The consequences of obesity include high blood pressure, diabetes and hyperlipidemia (i.e. metabolic syndrome). Furthermore, degenerative arthritis, gallstone and fatty liver are all diseases that caused by or associate with obesity. The most critical case is cardiovascular disease as the probability of occurrence is up to 70% in morbid obese patients.

BMI (body mass index, weight kg / height x height meter squared) is a universal standard obesity measurement, in Asians 18.5 to 23 is a normal BMI; 24 to 25 is overweight; above 27 is called obese; and above 30 with obesity-related diseases or above 35, are known as “morbid obesity.”

For obesity treatment, the fundamental change must be lifestyle and exercise. Western countries have conducted a 10-year follow-up on weight loss methods. Treating patients with traditional curing methods will not have more than 5% of weight loss. Instead, patents underwent metabolic surgery will have at least 60% of weight reduction. Multiple outcomes vary from person to person, and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) produced specific guidelines for the Asian regions in 2011.


Type 2 diabetes treatments start from diet and exercise

Mr. Wong is about 170cm tall at the age of 35. In his early years, he weighed 120kg and had a BMI of 41.5, which is a typical case of “morbid obesity.” Mr. Wong snores heavily and requires 2 pillows during sleep to avoid symptoms of gastroesophageal reflux. He requires antihypertensive medications for his blood pressure and oral diabetic medications for blood sugar control, and later requiring insulin injections. Due to heavy weight, he started to develop degeneration in his knee joints, causing pain even when he attempts exercise. He then had to take painkillers to reduce pain, and walk.

Endocrinologist recommend Mr. Wong to start improving his lifestyle habits, including counting calories of three meals in a day, reducing the high fat and meat consumption; quitting sugary drinks, from 5 glasses of iced lemon tea to pure water each day; from zero exercise to 60 minutes a day, plus taking prescription anti-diabetic, successfully lost 15kg weight. After 9 months of treatment, Mr. Wong can sleep better, and his blood pressure lowered and blood sugar controlled improved. However, he still cannot completely get rid of the entanglement of morbid obesity.

On a 6-month basis, the chance of successful weight loss is actually less than 10% in patients treated with traditional treatments of education, exercise, diet and medication. Mr. Wong’s lifestyle change is indeed an important first step. After all, he should proactively build a good diet and exercise habits to enhance the effectiveness of weight control, otherwise the chance of recurrence will still be high.


Metabolic surgery for T2DM treatment


Miss Tang, a new college graduate, weighed 120kg. She wasn’t successfully hired since her potential employers had mistaken her obesity as laziness and low efficiency. Due to the prevalence of weight-loss and her “obesity” cannot be improved by the traditional methods, Miss Tang decided to participate in the intense weight-loss treatment. Her weight was reduced to 100kg in 3 months’ time. However, the side effects of weight loss drugs for Miss Tang are depression, abnormal heartbeat and liver impairment.

In less than a year, Miss Tang and her weight jumped to 130kg and had a BMI of 45.6. After diagnosis, the doctor suggested Miss Tang to receive bariatric surgery (laparoscopic sleeve gastrectomy) as definitive treatment. The principle of this surgery is to fashion the stomach into a tube-like structure in which the stomach is reduced to around 25% of its original size; and achieve weight loss ultimately by reducing food consumption and altering hormonal environment in the gut which has little effect on intestinal absorption and digestion. Two months after the surgery, Miss Tang’s weight had dropped to 98 kg; and weighed 80kg in a year time and achieved a BMI of 30. This would not have been successful without her changing diet and regular exercise subsequent to receiving the operation.

Metabolic surgery also consists of intragastric balloon and laparoscopic gastric bypass. Surgeons will suggest the most suitable surgical treatment based on each patient’s condition. As the name implies, intragastric balloons are space-occupying devices which replace gastric luminal volume and may distend the stomach, potentially inducing neurohormonal effects and changes in motility. Metabolic surgery is associated with larger and more sustained weight loss and better diabetes remission, as well as has a positive impact on obstructive sleep apnea and the prevention of cancer.