Because of urbanization in India, lifestyle disorders such as obesity have spiked in people as there are major changes in the lifestyle and dietary habits in today's population. Obesity has many health effects on a person such as less physical strength, negative impact on mental health, and predisposition to other disease such as diabetes mellitus, hypertension, dyslipidaemia, cardiovascular issues, fatty liver disease, sleep apnoea, cirrhosis and cancer in different organs.
The recent statistics and data in India related to obesity and the ill effects on overall health are quite worrisome for everyone. As per the National Family Health Survey (NFHS-4A), a government health survey, it was concluded that men who are overweight in the country has increased by two times, in the past decade. On the other hand, one in every five women is now suffering from obesity. While the maximum cases of morbidly obese patients were found among the urban upper- and middle-class families, the rural population had also contributed a significant 15% of the total cases of obesity. Onlymyhealth editorial team spoke to Dr. Vikas Singla, Director & Head, Gastroenterology, Max Super Speciality Hospital, Saket, New Delhi, about the scar less treatment options for obesity.
Endoscopy treatment and advent of endoscopic weight loss procedure
The main goal of obesity treatment is to reduce the weight so as to achieve physical well being and reduce the obesity related complications. Ten percent reduction in total body weight (10 kg in person weighing 100kg) has been found to be associated with improvement in diabetes, hypertension and lipid levels. Reducing higher extra body weight will reduce the obesity related complications further. The nutritionist, psychologist, endoscopist and surgeon constitute a multidisciplinary team, which takes care of an obese individual, and helps them in achieving a healthy life. Though the physical activity and dietary changes havd been advocated as first line treatment for obesity, but the low efficacy and poor acceptance creates a demand for the alternate treatment options.
Endoscopic scar less solutions for obesity
The endoscopic scar less treatment options for obesity include:
1. Bariatric surgery
Bariatric surgery has proven to be effective treatment for achieving and maintaining long term weight loss. The success achieved in sustaining long term weight loss and resolution of obesity associated comorbidities such as diabetes and hypertension is notably significant. Despite being a very effective tool, only 1% of the eligible patients undergo bariatric surgery. So, there is always an unmet need of the procedure which is efficacious and has good acceptability. In the meantime, there are other endoscopic procedures that have taken a stride in the treatment of obesity and may fill this gap and provide an effective alternative.
2. Intra gastric ballooning (IGB)
Intragastric balloon is one of the most effective tools for reducing the excess body weight. IGB is mainly a non-surgical procedure that is performed under anesthesia. An endoscopic camera called gastroscope is inserted through the mouth inside the stomach to place a balloon. Once the camera is in the stomach, it is then filled with a sterile saline solution of around 500-750 ml, using a small tube attached to the balloon and then the tube is detached gently. And then, once in the stomach, it can result in early stomach filling and less calorie intake, because of the weight of the balloon.
In general, ballooning helps to lose 10% of total body weight loss (TBWL). A lot of patients are able to control insulin and reduce the oral medicines being taken to manage blood sugar, blood pressure and bad lipids. The total procedure including insertion and adjustment of the balloons can be performed within 25-30 minutes and the patient can be discharged either same or next day.
This procedure is very useful and effective without any major side effects. The Gastric balloon should be in the stomach for atleast 6-12 months and then should be removed endoscopically. For the removal, catheter attached to the balloon is pulled out, and balloon is deflated, grasped and removed through the mouth.
3. Endoscopic Sleeve Gastroplasty (ESG)
ESG is a new endoscopic technique effective in controlling the body weight where the stomach size is reduced. Endoscopic sleeve gastroplasty is done only under anaesthesia, and does not require any skin incision. Basically, a scope goes through the throat, inside the stomach, and sutures are applied which decreases the size of the stomach and limits the food consumption. After the procedure, the patients gets early satiety due to reduced stomach size, leading to lesser calorie intake, and effective weight loss. This procedure has shown a positive effect on the patients by treating the comorbid health conditions, and reducing the extra body weight.
This procedure is not only minimally invasive, but highly safe and effective also for weight reduction.
In most cases, the patient requires getting admitted in the hospital for 48 hours, and are discharged after some time. Large studies have established the safety and efficacy of these procedures. Expected weight loss is 20% of total body weight leading to control and reduction in obesity related comorbidities such as diabetes mellitus, hypertension, dyslipidaemia, sleep apnoea and osteoarthritis.
To ensure the safety and the better outcome, these endoscopic procedures should be performed on carefully selected individuals, in a centre specially equipped to take care for the obese, and in multidisciplinary setting that provides optimized post- procedure care. With the development and technology in terms of endoscopic solutions, it has increased options for the management of obese people, which truly is the main goal of science and doctors.
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