Weight loss for a morbidly obese patient is a big challenge and often cannot be attained. Bariatric surgery is that superspeciality branch of surgery which deals with weight loss operations. There are three categories of bariatric surgery, restrictive and malabsorptive and combined.
Restrictive procedures include gastric banding and sleeve resection where the stomach volume is effectively reduced. Resection of majority portion of stomach also causes ghrelin level (a hormone produced by stomach responsible for increased appetite) to fall which automatically helps the patient attain satiety after taking a small amount of food. In malabsorptive procedures a bypass (between the stomach and small intestine) is performed with or without a stomach reduction. This causes controlled malabsorption of food material leading to significant weight loss.It can be mentioned here that body mass index (B.M.I) is taken as a guide to measured by dividing the weight of a person in kilograms by the square of the height in meters. W.H.O classifies different categories of weight by B.M.I as follows.
In western countries Bariatric surgery has now becomes very common the reason being awareness of the dangers of obesity; like disease, hypertension, coronary heart disease, hypercholesterolemia, various types of cancer, infertility, osteoarthritis, mental disorders, sleep apnea etc. It should be mentioned here that roughly 50% of the American population is obese and the trend is increasing. It is alarming to note that even in Bangladesh the incidence of obesity is increasing. The interesting as aspect of Bariatric surgery is that it has the potential of curing Diabetes mellitus. In the recent consensus meeting in kerala on the 8th and 9th august 2008, all the major Asian countries sent their representatives to formulate guidelines for Bariatric surgery. Many of the surgeons presented their scientific papers showing 80%to100% cure of diabetes by this type of surgery. Professor Sayeed Ahmed Siddiky, plastic surgeon from Cosmetic Surgery Centre Ltd. represented Bangladesh data on obesity and his initial experience of Bariatric surgery in Dhaka. It is to be mentioned that senior Bariatric surgeons like Dr. Harry Frydenburg from Australia, Dr. Cheng from Singapore, Dr. Kazunori Kasama from Japan and a number of diabetologists were among the participants in the conference. Dr. Muffazil Lakdawala, a prominent Bariatric surgeon from Mumbai organized the meet. At the consensus there was a unanimous decision that Bariatric surgery can be considered as a surgical cure for certain type2 diabetes mellitus (T2DM), and that there should be an Asian chapter for Bariatric surgery just like North American and European chapters which are already contributing for the treatment of obesity and diabetes in there respective countries.
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