Over Weight is now a main issue of great concern in our day to day
life,whether child or adult or a retired person or old every body now
is concerned for this.It is a known fact that Overweight is related to
bad physique,uglylooking,inferiority complex,a psychological complex
leading neropsychiatric disease mixed with anxiety,depression,
sleepnessness,bad performance in day to day activities,less concern
for education,sports ,l azyness and no interst in personal and
physical meeting leading to overeating and viceversa gaining more
weight.Beside this aspect of Weight concerns in our middle aged and
youngesters,it is of our concern in aged person as it is directly
related to Diabetes,Hypertension(High BP)leading cause of more hear
attack,Chest pain,Storke and paralysis, Kidney Failure,clogging and
blockage of Arteries, changes in vision,sedantry habits,addictions,
psychosomatic and sexual diseases beside arthritis,pain over heels and
knee joinst and over accidents and skin diseases.
I know each and everyone of us (including me) at some point in our
lives are fighting the “battle of the bulge”, hence it is a worth
writing on this topic.
Another reason for this writing is the fact that notwithstanding the
“magical guaranteed weight loss” as advertised as we regularly see in
print or electronic media,internet or socalled practitioners of
different types like yoga,acupressure,reki,physical educator,gyms and
physical training centres, Exercise centres and instrument sellers and
companies of different type of weight reducing machines and devices
and beauty ayurvedic,homeo and ingenious and allopathic centres are
claiming and attracting every set of people and now senior Doctors are
running a camp of Obesity reducing surgeries through laproscopes (Mini
Hole surgeries )with a surest gurantee of melting down few KGS in few
days.But is it so easy! or so safe without any side effects ? Let me
be a party pooper here by saying emphatically…there are no and I mean
NO SHORT CUTS.EVERY TIME WE RESORT TO THESE DEVICES EITHER MOST OF THE
ARE SHORT LASTING OR WE HAVE TO BEAR SOME SIDE EFEFECTS IF WE ARE NOT
VERY MUCH DEDICATED FOR OUR EFFORTS TO REDUCE OVERWEIGHT SERIOUSLY,SO
WE GAIN WHAT WE LOOSE IN EARLY DEDICATION.
So let us see why this is such a big problem and what are some of the
factors that play a role in weight gain. I would call it weight gain
rather than obesity because the term obesity does not include
overweight people by definition.
This brings us the fundamental question, when would one be called
normal / overweight/ obese or morbidly obese? This classification is
based on BMI or Body Mass Index, which is basically a product of a
person’s bodyweight divided by a person’s height. A BMI of 18-25 is
normal, 25-28 over weight, 28-35 obese and above 35 morbidly obese.
You can calculate your BMI using this online link on any health portal website.
Why does one gain weight? This is a question the answer to which each
and everyone wants to know, because if we know the answer to this,
very easily we can avoid the causes thereby avoiding weight gain.
Sounds pretty simple, doesn’t it?? Sadly it isn’t that simple.
But to take a common analogy that I give to my patients’ weight gain
is like a bank balance, there are only to ways to increase your bank
balance (weight) either you earn more (increased intake) or spend less
(decreased output).
But sadly I’m sure all of us agree it’s easier to gain weight (except
for the lucky few who have genetics on their side), than increase your
bank balance. Now once we have the grass root level basic fundamental
cause of weight gain let us examine a few reasons as to why and how it
actually happens.
INCREASED INTAKE / WRONG INTAKE / IMPROPER INTAKE
As you can see from the heading, it is not only increased intake but
also the intake of wrong kinds of food and improper intake, which also
contributes to weight gain.
1.Over eating: Though most of us tend not to agree to it, it is often
the most common cause for weight gain. Every time you have that extra
spoonful, it adds up in the long run. It is said that after a meal one
should feel that he can have a little more…. that, is the time one
should stop. But more often than not, we stop when we feel full and
that is already too much.
2. Fast food: Fast food is fast to make and convenient to eat can be
eaten on the move but more often than not is full of fats/cheese &
salt.
Anyone who has read science in school knows that fat has more calories
(9Kcals/gm) as compared to protein (4Kcals/gm) or carbohydrates
(4Kcals/gm). So, the more fats you eat the more calories you are
putting in. Carbohydrates are easy to absorb and after your basic
energy requirements are met, are converted to fat for storage.
Chips – a favorite amongst most is another common cause. An old saying
for them, which holds very true, is “ A minute on your lips & a
lifetime on your hips”, hence avoid them.
Increased salt intake causes more water retention in the body and
hence is also an important factor for weight gain.
3.Improper timing: The time of a meal also is an important factor.
Food should be eaten at least 2 hours before one goes to bed to allow
digestion to occur properly. So, siesta’s after a heavy lunch or
eating just before going to bed are not such good ideas after all.
There is research also to suggest that, the later in the night one
eats, the more chances are that all that food is being converted to
fat. So, having “ a midnight snack or munchies” is again not such a
great idea.
4.Alcohol: Alcohol has often been blamed for gaining weight but the
gain in weight is more related to the increased snacking, which goes
along with consumption of alcohol.
5.Fizzy Drinks: These are aerated drinks with empty calories, which
are of no use and add up to the over all “Bank Balance of Calories”.
Instead, substitute it with fresh fruits or fresh lime, which is much
healthier but of course try and avoid excess salt or sugar in them.
DECREASED OUTPUT:
This is now turning out to be an important part of the whole weight
gain process, especially so in youngsters and children.
1.Sedentary lifestyles: Now with the comfort levels increasing,
activity has reduced. We use the lifts instead of stairs, vacuum
cleaners instead of brooms, cars instead of walking, etc. The amount
of calories burnt per day is decreasing with more mental activity than
physical.
Some amount of physical activity is needed daily to keep the Basal
metabolic rate higher so that you can burn more calories. Of course
though ideal, considering family and work pressures, it is
understandable that a regular gymming schedule is not always possible.
But, one can incorporate small things into the daily schedule to
increase the output like taking the stairs instead of the lift,
walking to the nearby store instead of driving, morning or evening
walks, etc which do not take up too much of your time but help in
spending those calories.
2. Children especially should have some regular physical activity in
their daily schedule or we are going to be waking up to a generation
of overweight youngsters. It is already happening in the west and is a
major health hazard. We can see it happening around us in India too.
Real games instead of Video Games, fruits instead of chips or pizza &
fruit juices instead of a fizzy drink should be the mantra for the
kids.
MEDICAL CONDITIONS FOR WEIGHT GAIN:
There are a few medical conditions that can be a cause for weight
gain. These are usually hormonal imbalances. The most common being:
1.Hypothyroidism: Here there is a decreased secretion of “Thyroid
Hormone” which is responsible to maintain the Basal Metabolic Rate and
hence there is a tendency towards weight gain. This is a treatable
condition and after proper tests to find out the hormonal levels,
replacement of the hormones causes a reduction in weight.
2. PCOD: Poly Cystic Ovarian Disease or PCOD is another condition
associated with weight gain. Here again the hormonal imbalances cause
weight gain and the weight gain in turn worsens the PCOD. Medical &
surgical options are available for treatment of this condition. A
curious thing seen here is that weight reduction helps with the
gyneacological condition with normalization of hormones.
3. Adrenal Hormonal Imbalance: This also can cause weight gain because
of water retention.
WEIGHT GAIN & DIETING
A lot has been written n said about dieting and weight loss. Every
other person is an expert in some sort of a diet. But a recent study
has brought the proper perspective, as I have been saying for quite
some time now, its not what kind of a diet you follow but the total
intake versus the total output.
So whether it’s a low carb diet, a low fat diet or an only protein
diet, it doesn’t really matter. What matters is,the total amount of
calories going in.
Crash Dieting is a not a way to loose weight at all. You might loose
weight initially but you are loosing muscle bulk and replacing it with
fat. And most of the food that one eats gets converted to fat directly
because of the body’s survival mechanisms. Secondly, with crash
dieting there is a tendency to alternate binging with crash dieting
and this doesn’t help.
So, what one needs is a proper balanced diet according to the work he
or she does, which has all the necessary nutrients.
TREATMENT OPTIONS
I’m sure all of us have heard or read quite a bit on the treatment
options. I’m not going to discuss exercise, lifestyle modification and
diet control which are essential to all treatments as an adjunct.
For the ease of understanding, I will divide the treatment options
according to the BMI.
BMI of 25-28(30) – Overweight Category:
This is the category for which we have the most number of options.
1. Isometric Exercise/ Non Surgical Body Contouring – This is an
option where in, with the help of targeted muscle stimulation & Infra
red waves, isolated areas of the body are treated to achieve targeted
contouring and inch loss. Here the patient comes in twice or thrice a
week to the center, where the machine does the work for them and helps
to achieve targeted contouring.
Very good for people in whom muscle laxity is a cause for bad body
contour especially in the tummy area. Also very good immediately post
pregnancy to help reduce the flab and tighten the muscles which have
become loose post pregnancy and child birth
2. Ultrasonic Lipolysis: This involves breaking down the fat cells
directly with the use of a non-invasive ultrasonic wave. The patient
comes in once a month for the treatment, which lasts 45 mins to an
hour. The released fat has to be reabsorbed and excreted by the body.
It works well for small isolated areas like the saddlebags, lower
tummy. This doesn’t work for large areas.
3. Injection Lipolysis or MESOTHERAPY: This involves giving multiple
injections in the target areas to help dissolve fat in that area. The
injection is usually of a derivative of Soya protein, which helps the
cell membranes of the fat cells to break down and release the fat into
the body. This is absorbed by the body and excreted.
It requires injections maybe once a month for 4 or 5 times. It works
well if given properly and for small areas like the double chin or the
saddlebags. Contrary to what people might claim it is not for large
areas. Complications in the form or small injections abscess or
collections of liquefied fat, which may require drainage, are
occasionally seen.
4. LASER Lipolysis: This is a minimally invasive procedure which
involves insertion of a small LASER probe in the affected area help
break down the fat cells in the track of the probe thereby releasing
fat into the body which is reabsorbed and excreted. This is also an
office procedure and requires multiple sittings maybe a month apart.
Works well again for isolated areas like double chin, cheek fat,
saddlebags, arms, etc. Large volume Lipolysis again is technically
possible to a certain extent but not practical. The patient does need
to use pressure garments, should have the patience to wait for the
results for a few months and of course undergo multiple sittings.
5. Liposuction: This is a surgical procedure where a cannula is
inserted under the skin by small 1-1.5 cm incisions in hidden areas to
suck out the fat. This again is a procedure for body contouring.
Though one does loose weight, he will loose more in inches
There are various techniques like the mechanical, ultrasonic, VASER,
power assisted. All these are different methods of suction depending
on the type of probe used to breakdown the fat cells.
As regards to the technique there is also the tumescent technique
which is the preferred technique nowadays and basically involves
infiltrating large volumes of saline along with some drugs to help
minimize bleeding and trauma to other structures in the vicinity.
Liposuction can also be classified according to the volumes to be
removed. Small, moderate or mega liposuctions. Small volume suction
can be done under local anaesthesia. Moderate volumes can be done
under local anaesthesia with sedation or general anaesthesia depending
on the patient’s comfort level. Mega liposuctions require anaesthesia,
hospitalizations and in some rare instances blood transfusions.
Internationally, the accepted volumes of fat that can be safely sucked
out at one sitting is @ 8% of body weight in men and @ 9-10% of body
weight in women. This is because of the fact that men tend to have an
equal amount of fat inside the abdomen, whereas in women most of the
fat is extra abdominal and also the fat that men have more fibrous
fatty deposits. Hence, women are good candidates for liposuction.
Problems after liposuction are because of the swelling. Here as the
fat is physically being sucked out, the effects are noticed
immediately, but in a few days swelling sets in and takes around a
month before significant changes can be felt. This also depends on the
areas targeted and the amount removed. Full healing takes around 3-4
months and during this period the patient needs to wear a pressure
garment to help the skin shrink. Some amount of unevenness maybe
present which gradually settles with time and massages.
Rarely in smokers, there maybe areas of skin necrosis. Sometimes
especially with large volume liposuctions, there maybe some collection
of fluid called seroma’s which might require drainage.
BMI of 30-35 – Obese Category:
This category is the so-called “Grey Zone” of weight loss treatments.
As these patients are not yet candidates for a Bariatric procedure and
the procedures for the overweight category cannot fully help in
treating these patients. But increasingly we are seeing patients in
this category.
In these patients it has to be a combination of procedures and
sometimes multiple sittings are needed to get the desired changes.
More often than not we do large volume liposuction in such cases,
maybe one or two sittings with a gap of 6 months in between combined
with a proper diet and exercise schedule. The procedure of Liposuction
has already been discussed.
BMI of 35 and more – Morbidly obese Category:
These patients have other metabolic problems along with the fact that
they are overweight. These are candidates for Bariatric procedures
that are procedures aimed at reducing the intake drastically (Gastric
banding or Sleeve gastrectomy) or reducing absorption of food (Gastric
& Duodenal bypass procedures).
These are major surgeries and have to be done in specialized centers
and involve a multidisciplinary approach with the involvement of
plastic surgeon, gastroenterologist, psychiatrist, dietician, physical
therapists, anesthetists, etc. This itself is a topic by itself.
The aim of this blog was to try and bring things into perspective for
a person looking at weight loss or to just get in shape. Ultimately, “
a Stitch in time does save Nine”! So the earlier we wake up to the
fact that weight is becoming a problem to all of us, the better it is.
If not to reduce, at least try and modify our lifestyle and being
about some changes in how we do things, it might help prevent the
problem from becoming worse, where a much more drastic and major
procedure might be required.
As you must have seen in the course of the blog that, this is not a
simple topic and I have not even scraped the surface of the problem.
But, the aim is to try and simplify things so one can understand what
are the little things we can do to bring about a bigger change.
Whatever said and done, all the procedures are only an adjunct to
lifestyle modification to get the full benefits in the long run.
Change in dietary habits, maintaining a negative intake output
balance, increasing physical activity will all go a long way in
helping one keep fit and stay healthy.Simple formula is enought your
ouput or expenditure should be more than your input or intake,a strong
mind with dedication brings change drasitically but one fact is common
in India after heart attack or Kidney failure or Stroke many Obese
becomes thin dur to strong dedication and confrmed rigid power of
determination to reduce weighrt ,so be positive result must come.
So let us bring about the change… by being the change!!!!
DR.D.R.NAKIPURIA
SILIGURI
drnakipuria@hotmail.com
life,whether child or adult or a retired person or old every body now
is concerned for this.It is a known fact that Overweight is related to
bad physique,uglylooking,inferiority complex,a psychological complex
leading neropsychiatric disease mixed with anxiety,depression,
sleepnessness,bad performance in day to day activities,less concern
for education,sports ,l azyness and no interst in personal and
physical meeting leading to overeating and viceversa gaining more
weight.Beside this aspect of Weight concerns in our middle aged and
youngesters,it is of our concern in aged person as it is directly
related to Diabetes,Hypertension(High BP)leading cause of more hear
attack,Chest pain,Storke and paralysis, Kidney Failure,clogging and
blockage of Arteries, changes in vision,sedantry habits,addictions,
psychosomatic and sexual diseases beside arthritis,pain over heels and
knee joinst and over accidents and skin diseases.
I know each and everyone of us (including me) at some point in our
lives are fighting the “battle of the bulge”, hence it is a worth
writing on this topic.
Another reason for this writing is the fact that notwithstanding the
“magical guaranteed weight loss” as advertised as we regularly see in
print or electronic media,internet or socalled practitioners of
different types like yoga,acupressure,reki,physical educator,gyms and
physical training centres, Exercise centres and instrument sellers and
companies of different type of weight reducing machines and devices
and beauty ayurvedic,homeo and ingenious and allopathic centres are
claiming and attracting every set of people and now senior Doctors are
running a camp of Obesity reducing surgeries through laproscopes (Mini
Hole surgeries )with a surest gurantee of melting down few KGS in few
days.But is it so easy! or so safe without any side effects ? Let me
be a party pooper here by saying emphatically…there are no and I mean
NO SHORT CUTS.EVERY TIME WE RESORT TO THESE DEVICES EITHER MOST OF THE
ARE SHORT LASTING OR WE HAVE TO BEAR SOME SIDE EFEFECTS IF WE ARE NOT
VERY MUCH DEDICATED FOR OUR EFFORTS TO REDUCE OVERWEIGHT SERIOUSLY,SO
WE GAIN WHAT WE LOOSE IN EARLY DEDICATION.
So let us see why this is such a big problem and what are some of the
factors that play a role in weight gain. I would call it weight gain
rather than obesity because the term obesity does not include
overweight people by definition.
This brings us the fundamental question, when would one be called
normal / overweight/ obese or morbidly obese? This classification is
based on BMI or Body Mass Index, which is basically a product of a
person’s bodyweight divided by a person’s height. A BMI of 18-25 is
normal, 25-28 over weight, 28-35 obese and above 35 morbidly obese.
You can calculate your BMI using this online link on any health portal website.
Why does one gain weight? This is a question the answer to which each
and everyone wants to know, because if we know the answer to this,
very easily we can avoid the causes thereby avoiding weight gain.
Sounds pretty simple, doesn’t it?? Sadly it isn’t that simple.
But to take a common analogy that I give to my patients’ weight gain
is like a bank balance, there are only to ways to increase your bank
balance (weight) either you earn more (increased intake) or spend less
(decreased output).
But sadly I’m sure all of us agree it’s easier to gain weight (except
for the lucky few who have genetics on their side), than increase your
bank balance. Now once we have the grass root level basic fundamental
cause of weight gain let us examine a few reasons as to why and how it
actually happens.
INCREASED INTAKE / WRONG INTAKE / IMPROPER INTAKE
As you can see from the heading, it is not only increased intake but
also the intake of wrong kinds of food and improper intake, which also
contributes to weight gain.
1.Over eating: Though most of us tend not to agree to it, it is often
the most common cause for weight gain. Every time you have that extra
spoonful, it adds up in the long run. It is said that after a meal one
should feel that he can have a little more…. that, is the time one
should stop. But more often than not, we stop when we feel full and
that is already too much.
2. Fast food: Fast food is fast to make and convenient to eat can be
eaten on the move but more often than not is full of fats/cheese &
salt.
Anyone who has read science in school knows that fat has more calories
(9Kcals/gm) as compared to protein (4Kcals/gm) or carbohydrates
(4Kcals/gm). So, the more fats you eat the more calories you are
putting in. Carbohydrates are easy to absorb and after your basic
energy requirements are met, are converted to fat for storage.
Chips – a favorite amongst most is another common cause. An old saying
for them, which holds very true, is “ A minute on your lips & a
lifetime on your hips”, hence avoid them.
Increased salt intake causes more water retention in the body and
hence is also an important factor for weight gain.
3.Improper timing: The time of a meal also is an important factor.
Food should be eaten at least 2 hours before one goes to bed to allow
digestion to occur properly. So, siesta’s after a heavy lunch or
eating just before going to bed are not such good ideas after all.
There is research also to suggest that, the later in the night one
eats, the more chances are that all that food is being converted to
fat. So, having “ a midnight snack or munchies” is again not such a
great idea.
4.Alcohol: Alcohol has often been blamed for gaining weight but the
gain in weight is more related to the increased snacking, which goes
along with consumption of alcohol.
5.Fizzy Drinks: These are aerated drinks with empty calories, which
are of no use and add up to the over all “Bank Balance of Calories”.
Instead, substitute it with fresh fruits or fresh lime, which is much
healthier but of course try and avoid excess salt or sugar in them.
DECREASED OUTPUT:
This is now turning out to be an important part of the whole weight
gain process, especially so in youngsters and children.
1.Sedentary lifestyles: Now with the comfort levels increasing,
activity has reduced. We use the lifts instead of stairs, vacuum
cleaners instead of brooms, cars instead of walking, etc. The amount
of calories burnt per day is decreasing with more mental activity than
physical.
Some amount of physical activity is needed daily to keep the Basal
metabolic rate higher so that you can burn more calories. Of course
though ideal, considering family and work pressures, it is
understandable that a regular gymming schedule is not always possible.
But, one can incorporate small things into the daily schedule to
increase the output like taking the stairs instead of the lift,
walking to the nearby store instead of driving, morning or evening
walks, etc which do not take up too much of your time but help in
spending those calories.
2. Children especially should have some regular physical activity in
their daily schedule or we are going to be waking up to a generation
of overweight youngsters. It is already happening in the west and is a
major health hazard. We can see it happening around us in India too.
Real games instead of Video Games, fruits instead of chips or pizza &
fruit juices instead of a fizzy drink should be the mantra for the
kids.
MEDICAL CONDITIONS FOR WEIGHT GAIN:
There are a few medical conditions that can be a cause for weight
gain. These are usually hormonal imbalances. The most common being:
1.Hypothyroidism: Here there is a decreased secretion of “Thyroid
Hormone” which is responsible to maintain the Basal Metabolic Rate and
hence there is a tendency towards weight gain. This is a treatable
condition and after proper tests to find out the hormonal levels,
replacement of the hormones causes a reduction in weight.
2. PCOD: Poly Cystic Ovarian Disease or PCOD is another condition
associated with weight gain. Here again the hormonal imbalances cause
weight gain and the weight gain in turn worsens the PCOD. Medical &
surgical options are available for treatment of this condition. A
curious thing seen here is that weight reduction helps with the
gyneacological condition with normalization of hormones.
3. Adrenal Hormonal Imbalance: This also can cause weight gain because
of water retention.
WEIGHT GAIN & DIETING
A lot has been written n said about dieting and weight loss. Every
other person is an expert in some sort of a diet. But a recent study
has brought the proper perspective, as I have been saying for quite
some time now, its not what kind of a diet you follow but the total
intake versus the total output.
So whether it’s a low carb diet, a low fat diet or an only protein
diet, it doesn’t really matter. What matters is,the total amount of
calories going in.
Crash Dieting is a not a way to loose weight at all. You might loose
weight initially but you are loosing muscle bulk and replacing it with
fat. And most of the food that one eats gets converted to fat directly
because of the body’s survival mechanisms. Secondly, with crash
dieting there is a tendency to alternate binging with crash dieting
and this doesn’t help.
So, what one needs is a proper balanced diet according to the work he
or she does, which has all the necessary nutrients.
TREATMENT OPTIONS
I’m sure all of us have heard or read quite a bit on the treatment
options. I’m not going to discuss exercise, lifestyle modification and
diet control which are essential to all treatments as an adjunct.
For the ease of understanding, I will divide the treatment options
according to the BMI.
BMI of 25-28(30) – Overweight Category:
This is the category for which we have the most number of options.
1. Isometric Exercise/ Non Surgical Body Contouring – This is an
option where in, with the help of targeted muscle stimulation & Infra
red waves, isolated areas of the body are treated to achieve targeted
contouring and inch loss. Here the patient comes in twice or thrice a
week to the center, where the machine does the work for them and helps
to achieve targeted contouring.
Very good for people in whom muscle laxity is a cause for bad body
contour especially in the tummy area. Also very good immediately post
pregnancy to help reduce the flab and tighten the muscles which have
become loose post pregnancy and child birth
2. Ultrasonic Lipolysis: This involves breaking down the fat cells
directly with the use of a non-invasive ultrasonic wave. The patient
comes in once a month for the treatment, which lasts 45 mins to an
hour. The released fat has to be reabsorbed and excreted by the body.
It works well for small isolated areas like the saddlebags, lower
tummy. This doesn’t work for large areas.
3. Injection Lipolysis or MESOTHERAPY: This involves giving multiple
injections in the target areas to help dissolve fat in that area. The
injection is usually of a derivative of Soya protein, which helps the
cell membranes of the fat cells to break down and release the fat into
the body. This is absorbed by the body and excreted.
It requires injections maybe once a month for 4 or 5 times. It works
well if given properly and for small areas like the double chin or the
saddlebags. Contrary to what people might claim it is not for large
areas. Complications in the form or small injections abscess or
collections of liquefied fat, which may require drainage, are
occasionally seen.
4. LASER Lipolysis: This is a minimally invasive procedure which
involves insertion of a small LASER probe in the affected area help
break down the fat cells in the track of the probe thereby releasing
fat into the body which is reabsorbed and excreted. This is also an
office procedure and requires multiple sittings maybe a month apart.
Works well again for isolated areas like double chin, cheek fat,
saddlebags, arms, etc. Large volume Lipolysis again is technically
possible to a certain extent but not practical. The patient does need
to use pressure garments, should have the patience to wait for the
results for a few months and of course undergo multiple sittings.
5. Liposuction: This is a surgical procedure where a cannula is
inserted under the skin by small 1-1.5 cm incisions in hidden areas to
suck out the fat. This again is a procedure for body contouring.
Though one does loose weight, he will loose more in inches
There are various techniques like the mechanical, ultrasonic, VASER,
power assisted. All these are different methods of suction depending
on the type of probe used to breakdown the fat cells.
As regards to the technique there is also the tumescent technique
which is the preferred technique nowadays and basically involves
infiltrating large volumes of saline along with some drugs to help
minimize bleeding and trauma to other structures in the vicinity.
Liposuction can also be classified according to the volumes to be
removed. Small, moderate or mega liposuctions. Small volume suction
can be done under local anaesthesia. Moderate volumes can be done
under local anaesthesia with sedation or general anaesthesia depending
on the patient’s comfort level. Mega liposuctions require anaesthesia,
hospitalizations and in some rare instances blood transfusions.
Internationally, the accepted volumes of fat that can be safely sucked
out at one sitting is @ 8% of body weight in men and @ 9-10% of body
weight in women. This is because of the fact that men tend to have an
equal amount of fat inside the abdomen, whereas in women most of the
fat is extra abdominal and also the fat that men have more fibrous
fatty deposits. Hence, women are good candidates for liposuction.
Problems after liposuction are because of the swelling. Here as the
fat is physically being sucked out, the effects are noticed
immediately, but in a few days swelling sets in and takes around a
month before significant changes can be felt. This also depends on the
areas targeted and the amount removed. Full healing takes around 3-4
months and during this period the patient needs to wear a pressure
garment to help the skin shrink. Some amount of unevenness maybe
present which gradually settles with time and massages.
Rarely in smokers, there maybe areas of skin necrosis. Sometimes
especially with large volume liposuctions, there maybe some collection
of fluid called seroma’s which might require drainage.
BMI of 30-35 – Obese Category:
This category is the so-called “Grey Zone” of weight loss treatments.
As these patients are not yet candidates for a Bariatric procedure and
the procedures for the overweight category cannot fully help in
treating these patients. But increasingly we are seeing patients in
this category.
In these patients it has to be a combination of procedures and
sometimes multiple sittings are needed to get the desired changes.
More often than not we do large volume liposuction in such cases,
maybe one or two sittings with a gap of 6 months in between combined
with a proper diet and exercise schedule. The procedure of Liposuction
has already been discussed.
BMI of 35 and more – Morbidly obese Category:
These patients have other metabolic problems along with the fact that
they are overweight. These are candidates for Bariatric procedures
that are procedures aimed at reducing the intake drastically (Gastric
banding or Sleeve gastrectomy) or reducing absorption of food (Gastric
& Duodenal bypass procedures).
These are major surgeries and have to be done in specialized centers
and involve a multidisciplinary approach with the involvement of
plastic surgeon, gastroenterologist, psychiatrist, dietician, physical
therapists, anesthetists, etc. This itself is a topic by itself.
The aim of this blog was to try and bring things into perspective for
a person looking at weight loss or to just get in shape. Ultimately, “
a Stitch in time does save Nine”! So the earlier we wake up to the
fact that weight is becoming a problem to all of us, the better it is.
If not to reduce, at least try and modify our lifestyle and being
about some changes in how we do things, it might help prevent the
problem from becoming worse, where a much more drastic and major
procedure might be required.
As you must have seen in the course of the blog that, this is not a
simple topic and I have not even scraped the surface of the problem.
But, the aim is to try and simplify things so one can understand what
are the little things we can do to bring about a bigger change.
Whatever said and done, all the procedures are only an adjunct to
lifestyle modification to get the full benefits in the long run.
Change in dietary habits, maintaining a negative intake output
balance, increasing physical activity will all go a long way in
helping one keep fit and stay healthy.Simple formula is enought your
ouput or expenditure should be more than your input or intake,a strong
mind with dedication brings change drasitically but one fact is common
in India after heart attack or Kidney failure or Stroke many Obese
becomes thin dur to strong dedication and confrmed rigid power of
determination to reduce weighrt ,so be positive result must come.
So let us bring about the change… by being the change!!!!
DR.D.R.NAKIPURIA
SILIGURI
drnakipuria@hotmail.com
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