Thursday, August 11, 2011

Surgery for Severe Obesity

Surgery for severe obesity

Obesity or excess body fat is a problem of modern lifestyle, thanks to junk food, hectic lifestyle and lack of exercise. Initially obesity was considered a problem of the western world. However, developing countries like India are expected to become the obesity capital of the world by the coming decade. Though it is best to prevent obesity from developing, people who unfortunately have this problem need not loose heart, as this can be effectively corrected by modern medicines and surgery when needed. 

What exactly is Obesity?

It means accumulation of unwanted, excess fat, either generally all over the body or locally, in one or more areas. Significant weight gain, seen in generalized Obesity, is decided as per the person’s height. It is expressed as a ratio called BMI – Body mass index. BMI >30 is considered overweight, >35 is severely overweight. The recommended BMI to call a person as healthy is 25-30.

Why is Generalized Obesity considered a serious health problem? 

Increasing weight brings a person to the doorsteps of further health problems like Diabetes, Hypertension, Heart Disease, High Cholesterol, Stroke and Kidney problems. However, medical research has proved that controlling body weight is the key to keeping a check on these problems – to prevent these diseases from developing in someone with high risk OR to control the problem by reducing the excess weight.

What are the problems due to Local Obesity?


This unwanted excess fat just beneath the skin results in loss of body shape in the particular area leading to both physical and psychological problems.


Embarrassment due to a pot belly in a male, wide hips or large buttocks in a female or large breast like chest in a teenager are quite common. This ‘extra bulge’ results in an unpleasant look, loss of attractiveness. When severe, the person may become a target of teasing/comments by colleagues/friends. Limitation in clothing and change in posture to hide the deformity lead to a change in personality and lifestyle to a more reserved type.This constant peer pressure leads to loss of self-esteem and depression; especially when the common remedy of exercise and diet control fails to help. Physical problems are usually specific to the area of unwanted local fat. Excess inner thigh fat causes skin irritation due to constant rubbing with the other thigh, excess abdomen fat with loose hanging skin interferes in personal activities as passing urine, sexual activity and walking; excess breast and tummy fat increases the load on the spine with increased risk for spondylosis and disc prolapse. Unwanted skin folds lead to poor skin hygiene and increased infection risk, especially in a hot and humid climate seen in any tropical country.

A unique problem is the bulging male belly, called the ‘android pattern’ of fat deposition. In addition to the fat beneath the skin (parietal fat) there is significant fat deep inside the abdomen (visceral fat), even though there is no visible fat anywhere else. In contrast to this, unwanted fat deposits in females tend to be parietal fat - seen in the hips, buttocks and thighs – the ‘Gynoid pattern’ of fat deposition. While visceral fat may be reduced to some extent without surgery - by exercise and diet control, parietal fat does not respond to the same measures – it needs liposuction for removal when in excess. Thus liposuction gives more dramatic results in females compared to males.

So, what are the benefits of correcting this excess local fat?

It improves body shape, appearance and restores beauty with obvious psychological benefits. Since time immemorial, a pleasing/attractive body shape has been considered to represent good health. This is because the human mind uses beauty as an indicator of overall health of a person. Even though a person with minimal loss of body shape may very well be healthy, the subconscious mind of an observer will see this unfavourably, in any situation in life. It is common knowledge, that attractive people get preferential treatment in situations such as marriage and employment. They get better opportunities in workplace, public life and personal life. Thus restoration of a pleasant body shape improves a person’s self-confidence and allows him to do better in the modern competitive, high pressure life.

So how is obesity corrected? 

Naturally, prevention is the best cure, but what about someone who already has this problem? Correct diet and exercise are very effective tools to maintain health and weight, but how effective are they in shedding the extra fat? They are certainly helpful, though with limitations. A high protein with low carbohydrate & fat diet – on advice of a dietician – along with exercise, when followed strictly over a few weeks can help in fat loss, especially visceral fat. However, these do not help in two situations. One, in the severely obese person, with significant visceral and parietal fat who may find it difficult to even move around due to the excess weight or associated diseases; second in people with near- normal weight with unwanted fat just beneath the skin-parietal fat. The first group of people needs Bariatric surgery – a surgery on the stomach and intestines; cosmetic surgery for the parietal fat plays a supplementary role-later. The second group can be helped only by Cosmetic Surgery.

A person with unwanted bulges, who is not overweight, initially tries to loose the excess fat by exercise and food restriction. However this local fat is beyond the general control mechanism of the body as it is not contributing to excess weight. Hence the person fails in his efforts , gets dejected and gives up exercise and diet control - this actually aggravates the problem. The person falls deeper into the trap of overeating and weight gain. It is in this group of patients that Cosmetic Surgery plays a vital role to break the vicious cycle – once significant removal of the parietal fat is achieved by surgery, the improved looks keeps the person motivated to loose the further visceral fat or maintain overall health by regular exercise and diet control.

How exactly does Cosmetic Surgery restore an attractive shape?

A Plastic Surgeon evaluates the problem area and decides on the cause of shape loss. When the fat excess is the primary problem, and the loose skin only secondary to this, liposuction alone may be sufficient to tackle the problem. The loose skin will shrink after fat correction to adjust to the new body shape. If the excess skin is far greater than the excess fat, skin is unlikely to shrink after removal of fat alone - skin needs to be removed at the time of the initial procedure itself. This procedure is called as tummy tuck when done for the abdomen, Brachioplasty for the arms and Thigh-plasty when done for the thigh. With proven benefits of both these procedures, they are now done regularly worldwide in increasing numbers, fueled by improved beauty consciousness and a spiraling demand for beauty restoration and enhancement.                                                                    



However, when body reshaping surgery is needed in multiple areas, staged surgery is safer – only few areas are tackled at a time, to keep the procedure within safe limits. Also, once fat is removed by liposuction, it is unlikely to recur unless there is a significant weight gain. Thus, when done by a trained Plastic Surgeon, Liposuction gives predictable results with minimal risk of discomfort or complications.

Among the most severe of psychological problems due to unwanted local fat are seen in a teenager with Gynaecomastia – bulging chest in a male giving a breast like feminine appearance.This causes multiple problems, usually seen in situations such as gym class or swimming- when the child/adolescent needs to remove the shirt in the presence of others. This puts the person at a risk of not only embarrassment, but also physical harm. Individuals with no regression or even progression of the deformity often receive little or no understanding about the shame and humiliation they experience. Coaches, physicians, parents, and peers (both boys and girls) can inflict damage out of ignorance, cruelty, or both. Postural and clothing modifications to mask the deformity are the norm in these patients from puberty through adulthood. Correction restores self esteem, the person is able to stand with his chest out and take on life’s daily challenges with a new air of confidence.


Thus surgical procedures for body reshaping, done scientifically with adequate safety, can restore a person’s body image and self-confidence. This can give the extra push needed in life by opening new doors of opportunity and change a person’s life altogether. It is noteworthy that if these procedures are overdone or are done with disregard for safety norms or by inadequately trained persons, there is a risk of major life threatening complications. It is such events that result in ‘sensational’ news and brings discredit to both the procedure and the specialty. Improved awareness alone will enable society to benefit by use of these measures in a safe way.