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Obesity Management - Part V, (November, 2006)

Those who are unduly over weight come under the category of "Obese" and "Morbidly Obese" having a BMI of over 30 up to 40 and exceeding 40 respectively. These are the people who need to have intensive management under professional guidance. They need to have a complete rethink on their life style and put in place radical but realistic changes in their life style, which they can adopt on a long term basis or ideally for rest of their life. Some of them would need professional counseling to get them to follow these measures with firm determination. A variegated diet regime and exercise/physical workout that suits a person has to be charted out by the attending physician and a specialist in nutrition after discussion and deliberation with the patient. Following these measures of suitable diet and physical workout, over a period of time slow but steady changes would be seen.

Some with a medical anomalies/diseases having direct correlation with excess weight like Diabetes or Hypothyroidism would definitely need medications. Others with unrelated diseases like high blood cholesterol, heart disease or acid peptic disease etc also need some medications as well as some fine tuning of their diet. A very small proportion of these obese and morbidly obese people, who respond poorly by the above measures over a long-term period of one year or more, would need some specific medications directed against obesity. A few morbidly obese may not respond to all these measures even when followed strictly over a long period of time. These are the very few who may be considered for surgical procedures specifically meant and tailored for them, called as “Bariatric Surgery”. But these surgical procedures are high-risk operations riddled with quite a few postoperative problems and should be the very last desperate measure, when all other options have failed and the subject is willing to take the risky and difficult option of Bariatric Surgery.

Now let us consider details of diet needed in reducing obesity and types of physical workout suitable for various hues of people.

Diet suitable for Normal and Obese individual:
An average normal individual doing moderate activity would need 1800 to 2000 calories worth of food per day. In individuals who need to reduce body weight, a diet that provides about 1200 calories per day would be ideal. This may be done in 2 or 3 steps and preferably by a professional, like a dietician or a consultant in Nutrition. The diet must be as variegated as possible and must closely match the dietary habits/preferences of the subject. The patient should be able to continue to take this diet on a long-term basis. The proportion of carbohydrates, proteins and fat would be roughly 50, 25 and 25% respectively. Include in the diet fresh vegetables and fruits generously. Use whole grains avoiding highly refined grains and preferably avoid all processed food. Best proteins and fats are in vegetables and vegetable oils; next best protein is in fowl. Red meat and diary products have the worst kind of proteins and fats. In addition to the prescribed energy needs by the three main categories – carbohydrates, proteins and fats- allowance must be made for supply of all essential vitamins, anti-oxidants and essential minerals. For this one may have to resort to suitably formulated multivitamin-mineral tablets/capsules.

Exercise for health and weight optimization:
Starting of any exercise routine should be slow and gradual, particularly in those over 50 years or those who have heart or lung disease. Finally a moderate level of physical activity is recommended in all. These consist of activities like swimming, fast walking or jogging etc for 30 to 60 minutes each time. This should be done 5-7 days a week. This can be done twice daily if faster results are desired. An alternative is to regularly visit a gym and perform aerobic workouts for 30 to 60 minutes. Additional muscle building exercises may also be performed and this is optional. A third option for exercising would be games like table tennis, lawn tennis, shuttle badminton etc. All these are little more strenuous, but if a person likes and enjoys one or more of these games, it is ideal.


Drugs for obesity:
All drugs for any disease are double-edged weapons and invariably have some undesirable side effects. Drugs used for control of obesity are mostly appetite suppressants and do have quite a few side effects. Hence they are only advised if a reasonable period of diet and exercises of say six months to one year have not produced desired results. They should be taken only under the advice and regular supervision of doctors. The drugs available are – sibutramine, orlistat (Xenical), phentermine, diethyl-propion, fluoxetine, bupropion etc

Morbid obesity – management*:
A few in this category may respond to diet, exercises and drugs mentioned above. If there is some response, it is worthwhile to further streamline and fine-tune these measures to get gradual and sustained improvement. This is far better than the last option of major surgery. But if there is no noticeable improvement even after a rigorous regime for a year or so, one may explore the last option of surgery specifically meant for such patients, called as “Bariatric Surgery”. Bariatric Surgery conducted in these grossly obese persons, many of whom invariably have heart or lung problems resulting directly or indirectly from obesity is a major and risky procedure. Though the main purpose of weight reduction if often achieved by this surgery, the possibility of annoying complications following surgery are Considerable and real. Hence the pros and cons of this kind of surgery are to be thoroughly discussed by the patient and his family with the attending surgeon.

Presently this Bariatric Surgery is performed by the “minimally invasive” or “laparoscopic” method in very few highly specialized surgical centers. One would do well to select a good center, with an experienced surgeon with fair number of such surgeries under his belt. There are different kinds of surgical procedures, basically belonging to two groups. The first group reduces the size of the stomach, so that eating a small meal produces a sensation of fullness. The second group are by pass operations taking the consumed food from upper stomach or intestines straightaway into the large bowel thus avoiding digestion and absorption of most of the food consumed. Of the various operations the common methods are: 1) Adjustable Gastric Band, also called as “Lap band”. 2) Vertical Banded Gastroplasty ( VBG) and 3)Roux en Y gastric Bypass ( RNY).

Special Note:
Detailed diet charts are not given since each one’s diet needs individual attention by a specialist and it needs to be regularly monitored and adjusted depending on patient preferences and the response in terms of weight loss. Hence do consult a dietician for proper guidance and help.

Please do keep record of your weight taken once every fortnight. Make a note of any indiscretions in diet or missing your regular exercise regime.

Diet and exercise for weight reduction needs a motivated and strong mental make up. Regular practice of Yoga – Pranayama, Meditation, Relaxation, some Asanas and finally Dhyana (Concentration) will help considerably in achieving the mental strength. You may read about these techniques described in our site or ideally attend a course conducted by a master in a Yoga Institution.

YOU need to be firmly committed to be in good health and achieving optimum weight would be the most important step for good health.

Please do feel free to seek any further information or guidance.

Be well informed; be slim and healthy and be happy!

Dr. M.Mohan Rao, MBBS,MS,FICS,MCH,

Director & Senior Surgeon (Retired but not tired),
Dr. U Mohan Rau Memorial Hospital.

Dated 13.9.08 - Additional useful link - Five "not so obvious" causes for Weight gain and what to do ?

*Dated 06.12.2010 - Additional info - Click her to watch slideshow / Video on Obesity Surgery

Dated 14.7.2014 - Additional info - Slide show on Nutritious Vegetarian Diet- go to



Updated on 14.7.2014.

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