes

Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat.

When most of the diets are too high in calories & often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Symptoms

Obesity is diagnosed when your body mass index (BMI) is 30 or higher. To determine your body mass index, divide your weight in pounds by your height in inches squared and multiply by 703. Or divide your weight in kilograms by your height in meters squared.

BMI Weight status
Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0 and higher Obesity

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don't have excess body fat.

Risks

Obesity usually results from a combination of causes and contributing factors:

  • Family inheritance and influences
  • Lifestyle choices
  • Certain diseases and medications
  • Social and economic issues
  • Age
  • Other factors (Pregnancy, Quitting smoking, Lack of sleep, Stress, Microbiome, Previous attempts to lose weight etc)

Even if you have one or more of these risk factors, it doesn't mean that you're destined to develop obesity. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.

Prevention

Whether you're at risk of obesity, currently overweight or at a healthy weight, you can take steps to prevent unhealthy weight gain and related health problems. Not surprisingly, the steps to prevent weight gain are the same as the steps to lose weight: daily exercise, a healthy diet, and a long-term commitment to watch what you eat and drink.

  • Exercise regularly.
  • Follow a healthy-eating plan
  • Know and avoid the food traps that cause you to eat.
  • Monitor your weight regularly
  • Be consistent

When to see a doctor

If you're concerned about weight-related health problems, you have come at the right place Request a Callback to discuss about obesity management. We can evaluate your health risks and discuss your weight-loss options.

How we can HELP

Obesity Doctor is one of the most renowned & awarded Obesity/Weight Loss Clinic in India.

Obesity Clinic is a Super Speciality Surgery Center specializing in Bariatric Surgery procedures. We specialize in laparoscopic (key-hole surgery) surgery, Single incision or Scar-less surgery. These techniques are much kinder to the patients as compared to open surgery. Laparoscopy leads to less pain, early recovery and faster return to work.

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Types of Weight Loss Surgery

Bariatric Surgery / Weight Loss Surgeries / Obesity Surgeries.

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  • Roux-en Y Gastric Bypass Surgery

  • Gastric Balloon Surgery

  • Gastric Sleeve Surgery OR Sleeve Gastrectomy

  • Single Incision Sleeve Gastrectomy

  • Adjustable Gastric Banding Surgery

  • c

  • Duodenal Switch (DS) & Duodeno-Jejunostomy (DJB)

  • Revisional Bariatric Surgery

Why Surgery ?

Benefits of Bariatric Surgery and Why you sould choose it.

Bariatric/weight loss surgery is the only valid treatment option that leads to sustained weight loss in patients suffering from clinically severe obesity. Most people who suffer from obesity have usually tried all methods to lose weight without success before they consider surgery.

Bariatric surgery is recommended for people who are suffering from morbid obesity (if they are more than 30 to 35 kg above their ideal body weight). Bariatric surgery is also a very good treatment option for obese people who suffer from type 2 diabetes mellitus. Surgery leads to significant improvement in diseases associated with obesity such as- diabetes, high blood pressure, dyslipidemia, knee joint pains, PCOD, obstructive sleep apnoea, fatty liver disease, infertility and so on.

Bariatric surgery is the only way people can lose massive amount of weight. It is also easier to maintain the weight loss after surgery than after any other method of losing weight. Surgery also leads to a significant improvement in the quality of life of these patients.

On a daily basis, we see patients who put in their heart and soul into their efforts to lose weight. They have been to every weight loss clinic, celebrity dieticians, gyms, yoga gurus and weight loss retreats. Unfortunately, more often than not, they meet with disappointment and tend to yo-yo between weight loss and weight gain. This entire process is extremely disheartening and demotivating for the patients.

So, if you have tried hard to lose weight without success and the weight is bearing you down, you have come to the right place because bariatric surgery is the only way at the moment that can lead to sustained weight loss in patients suffering from morbid obesity.

Frequently Asked Questions

  1. How much weight can I lose after bariatric surgery and how much time does it take?

    Bariatric surgery leads to about 65 to 75% excess weight loss. Excess weight is calculated as actual weight minus ideal body weight. It takes about 12 to 18 months to lose this weight. Weight loss is very quick in the first 6 months and then it tends to slow down.

  2. Obesity is a chronic progressive disease. Diet and lifestyle modification are an integral part of management of obesity. Patients who embrace the diet and lifestyle modification after surgery tend to get better results. Some degree of weight regain is expected in the long term but it can be controlled if the patient is following a healthy lifestyle.

  3. After bariatric surgery, patients need to be on a liquid diet for about 15 days. This is followed by a phase of semi-solid or soft diet for another 15 days. After a month, most patients are able to have normal food, albeit in limited quantity. Initially the intake is very low but over a period of time, patients are able to eat better. It is also advised to have nutritional supplements in the form of protein supplement, iron, calcium and multivitamins. These will be advised by your doctor based upon your reports as well as the type of surgery.

  4. The cost of bariatric surgery depends on the type of surgery and the room category that you choose. At the moment insurance companies do not cover it routinely but evaluate on case to case basis. There is also an option of medical loan through which patients can get the facility of paying for the surgery in monthly EMIs.

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  • Roux-en Y Gastric Bypass Surgery

  • Gastric Balloon Surgery

  • Gastric Sleeve Surgery OR Sleeve Gastrectomy

  • Single Incision Sleeve Gastrectomy

  • Adjustable Gastric Banding Surgery

  • c

  • Duodenal Switch (DS) & Duodeno-Jejunostomy (DJB)

  • Revisional Bariatric Surgery

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Obesity is one of the biggest health problems in the world.

It’s associated with several related conditions, collectively known as metabolic syndrome. These include high blood pressure, elevated blood sugar and a poor blood lipid profile.

People with metabolic syndrome are at a much higher risk of heart disease and type 2 diabetes, compared to those whose weight is in a normal range.

Over the past decades, much research has focused on the causes of obesity and how it could be prevented or treated.

Many people seem to think that weight gain and obesity are caused by a lack of willpower.

That’s not entirely true. Although weight gain is largely a result of eating behavior and lifestyle, some people are at a disadvantage when it comes to controlling their eating habits.

The thing is, overeating is driven by various biological factors like genetics and hormones. Certain people are simply predisposed to gaining weight ( 1 Trusted Source ).

Of course, people can overcome their genetic disadvantages by changing their lifestyle and behavior. Lifestyle changes require willpower, dedication and perseverance.

Nevertheless, claims that behavior is purely a function of willpower is far too simplistic.

They don’t take into account all the other factors that ultimately determine what people do and when they do it.

Here are 10 factors that are leading causes of weight gain, obesity and metabolic disease, many of which have nothing to do with willpower.

Obesity has a strong genetic component. Children of obese parents are much more likely to become obese than children of lean parents.

That doesn’t mean that obesity is completely predetermined. What you eat can have a major effect on which genes are expressed and which are not.

Non-industrialized societies rapidly become obese when they start eating a typical Western diet. Their genes didn’t change, but the environment and the signals they sent to their genes did.

Put simply, genetic components do affect your susceptibility to gaining weight. Studies on identical twins demonstrate this very well ( 2 Trusted Source ).

Summary Some people appear to be genetically susceptible to weight gain and obesity.

Heavily processed foods are often little more than refined ingredients mixed with additives.

These products are designed to be cheap, last long on the shelf and taste so incredibly good that they are hard to resist.

By making foods as tasty as possible, food manufacturers are trying to increase sales. But they also promote overeating.

Most processed foods today don’t resemble whole foods at all. These are highly engineered products, designed to get people hooked.

Summary Stores are filled with processed foods that are hard to resist. These products also promote overeating.

Many sugar-sweetened, high-fat junk foods stimulate the reward centers in your brain ( 3, 4 Trusted Source ).

In fact, these foods are often compared to commonly abused drugs like alcohol, cocaine, nicotine and cannabis.

Junk foods can cause addiction in susceptible individuals. These people lose control over their eating behavior, similar to people struggling with alcohol addiction losing control over their drinking behavior.

Addiction is a complex issue that can be very difficult to overcome. When you become addicted to something, you lose your freedom of choice and the biochemistry in your brain starts calling the shots for you.

Summary Some people experience strong food cravings or addiction. This especially applies to sugar-sweetened, high-fat junk foods which stimulate the reward centers in the brain.

Junk food producers are very aggressive marketers.

Their tactics can get unethical at times and they sometimes try to market very unhealthy products as healthy foods.

These companies also make misleading claims. What’s worse, they target their marketing specifically towards children.

In today’s world, children are becoming obese, diabetic and addicted to junk foods long before they’re old enough to make informed decisions about these things.

Summary Food producers spend a lot of money marketing junk food, sometimes specifically targeting children, who don’t have the knowledge and experience to realize they are being misled.

Insulin is a very important hormone that regulates energy storage, among other things.

One of its functions is to tell fat cells to store fat and to hold on to the fat they already carry.

The Western diet promotes insulin resistance in many overweight and obese individuals. This elevates insulin levels all over the body, causing energy to get stored in fat cells instead of being available for use ( 5 Trusted Source ).

While insulin’s role in obesity is controversial, several studies suggest that high insulin levels have a causal role in the development of obesity ( 6 Trusted Source ).

One of the best ways to lower your insulin is to cut back on simple or refined carbohydrates while increasing fiber intake ( 7 Trusted Source ).

This usually leads to an automatic reduction in calorie intake and effortless weight loss — no calorie counting or portion control needed ( 8 Trusted Source , 9 Trusted Source ).

Summary High insulin levels and insulin resistance are linked to the development of obesity. To lower insulin levels, reduce your intake of refined carbs and eat more fiber.

Many pharmaceutical drugs can cause weight gain as a side effect ( 10 Trusted Source ).

For example, antidepressants have been linked to modest weight gain over time ( 11 Trusted Source ).

Other examples include diabetes medication and antipsychotics ( 12 Trusted Source , 13 Trusted Source ).

These drugs don’t decrease your willpower. They alter the function of your body and brain, reducing metabolic rate or increasing appetite ( 14 Trusted Source , 15 Trusted Source ).

Summary Some medications may promote weight gain by reducing the number of calories burned or increasing appetite.

Leptin is another hormone that plays an important role in obesity.

It is produced by fat cells and its blood levels increase with higher fat mass. For this reason, leptin levels are especially high in people with obesity.

In healthy people, high leptin levels are linked to reduced appetite. When working properly, it should tell your brain how high your fat stores are.

The problem is that leptin isn’t working as it should in many obese people, because for some reason it cannot cross the blood-brain barrier ( 16 Trusted Source ).

This condition is called leptin resistance and is believed to be a leading factor in the pathogenesis of obesity.

Summary Leptin, an appetite-reducing hormone, doesn’t work in many obese individuals.

Another factor that dramatically influences people’s waistline is food availability, which has increased massively in the past few centuries.

Food, especially junk food, is everywhere now. Shops display tempting foods where they are most likely to gain your attention.

Another problem is that junk food is often cheaper than healthy, whole foods, especially in America.

Some people, especially in poorer neighborhoods, don’t even have the option of purchasing real foods, like fresh fruit and vegetables.

Convenience stores in these areas only sell sodas, candy and processed, packaged junk foods.

How can it be a matter of choice if there is none?

Summary In some areas, finding fresh, whole foods may be difficult or expensive, leaving people no choice but to buy unhealthy junk foods.

Added sugar may be the single worst aspect of the modern diet.

That’s because sugar changes the hormones and biochemistry of your body when consumed in excess. This, in turn, contributes to weight gain.

Added sugar is half glucose, half fructose. People get glucose from a variety of foods, including starches, but the majority of fructose comes from added sugar.

Excess fructose intake may cause insulin resistance and elevated insulin levels. It also doesn’t promote satiety in the same way glucose does ( 17 Trusted Source , 18 Trusted Source , 19 Trusted Source ).

For all these reasons, sugar contributes to increased energy storage and, ultimately, obesity.

Summary Scientists believe that excessive sugar intake may be one of the main causes of obesity.

People all over the world are being misinformed about health and nutrition.

There are many reasons for this, but the problem largely depends on where people get their information from.

Many websites, for example, spread inaccurate or even incorrect information about health and nutrition.

Some news outlets also oversimplify or misinterpret the results of scientific studies and the results are frequently taken out of context.

Other information may simply be outdated or based on theories that have never been fully proven.

Food companies also play a role. Some promote products, such as weight loss supplements, that do not work.

Weight loss strategies based on false information can hold back your progress. It’s important to choose your sources well.

Summary Misinformation may contribute to weight gain in some people. It can also make weight loss more difficult.

If you have concerns about your waistline, you should not use this article as an excuse to give up.

While you can’t fully control the way your body works, you can learn how to control your eating habits and change your lifestyle.

Unless there is some medical condition getting in your way, it is within your power to control your weight.

It often takes hard work and a drastic lifestyle change, but many people do succeed in the long run despite having the odds stacked against them.

The point of this article is to open people’s minds to the fact that something other than individual responsibility plays a role in the obesity epidemic.

The fact is that modern eating habits and food culture must be changed to be able to reverse this problem on a global scale.

The idea that it is all caused by a lack of willpower is exactly what food producers want you to believe, so they can continue their marketing in peace.

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