Is OBESITY A Disease Or A Choice?

Its very Interesting to note that Obesity is a disease, but to survive the disease we need to make careful choices in life to live a complete life. By Defining the obesity as a disease we have conveniently removed our responsibility to control the disease and given the responsibility burden to somebody else. As human beings we have lost control over ourselves and the environment and therefore we did not have any other choice but to blame on things which we don’t have control.

As it was rightly said “Genetics load the gun and the environment pulls the trigger, George bray 1996”

This clearly states where we stand, as human beings genetically predisposed to Obesity, the factors which play a important role is the environment. We all agree that environment can be modified according to our needs and which are going to play a important role in modifying the progress of the disease. In defining obesity specifically, one of the most comprehensive definitions is provided by the Obesity Medicine Association. Obesity is defined as a “chronic, relapsing, multi-factorial, neurobehavioral disease, where in an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”

According to the Centers for Disease Control and Prevention, obesity affects 42.8% of middle-age adults. Obesity is closely related to several other chronic diseases, including heart disease, hypertension, type 2 diabetes, sleep apnea, certain cancers, joint diseases, and more.

The so-called “Obesogenic” environment with its reduced food costs, the especially plentiful high calorie dense foods, larger serving portions, reduced physical activity, and the influential food industry, are likely contributors. The pathology of obesity is vast and varies based on the cause of weight gain. There is not just one type or cause for obesity. Obesity include congenital, stress-induced, hormonal related, to name a few. Obesity is related to genetic, psychological, physical, metabolic, neurological, and hormonal impairments. It is intimately linked to heart disease, sleep apnea, and certain cancers. Obesity is one of the few

diseases that can negatively influence social and interpersonal relationships .Why obesity is a disease is becoming more evident as we increase our knowledge of fat mechanics.

Main aim of defining it as a disease is to effectively find ways at different levels to control the weight process.

Firstly to aim for prevention and contain the weight gain process.. Find various pathways to stop this pandemic. To successfully confront the obesity pandemic will require attacking the disease and its manifestations, not just its symptoms. The epidemic of obesity and its associated complications are challenging the world’s health care system and might slow or even reverse the life expectancy gains of the last 50 years. Understanding its multiple causes would help in the development of effective preventions and treatments. It has been suggested that obesity is a biologic adaptation to this

obesogenic environment. Theirs a complex interplay of both genetic and environmental factors in regulation of energy intake, expenditure, and energy balance.

It’s a chronic, relapsing, multi-factorial, means it has to be followed lifelong and various factors have to be considered to attain a lifelong success. It has to be understood that most of the diseases or co morbid conditions are so inter linked that controlling weight gives us control over number of disorders which are beyond our comprehension. Treating obesity is like treating a whole bunch of diseases. These are the reasons for importance of weight control or comprehensive programme for controlling obesity.

When the weight gain becomes beyond certain limit when living life becomes a burden and controlling co morbid diseases becomes almost impossible, then the most proven and only long term weight loss process is Bariatric surgery. At this level whether the issue of obesity is choice or Disease is not an issue, the issue is how to treat the Obesity as a disease and make favorable choices so as to get successful outcomes lifelong.

There are definite indications and guidelines to follow when any one wishes to get rid of this weight problem. These Guidelines are ;

Asian Adults with a body mass index (BMI) ≥37.5 kg/m2 without comorbid illness or a BMI 32.5 to 37.5 kg/m2 with at least one serious comorbidity, such Type 2 diabetes,Obstructive sleep apnea (OSA),Hypertension, Hyperlipidemia , Obstructive sleep apnea,Nonalcoholic fatty liver disease (NAFLD),etc. are candidates for a bariatric surgical procedure. Adults with BMI between 27.5 to 32.5 kg/m2 and either difficult-to-control type 2 diabetes mellitus or metabolic syndrome should also be considered as candidates.

Bariatric surgery should be performed in conjunction with a comprehensive preoperative assessment and a follow-up plan consisting of nutritional, behavioral, and medical programs. A multidisciplinary team that includes a nutritionist, medical bariatric specialist, psychologist/psychiatrist, nurse specialist, and skilled surgeon offers well-rounded assessments and support for the obese patient considering a bariatric surgical procedure. The advantage of the team approach is assistance provided to the patient that facilitates the long-term lifestyle changes conducive to long-term maintenance of weight loss.

Its very important to asses the patient preoperatively the Behaviour patterns like The role of food in a patient’s life and the extent that eating may be driven by unrecognized environmental and behavioral stimulations should be assessed, including Previous attempts at weight loss, Eating and dietary styles, Physical activity/inactivity, Substance abuse ,Health-related risk behaviors. Its important to asses the Current life situation so as to help them get counseling which will help them to recover faster following Bariatric surgery and follow it lifelong. The psychosocial, emotional, and lifestyle expectations should be assessed to determine if they are realistic and if the patient is committed to actively and permanently following postoperative guidelines for improved health. All patients should make nutritional plans for prior to, around the time of, and after bariatric surgery. Nutritional education should also provide information on how to read nutritional content of foods. A complete history and physical examination is performed to assess for co morbid illnesses, such as hypertension, diabetes, obstructive sleep apnea (OSA), malnutrition, restrictive lung disease, and appropriateness as a surgical candidate. Many obese patients have undiagnosed ailments related to their obesity.

Once assessment is done its important to realize that this is a great opportunity to get your health back and life starts fresh. All this requires yourself to make a concrete decision to lead a new life in a new environment of Healthy choices where in your Disease is treated with pure aim of long term benefits. With this assessment the type of bariatric surgery can be planned based on your requirement based on your Health issues. Bariatric surgery is a new lifeline with unlimited benefits which has made it one of the greatest inventions where surgeon has the ability to create new you. The preparation starts much before the surgical process starts and it’s a preparation for a new future.

“We may not be able to modify your Genetics but we will help you to change you and your Environment”.