Can Malnutrition cause obesity?

How Malnutrition Can Cause Obesity: Insights from Top Bariatric Surgeons

Obesity is a multi-factorial disease; it simply means that, no single cause which can be solely attributed to it. It is also well known that scientists do not know exactly what exactly causes weight gain. Often, we all see people who can eat whatever comes their way and they still remain thin. With the exception of these lucky few, we are programmed to gain weight with age.

According to top bariatric surgeons, it is a matter of the balance between what you eat, and how much you spend. If we consume calorie-dense food regularly and don’t burn those extra calories, we are likely to gain weight. But can malnutrition cause obesity?

Surprisingly yes.

Obesity Surgeons who treat obese teens know that children who were underweight at birth are prone to gain too much weight in their childhood and adolescence. Children who faced food shortages during famines later on developed abdominal obesity, the classic Indian Subcontinent profile of thin people with paunch, the so-called thin- obese in medical jargon. As we know that the tummy fat or abdominal obesity is the medically worst. This fat is the harmfully active type that leads to diabetes, heart disease, and cholesterol disorders, the so-called metabolic syndrome.

Malnutrition means not eating right; right food at the right time. People who starve for too long to lose weight are initially successful in losing some weight, but complex hormonal reactions result in weight regain, overshooting the earlier weight. This is known Yo-Yo dieting. Secondly, prolonged fasting slows down our metabolism and stops losing further weight, and starts regaining on the same diet. We tend to lose more muscle mass than fat during the starvation phase and fail to regain our muscle back. So with each dieting cycle of malnutrition, we lose more and more muscle mass and gain more fat.

Starvation or fasts followed by eating calorie-rich low protein food ultimately results in further weight gain and obesity. The best bariatric surgeons know well from their experience that protein-deficient diets after bariatric surgery are counterproductive in the long run and patients may end up regaining all their weight.

Malnutrition can really make us obese.

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Behavioural Disorders in Obese: Important to Evaluate before WLS

Addressing Behavioral Disorders in Obese Patients: The Role of Laparoscopic Bariatric Surgery

Laparoscopic Bariatric Surgery and Its Effectiveness

Laparoscopic Bariatric surgery is one of the most effective treatments of morbid obesity, resulting in significant and sustained weight loss as well as improvement of various other related co-morbidities and quality of life.

Prevalence of Psychosocial Disorders in Morbidly Obese Individuals

Along with all other co-morbid conditions like Type 2 Diabetes Mellitus, Hypertension, and PCOD, etc., the prevalence of psychosocial disorders, including suicidal behavior, as well as substance abuse or eating disorders, is quite high among morbidly obese individuals.

Importance of Psychiatric Evaluation Before Bariatric Surgery

That is why, while evaluating for bariatric surgery, a psychiatric evaluation of individuals undergoing bariatric surgery is a must nowadays, since one might miss a pre-existing mental illness leading to inadequate treatment before and after surgery.

Factors Contributing to Suicidal Behavior Post-Surgery

Some of these issues like lack of physical activity before and after surgery, lack of improvement in quality of life, persistence or recurrence of sexual dysfunction, and history of ill-treatment in childhood might contribute to suicidal ideas if not assessed preoperatively.

High Expectations and Potential Disappointments Post-Surgery

These patients might have very high expectations of body appearance post-operatively and might be disappointed by the physical outcomes of the surgery. Sometimes weight regain might also lead to suicidal behaviors.

Increased Alcohol Sensitivity Post-Bariatric Surgery

It has been found that after bariatric surgery, the alcohol sensitivity of certain individuals might rise. Alterations in the GI tract after surgery lead to altered absorption of alcohol. It has been seen on several occasions that certain individuals continue alcohol consumption after surgery. Therefore all candidates of bariatric surgery are counseled and educated about the ill effects of alcohol after bariatric surgery and to minimize the use of it.

Compulsive Eating Disorder and Its Persistence Post-Surgery

When undergoing the dietary pattern of morbidly obese patients, there is a high prevalence of compulsive eating disorder. These problems can also persist after bariatric surgery. Few patients may develop ‘loss of control’ eating, and even self-induced vomiting. These conditions are associated with less weight loss and increased fear of weight regain.

Importance of Comprehensive Follow-Up Programs

According to Dr. Atul NC Peters, one of the pioneers of weight loss treatment in Delhi and among the top 10 obesity surgeons in India, it is important that such follow-up programs are developed, that address these types of problems focusing on psycho-social factors as well as eating disorders for a successful outcome.

Obesity in Children and Adolescents

Addressing Obesity in Children and Adolescents: Causes, Risks, and Effective Interventions

The prevalence of obesity is increasing in both children and adolescents, in both sexes and in various ethnic and racial groups.

Many factors, including genetics, environment, metabolism, lifestyle, and eating habits, are believed to play a role in the development of obesity. However, more than 90% of cases are idiopathic; less than 10% are associated with hormonal or genetic causes.

Defining Obesity in Childhood and Adolescence

There is no single definition of obesity in childhood and adolescence.

Consensus committees all over the world have concluded that children and adolescents be considered overweight or obese if the BMI exceeds the 85th or 95th percentiles, on curves generated from the 1963-1965 and 1966-1970 NHANES, or exceeds 30 kg/m² at any age.

Energy Intake and Sedentary Lifestyle

During childhood and adolescence, excess fat accumulates when total energy intake exceeds total energy expenditure. Reduced energy expenditure is attributed to modern-day sedentary lifestyles. This is particularly associated with excessive television viewing, excessive computer use, and insufficient physical activity. Also, this is often seen when feedings are supplemented with additives such as carbohydrates or fat.

Hormonal Dysfunction and Familial Obesity

Some hormonal dysfunction like that in ghrelin leptin hormonal axis may be the causative factor in as many as 10% of obese children, particularly in those who appear to manifest familial morbid obesity.

Race and ethnicity are also associated with increased rates of obesity in children and adolescents.

Childhood Obesity as a Predictor of Adult Obesity

Childhood obesity is predictive of adult obesity such as with 80% of teenagers who are obese continue to be obese as adults.

This is associated with an increased incidence of type 2 diabetes, hypertension, gallstones, and hypercholesterolemia.

Chest Conditions Associated with Childhood Obesity

There are serious chest conditions associated with childhood obesity like reactive airways, poor exercise tolerance, increased work of breathing, and increased oxygen consumption.

They might develop obesity-hypoventilation syndrome and experience right-sided heart failure with right ventricular hypertrophy.

Acute Complications of Childhood Obesity

Acute complications of childhood obesity include hyperlipidemia, accelerated growth and bone maturation, ovarian hyperandrogenism and gynecomastia, cholecystitis, pancreatitis, and pseudotumor cerebri.

There is an increased incidence of fatty liver and they might develop liver cirrhosis and kidney disease.
Obstructive Sleep apnea and sleep-disordered breathing are common in children and adolescents with obesity which might lead to neurocognitive dysfunction.
Excess weight in children can cause numerous orthopedic disorders, including genu valgum, slipped capital femoral epiphysis, with bowing of the long bones.
Emotional and psychosocial sequelae are also widespread in obese children.
Social isolation, peer problems, and lower self-esteem are frequently observed.
Gout and colorectal cancer rates are found to be increased among men who had obesity as adolescents as well as arthritis.

Therapeutic Interventions for Childhood Obesity

Any therapeutic intervention in the child with obesity in aimed to achieve control of weight gain and reduction in body mass index (BMI) safely and effectively and to prevent the long-term complications of obesity in childhood and adulthood.

These might also require psychiatric assistance for unusual eating disorders or severe depression. It involves a team involving nurse educators, nutritionists, exercise physiologists, and counsellors.

Parental Involvement and Lifestyle Changes

Parents must advice children to walk at least 20 to 30 min daily. Limit their television timings and must indulge in vigorous exercise with children. Low-calorie balanced diet, in association with patient and parent education, behavioral modification, and exercise can limit weight gain in many patients with mild or moderate obesity. Reductions in total and saturated fat may be particularly useful in adolescents who consume large quantities of high-fat, snack, and packaged fast foods, including french fries, pizza, chips, and crackers. Also, they might sometimes require and care if evidence of psychopathology or dysfunction is present.

Bariatric Surgery for Childhood Obesity

According to Dr. Atul NC Peters, one of the pioneers of weight loss treatment in Delhi and among the top 10 obesity surgeons in India, various bariatric surgical procedures have been performed in “carefully selected” patients with a body mass index (BMI) >40 kg/m ² who have severe comorbidities such as nonalcoholic fatty liver disease. It is important to consider several other factors before deciding whether a child or adolescent should undergo bariatric surgery like previous attempts at weight loss, and ability to adhere to follow-up care. Laparoscopic sleeve gastrectomy is the most widely performed procedure in childhood obesity nowadays.

Evidence suggests that bariatric surgery can decrease the grade of steatosis, hepatic inflammation, and fibrosis in Non-Alcoholic Fatty Liver Disease. With more and more people opting for various bariatric surgical procedures, weight loss surgery cost in Delhi has been such that it is becoming affordable day by day and several finance and loan schemes are also available in special circumstances.

Bariatric Surgery in Delhi

The Rise of Bariatric Surgery in Delhi: A Comprehensive Solution for Obesity and Type 2 Diabetes

Increasing Prevalence of Obesity

There is a dramatic increase in prevalence of obesity. The traditional approaches like dietary and lifestyle modification, physical activity, and pharmacotherapy fail to facilitate weight loss and treat obesity. So, bariatric surgery is the most sustainable treatment option. Bariatric surgery also promises improvement in obesity-related comorbidities like type 2 diabetes, hypertension, dyslipidemia, arthritis, etc. so, the term bariatric surgery is now replaced with bariatric and metabolic surgery. These days metabolic surgery for diabetes has emerged as a proven tool for the resolution or control of type 2 diabetes. This weight loss treatment in Delhi is being done only at specialized centers, by adequately trained and expert surgeons. Thus it gives a permanent cure to this traditionally regarded as a progressive, unrelenting disease called type 2 diabetes.

Bariatric Surgery in Delhi

In the last few years, there has been an increase in weight loss treatment in Delhi. Many centers are currently performing bariatric surgery. Patients from every corner of India prefer to come to Delhi for bariatric surgery owing to the availability of the best medical facilities, trained and experienced bariatric surgeons, and specialized paramedic staff. Even International patients prefer Delhi, India for bariatric surgery.
Sleeve gastrectomy and roux-en-Y gastric bypass are the most commonly performed weight loss procedures. Metabolic surgery for type 2 diabetes targets patients with uncontrolled diabetes who are currently on oral drugs and insulin. Scientific literature reports that bariatric and metabolic surgery results in weight loss, improvement/ normalization of blood sugar levels, reduction/ withdrawal of diabetes medications, and decrease in cardiovascular disease risk factors. It is a simple procedure and the patients may be able to leave the hospital in one day or even the same day in selected cases.

Comparing Surgical Procedures

In patients with reflux disease and type 2 diabetes, the results of sleeve gastrectomy may be inferior to the roux-en-Y gastric bypass but the excess weight loss of both the procedures may be comparable in a select subgroup of patients.

Nutritional Considerations Post-Surgery

Nutritional deficiencies are present in obese patients as consumption of a high-energy diet compromises on protein, vitamin, and mineral intake. As Sleeve gastrectomy and roux-en-Y gastric bypass involve removal or bypassing of some parts of the stomach and /or small intestine, so, macronutrient (protein) and micronutrient deficiencies (calcium, iron, B12, vitamin D, folate, etc.) are very likely to occur post-operatively in the patients. Nutritional assessment remains the key component pre-operatively and post-operatively to identify, prevent, and treat nutritional deficiencies at an early stage. Nutritional assessment involves taking physical measurements of the body (height, weight, etc.), analyzing blood and urine samples, identifying deficiency signs and symptoms, and performing a comprehensive dietary assessment.

Ensuring Surgical Success

Consuming a well-balanced energy-restricted diet with vitamin and mineral supplements and timely follow-up with the bariatric team promises success of the surgery.

Weight loss surgery in India

Why India is Emerging as a Top Destination for Weight Loss Surgery

Rising Obesity Rates in India

With the persisting need to address the problem of malnutrition, India has developed another nutritional problem, obesity. According to the National Family Health Survey 4, the number of obese people in the country has doubled in the last decade.

Obesity and Type 2 Diabetes

It is a known fact now that obesity is the major reason for developing Type 2 Diabetes. Several studies have revealed that obesity accounts for 80-85% risk of developing type 2 Diabetes. Moreover, most of the world’s population lives in countries where overweight and obesity kill more people than underweight.

Bariatric Surgery as an Effective Solution

Bariatric surgery is now more efficacious than lifestyle changes or medical treatment for sustained weight loss and remission of Type 2 Diabetes.

Cost-Effectiveness of Bariatric Surgery

The cost of weight loss surgery versus the cost of medicines and lifestyle changes has been debated extensively. Similarly, not only savings but also cost-effectiveness of weight loss surgery have also been discussed. Various studies have demonstrated cost-effectiveness and cost savings for bariatric procedures compared with usual medical care or intensive lifestyle interventions. All of these studies have been carried out in setups where weight loss surgery has been expensive as compared to the eastern world.

Delhi: A Hub for Medical Tourism

New Delhi, the capital city of India has now become a popular destination for medical tourism. Millions of foreign tourists visit India annually for their medical needs. There are many world-class and reputed hospitals in Delhi, which provide exemplary services in the field of medical care. The presence of highly qualified and experienced weight loss surgeons along with institutions of international repute have made Delhi a prime city for weight loss surgeries in India.

Reasons to Choose India for Bariatric & Metabolic Surgery

According to Dr. Atul NC Peters, Senior Consultant and Head of Apollo Institute of Bariatric and Metabolic Surgery, Indraprastha Apollo Hospitals, New Delhi, more and more patients are flying from the Western world for bariatric surgery in India. Not only for weight loss surgery, but people have also started travelling for metabolic surgery for Diabetes in India. Reasons for choosing India as a favorite destination for Bariatric & Metabolic Surgery are innumerate, a few of them being:

Bariatric Surgery cost in India is approx. half to one-third of the cost of the Western world.
There are no long waiting lists, as patients seeking weight loss surgery in Delhi are given almost immediate treatment.
International accredited hospitals and surgeons.
Dedicated bariatric surgical program which includes a team of expert surgeons, nurses, dieticians, and bariatric care specialists.
Fully equipped operation theaters with trained anesthetist.
Dedicated intensivist with exposure to more than a thousand operated bariatric surgical patients.
Safe and effective results.
Long-term follow-up schedules.
Options for single incision surgery.
Options of Robotic Surgery.

Hence India is now a preferred destination for weight loss surgery as well as metabolic surgery.