Controlling our body weight and staying healthy is a thorny issue for just about everyone, but for some people, it’s about more than just eating right and exercising more often. We asked the doctors of the recently opened Jiahui Bariatric Clinic to discuss this important topics of obesity and weight loss. Jiahui Bariatric Clinic’s multi-disciplinary team includes general surgery, endocrinology, nutrition, cardiology, rehabilitation, psychology, plastic surgery, anesthesiology, otolaryngology, sleep medicine, and case management services.

 

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 years old were overweight or obese.

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

Being obese or overweight has a serious impact on your health, and the risk of serious disease is higher in obese patients. Over accumulation of fat can lead to a variety of 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, and depression. In addition, obesity will increase the risk of endometrial, prostate, esophageal, ovarian, kidney, large intestine, breast, liver, pancreatic and other cancers. The life expectancy of obese people may be 5 to 20 years shorter than people with a healthy body weight due to these serious diseases.

1-Diet, exercise, and living habits
For people with severe obesity, the effect of adjusting their daily living habits is very limited: large study samples indicated that only 5-10 percent of patients can maintain an ideal weight after a few years. Jiahui dietitians and physical therapists are dedicated to offer individualized living habits adjustment plans to help our clients lose weight effectively. Under the guidance and supervision of our professionals, your weight loss goals can be achieved.

2-Medication treatment
Medication is one alternative for obese or overweight clients, but they should not be considered a replacement for changes in diet and living habits. A combining medication with changes in lifestyle habits can help patients lose 3-9% more weight than either option on its own. However, treatment with medication is not for everyone: children, elderly people over 70 (especially elderly adults with multiple illnesses) and pregnant women are not advised to use medication. Moreover, medications may have side effects, and the patient may regain the weight after they stop using the medication.

3-Surgical treatment
Laparoscopic 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.

Laparoscopic 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.

Who should consider weight loss/metabolic surgery?

The following groups may consider weight loss/metabolic surgery:

• Age ≥ 18 and < 65 years

• 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

• 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
  

• 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