Understanding the problem

Being Overweight and severe obesity are defined as abnormal or excessive fat accumulation that may impair health.

BMI or Body Mass Index (BMI) is a tool used to measure obesity. Obesity is classified as having a BMI of 30 or greater, whereby being overweight a BMI is defined between 25-29. Obesity increases your risk of developing related conditions such as diabetes, hypertension and sleep apnea, to name a few. Many individuals are affected by obesity and are not aware of it.

Understanding who suffers

Worldwide there are more people who are obese than underweight, with obesity having more than doubled between 1980 and 2014.

According to WHO:

  • In 2014, more than 1.9 billion adults were overweight. Of these over 600 million were obese.
  • Overall, about 13% of the world’s adult population (11% of men and 15% of women) were obese in 2014.
  • In 2014, an estimated 41 million children under the age of 5 years were overweight or obese.
  • Obesity is preventable.

In the past, obesity was thought to be caused by overeating and under-exercising, resulting from a lack of will power and self-control. Although these are significant contributing factors, doctors recognize that obesity is a complex medical problem that involves genetic, environmental, behavioural, and social factors.

Recent research shows that in some cases, certain genetic factors may cause the changes in appetite and fat metabolism that lead to obesity.

Although a person's genetic makeup may contribute to obesity, it's not the primary cause. Environmental and behavioural factors have a greater influence – consuming excess calories from high-fat foods and doing little or no daily physical activity over the long run will lead to weight gain. Psychological factors may also foster obesity. Low self-esteem, guilt, emotional stress, or trauma can lead to overeating as a means to cope with the problem.

Certain medical conditions such as binge eating disorder (BED), Cushing’s disease, and polycystic ovary syndrome can also lead to weight gain and obesity.

Potential Signs and Symptoms

Being overweight may not cause many noticeable problems. However, being obese may develop symptoms that affect daily life such as:

  • breathlessness
  • increased sweating
  • snoring
  • difficulty sleeping
  • inability to cope with sudden physical activity
  • feeling very tired every day
  • back and joint pains.

Obesity can also cause unnoticeable changes, but that can seriously harm health, such as high blood pressure (hypertension) and high cholesterol levels (fatty deposits blocking the arteries). Both conditions significantly increase the risk of developing a cardiovascular disease, such as:

  • coronary heart disease, which may lead to a heart attack
  • stroke, which can cause significant disability and can be fatal.

Another long-term problem that can affect obese people is type 2 diabetes. It is estimated that just under half of all cases of diabetes are linked to obesity. The main symptoms of diabetes are:

  • feeling very thirsty
  • going to the toilet a lot, especially at night
  • extreme tiredness.
Examinations Usually Required

If the BMI is in the obese range, health care providers will typically review patient's health history in detail, perform a physical exam and recommend some tests.

If the BMI is in the obese range, health care providers will typically review patient's health history in detail, perform a physical exam and recommend some tests.

These exams and tests generally include:

  • Taking complete health history (reviewing weight history, weight-loss efforts, exercise habits, eating patterns, medications, stress levels and other issues - conditions of a patient's health. Doctors may also review family's health history to see if predisposition is also responsible
  • A general physical exam. This includes also measuring height; checking vital signs, such as heart rate, blood pressure and temperature; listening to heart and lungs; and examining the abdomen.
  • Measuring waist circumference. Fat stored around the waist, sometimes called visceral fat or abdominal fat, and may further increase the risk of diseases, such as diabetes and heart disease. Women with a waist measurement (circumference) of more than 35 inches (80 centimetres, or cm) and men with a waist measurement of more than 40 inches (102 cm) may have more health risks than do people with smaller waist measurements. Like the BMI measurement, the waist circumference should be checked at least once a year.
  • Doctors will also check for other known possible health problems and may want to do blood tests to check for a range of other issues (these are outlined further down the page).
Proposing Treatment and Why AIMIS

Weight-loss surgery

In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories or both. While weight-loss surgery offers the best chance of losing the most weight, it can also pose serious risk.

Weight-loss surgery for obesity may be considered if other methods to lose weight that haven't worked and:

  • Body mass index (BMI) is 40 or more. This would be about 100 pounds (45 kilos) overweight for men or 80 pounds (35 kilos) for women.
  • BMI lower than 40 but posing serious health problem related to obesity, such as heart disease, type 2 diabetes, severe sleep apnea, high blood pressure or high cholesterol.
  • Understanding that lifestyle changes are necessary for surgery to work. Weight loss surgery can be lifesaving and life changing but its needs dedication to making dramatic and permanent changes to how one eats, exercises, and lives following surgery.

Common weight-loss surgeries include:

  • Gastric bypass surgery (Roux-en-Y Gastric Bypass) is the most common type of weight loss surgery. In this procedure the surgeon divides the stomach into two parts, sealing off the upper section from the lower. The surgeon then connects the upper stomach directly to the lower section of the small intestine. Essentially, the surgeon is creating a shortcut for the food, bypassing part of the stomach and the small intestine. Skipping these parts of the digestive tract means that the body absorbs fewer calories.
  • Gastric Band: Laparoscopic adjustable gastric banding (LAGB). In this procedure the stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently.
  • Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food.
  • Biliopancreatic diversion with duodenal switch. In this procedure a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed. It is only recommended in cases of severe obesity outlining a BMI of 50 or higher.

AIMIS is an expert in Robotic Bariatric Surgery involving the best US and International surgeons who are experts in the field.

AIMIS’s General Surgery -Bariatric Division Focuses On:

  • Gastric bypass surgery (Roux-en-Y Gastric Bypass)
  • Gastric Band
  • Gastric sleeve
  • Biliopancreatic diversion with duodenal switch.

To see the procedures we undertake with Robotic Xi Surgery, please click here

Getting More Information Before Moving Forward
You may have questions like:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
What AIMIS Can do:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide. AIMIS’s mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

Affordability

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

Further information on the problem:

Body mass index (BMI)

People are all built differently, so just weighing oneself cannot be used to decide if your weight is healthy. BMI is a standard measurement tool, doctors use to assess if someone's weight is putting their health at risk. It is a measure of weight related to height.

BMI is calculated by dividing weight (in kilograms) by the square of your height (in metres). So, for example, if someone weighs 90 kg and are 1.70 metres tall, their BMI is 90/ (1.70 x 1.70 = 31.2, which base d on the scaling chart, means this person is Grade 1 obese.

Accordingly, there are different categories of obesity as follows:

  • Ideal (normal) BMI is 18.5 to 24.9 kg/m2.
  • A BMI of 25-29.9 kg/m2 is overweight.
  • A BMI of 30-34.9 kg/m2 is obese (Grade I).
  • A BMI of 35-39.9 kg/m2 is obese (Grade II).
  • A BMI of ≥40 kg/m2 is obese (Grade III) or morbidly obese.

The higher the BMS, the more overweight a person is and puts greater risk to health. On the whole, BMI is a good estimate of how much of a specific person’s body is made up of fat. However, BMI may be less accurate in very muscular people. This is because muscle weighs heavier than fat. So, someone who is very muscular may have a relatively high BMI due to the weight of their muscle bulk but actually have a proportionally low and healthy amount of body fat. Also in people originally from Asia, the risk to health is higher at lower BMI measurements. Health risks are also calculated differently in older people.

Waist circumference

When overweight, measuring of waist circumference can also give some information about the risk of developing health problems (particularly coronary heart disease and type 2 diabetes). If two overweight or obese people have the same BMI, the person with a bigger waist circumference will be at a greater risk of developing health problems due to their weight. This is because it is not just whether someone is carrying excess fat but where they are carrying it. The risks to health are greater if the majority of extra fat is around the waist ('apple-shaped'), rather than hips and thighs ('pear-shaped'). The easiest way to measure waist circumference is to place the tape measure around the waist at belly button level.

As a rule for a man:

  • If waist measurement is 94 cm or above, the risk to health is increased.
  • If waist measurement of 102 cm or above, the risk is even higher.

As a rule for a woman:

  • If waist measurement is 80 cm or above, the risk to health is increased.
  • If waist measurement of 88 cm or above, the risk is even higher.

For people who are overweight, or obese (Grade 1), waist circumference is taken into account with BMI when assessing health risk. Very high waist circumference can be associated with very high levels of risk to your health even at the lower grades of obesity. For those with additional medical conditions such as diabetes, high blood pressure, high cholesterol levels, or coronary heart disease, risks are potentially even higher. Weight loss is even more crucial.

Further Information on Increased Risk Groups

Obesity usually results from a combination of causes and contributing factors, including:

  • Genetics. Genes may affect the amount of body fat stored, and where that fat is distributed. Genetics may also play a role in how efficiently body converts food into energy and how body burns calories during exercise.
  • Family lifestyle. Obesity tends to run in families. If one or both parents are obese, the risk of being obese is increased. That's not just because of genetics. Family members tend to share similar eating and activity habits.
  • Inactivity. Not many calories are burnt when inactive. With a sedentary lifestyle, more calories can be easily taken in every day than burnt through exercise and routine daily activities. Having medical problems, such as arthritis, can lead to decreased activity, which contributes to weight gain.
  • Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
  • Medical problems. In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.
  • Certain medications. Some medications can lead to weight gain if not compensated through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.
  • Social and economic issues. Research has linked social and economic factors to obesity. Avoiding obesity is difficult if there are no safe areas to exercise.

Similarly, healthy ways of cooking may not have been taught, or money to buy healthier foods may not be enough. In addition, people spending time with may influence weight.

  • Age. Obesity can occur at any age, even in young children. But when aging, hormonal changes and a less active lifestyle increase the risk of obesity. In addition, the amount of muscle in the body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs, and can make it harder to keep off excess weight.
  • Pregnancy. During pregnancy, a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
  • Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain that the person becomes obese. In the long run, however, quitting smoking is still a greater benefit to health than continuing to smoke.
  • Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in hormones that increase the appetite.

Most risk factors can be counteracted through diet, physical activity and exercise, and behavior changes.

Further examination that maybe required or requested

Blood test that maybe for further examination include:

  • Fasting lipid panel: test fasting cholesterol, triglycerides, and high-density lipoprotein cholesterol (HDL-C) levels
  • Liver function studies
  • Thyroid function tests
  • Glucose and insulin studies: Fasting glucose, type 2 diabetes diagnosis and measurement (haemoglobin A1c (HbA1c))
Why AIMIS for this Surgery

AIMIS provides Robotic and laparoscopic surgical options providing many benefits over typical open surgery. Robotic Surgery is considered a golden standard for Bariatric Surgery when in the hands of experienced surgeons. AIMIS has invested in the latest Robotic Technology the da Vinci Xi, providing superior 3D imaging, improved visual definition and clarity, facilitates anatomical access from virtually any position and precise tools providing greater range of motion and operative reach. This provides the technological tools to our leading surgeons to optimise clinical outcomes and provide the best healthcare has to offer.

As a result of da Vinci technology, da Vinci Gastric Surgery may offer many potential benefits when compared to traditional open surgery or laparoscopy and including:

Possible Benefits compared to traditional Laparoscopy

  • Lower rate of gastrointestinal leaks
  • Lower risk of needing follow-up surgery
  • Lower risk of converting to open surgery
  • Shorter hospital stay

And benefits over open surgery

  • Lower risk of complications and other side effects
  • Minimal blood loss
  • Less pain
  • Faster recovery and return to normal activities
Other Services Provided by AIMIS

In addition to its Innovative Healthcare, AIMIS provides all-encompassing seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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