Indian Perspective D R. R AJESH K HULLAR MS, FICS, FIAGES Senior - - PowerPoint PPT Presentation

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Indian Perspective D R. R AJESH K HULLAR MS, FICS, FIAGES Senior - - PowerPoint PPT Presentation

Sep 21, 2022 193 likes •589 views

Obesity & Metabolic Syndrome Indian Perspective D R. R AJESH K HULLAR MS, FICS, FIAGES Senior Consultant President : Obesity & Metabolic Surgery Society of India Hony. Secretary : Indian Ass. of Gastrointestinal Endo Surgeon

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

  • DR. RAJESH KHULLAR

MS, FICS, FIAGES

MINIMAL ACCESS METABOLIC & BARIATRIC SURGERY CENTRE MAX HEALTHCARE SAKET, NEW DELHI (INDIA)

Senior Consultant

President : Obesity & Metabolic Surgery Society of India

  • Hony. Secretary

: Indian Ass. of Gastrointestinal Endo Surgeon Hony Secretary : Hernia Society of India Joint Secretary : Asia Pacific Hernia Society (APHS)

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

Global Epidemic

Globesity

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective” Obesity & being overweight now kill more people than hunger does.

World Health Organization

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

What is obesity?

…a disease of excess fat storage with a number of associated diseases, known as co-morbidities.

It is also…

  • multi-factorial (many different factors can cause obesity)
  • life-long
  • progressive
  • potentially life-threatening
  • costly
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Obesity & Metabolic Syndrome “Indian Perspective”

  • When should obesity be treated?
  • Quantification of obesity

BMI = Body Mass Index = Body weight (Kg) Height (in m2)

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

Bariatric Recommendations

WHO CRITERIA RECOMMENDATION FOR ASIANS

  • Normal

Less than 25 kg per m2 Less than 23

  • Overweight

More than 25 kg per m2 More than 23

  • Obese

More than 30 kg per m2 More than 27.5

  • Severe Obesity

More than 35 kg per m2 More than 32.5

  • Morbid Obesity

More than 40 kg per m2 More than 37.5

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

What does obesity look like? *based on female 5’4” tall

Normal Weight (BMI 19 to 24.9)

130# BMI 22

Overweight (BMI 25 to 29.9)

152# BMI 26

Obese (Class I) (BMI 30 to 34.9)

175# BMI 30

Obese (Class II) (BMI 35 to 39.9 )

205# BMI 35

Morbidly Obese (BMI 40 or more)

234# BMI 40

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

Why obesity on the rise in INDIA

  • Growing affluence & urbanization
  • Sedentary lifestyles
  • Poor dietary habits
  • 5% of population consumes 40% of available fat
  • ? Genetic (Thrifty gene hypothesis)
  • Religion
  • Social Practices (Pregnancy, postpartum ghee rich diet)
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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

“Those four categories of changes in the environment are so profound that they create the perfect storm for re-regulating energy balance, re-regulating set point, and creating obesity.”

Four environmental changes

  • Altered food supply
  • Decreased physical activity
  • Stress and distress
  • Drugs
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Obesity & Metabolic Syndrome “Indian Perspective”

Hypertension Dyslipidemia

Morbid Obesity

Cancer Gall stone Coronary Heart Disease Diabetes Sleep Apnoea Arthritis

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Obesity & Metabolic Syndrome “Indian Perspective” Obesity Metabolic Syndrome

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Obesity & Metabolic Syndrome “Indian Perspective” The Metabolic Epidemic

  • 50 million Diabetic patient in the India
  • 93% of all diabetics have Type II DM
  • Over 50% of type II diabetic patients are Obese
  • Obesity increases the risk of diabetes by 40 fold

Arch Intern Med 2003;163:2146-2148. NIDDK web site, 2003 Endocrine physiology, Balint Kacsoh, 2000

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Obesity & Metabolic Syndrome “Indian Perspective”

3 6 9 12 15 18 21 24 27 30 33 36 39 42

Cancer GB BP Coronary Diabetes

Male Female

Obesity Increases Risk For Diabetes Most (BMI > 35)

Field AE, Arch Intern Med 2001;161:1581-6

77,690 females and 46,060 males adjusted for age, smoking, race, 10-year risk

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Obesity & Metabolic Syndrome “Indian Perspective”

Surgery Pharmacotherapy Lifestyle Modification

Diet Physical Activity

BMI

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Obesity & Metabolic Syndrome “Indian Perspective”

Yo-Yo Dieting

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

Sleeve Gastrectomy

  • Good weight loss
  • Irreversible
  • Restriction only
  • Primary / staged surgery
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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

Sleeve Gastrectomy

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

Roux-en-Y Gastric Bypass

  • Good weight loss
  • Irreversible
  • Malabsorption and restriction
  • Gold standard
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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

Gastric Bypass

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Obesity & Metabolic Syndrome “Indian Perspective”

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Obesity & Metabolic Syndrome “Indian Perspective” Rates of Remission of Diabetes

Adjustable Gastric Banding Roux-en-Y Gastric Bypass Biliopancreatic Diversion >95% (Immediate) 48% (Slow) 84% (Immediate)

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Obesity & Metabolic Syndrome “Indian Perspective”

Kaplan, LM et al. Bariatric Times. 2012;9(7):12–14.

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

Type II DM

? An operable intestinal disease

(A provocative yet reasonable hypothesis)

Francesco Rubino Obesity Surgery Jan 2008

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

How does Bariatric Surgery Resolve Diabetes?

Is it just weight loss? Is there is something else?

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Obesity & Metabolic Syndrome “Indian Perspective”

Mason EE Obes Surg (2005)

Improvement in glucose metabolism is obtained long before significant wt. loss appears

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Obesity & Metabolic Syndrome “Indian Perspective”

Incretin Anti-incretin

Normal

Incretin

tinm

Anti-incretin

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

Incretin Anti-incretin

Type II Diabetes

Anti-incretin

tinm

Incretin Anti-incretin

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Obesity & Metabolic Syndrome “Indian Perspective”

Incretin Anti-incretin

Proximal Gut Hypothesis

Roux-en-Y Gastric bypass Resolution of Type II Diabetes

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Obesity & Metabolic Syndrome “Indian Perspective”

Cleveland Clinic Journal of Medicine, Dec 2006 Dyslipidemia hypercholesterolem ia 63% resolved Metabolic syndrome 80% resolved Type II diabetes mellitus 83% resolved Obstructive sleep apnea 74%-98% resolved Hypertension 52-92% resolved

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Obesity & Metabolic Syndrome “Indian Perspective”

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Obesity & Metabolic Syndrome “Indian Perspective”

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Obesity & Metabolic Syndrome “Indian Perspective”

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

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Dr Rajesh Khullar

Obesity & Metabolic Syndrome “Indian Perspective”

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Obesity & Metabolic Syndrome “Indian Perspective”

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Obesity & Metabolic Syndrome “Indian Perspective”

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Obesity & Metabolic Syndrome “Indian Perspective”

First Institute in India to be recognized as an International Centre of Excellence in Bariatric Surgery. The ICE program is administered by the Surgical Review Corporation, USA.

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Obesity & Metabolic Syndrome “Indian Perspective”

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Obesity & Metabolic Syndrome “Indian Perspective”