According to WHO..
Obesity and overweight is defined as abnormal or excessive fat accumulation that may impair health.
BMI is commonly used to classify overweight and obesity in adults.
Super Obesity
Heaviest person in the world:
Pre operative Obesity
Pre Operative work up.
Detailed history and physical examination.
Discussion of various wt loss option with the Patient and family and risk involved.
Successful outcome based on 3 components:
Exercise and compliance with the new dietary regime. 50 to 75% excess body weight loss in lap gastric bypass and lap sleeve gastrectomy.
40% to 50% excess body weight loss in lap gastric band.
Lifelong follow up: vitamin and mineral life long, psychological assessment for substance abuse, eating disorder and suicide tendencies.
BMI Index.
20 to 25 Normal.
25 to 30 Over weight.
30 to 35 Obese.
35 to 40 Morbid Obese.
40 Onwards Super Obesity.
Lab and Radiological Tests.
CBC, LFTS, RFTS, Lipid profile , Glycosylated Hb .
Serum CA, Serum iron ,Serum iron binding capacity, uric acid ,Serum copper and selenium.
Vit-A,B-1,B-6,B-12,Vit-C,Vit-D.
Para hormone.
Glucose tolerance test.
Pulmonary function test.
X-ray chest over 40 and usg abdomen to rule out gallstones.
Upper GI endoscopy to rule out Hiatus hernia.
Echo and cardiac evaluation for super obese pt.
OPTIONS FOR MORBID OBESITY.
Endoscopic intragastric balloon insertion.
Lap Gastric banding.
Lap gastric by pass/Duodenal switch.
Lap Sleeve Gastrectomy.
Indications – Bariatric surgery
Patients with BMI > 40 Kg/m2
Those with BMI of 35 and associated co morbid like DM, HTN, SLEEP APNEA, BACKACHE .
Failure of medical treatment and behavioral intervention including diet and exercise.
Intra Gastric balloon Technique.