From the dawn of our history, food shortage and malnutrition have been a scourge. Many a civilizations have been felled because of hunger and famine. Technical and administrative advances have led to easier availability of food. Unfortunately this did not happen simultaneously across the world. Many parts of the world still continue to be under the grip of hunger. The result of these advances was a definite increase in life expectancy and a general improvement in public health. These advances, even though they have not found equitable distribution across the world, have had presence felt everywhere. This gradual increase in easy accessibility to food coupled with  a lack of physical activity may have led to what is a new public health crisis of the last few decades: obesity. A nation like ours today faces the double challenge of malnutrition and obesity. While we are still unable to feed all our children, obesity has already raised its ugly head. Obesity and malnutrition may be at two ends of a spectrum, but they are by no means mutually exclusive.

Ref-History of Obesity, or How What Was Good Became Ugly and Then Bad

·       Top of Form

·       Garabed Eknoyan

·       Bottom of Form

·       Renal Section, Department of Medicine, Baylor College of Medicine, Houston, TX.

Do you qualify for bariatric surgery?

Not all obese patients are selected for bariatric surgery. Only those with BMI of >40 or >35 with co morbidities such as Hypertension or Diabetes Mellitus are eligible. There is an argument for obese individuals with lower BMI too but evidence for the same is awaited.

Recently hypogonadism and sub fertility in men was added to the list of co morbidities, which are likely to benefit from bariatric surgery. However controlled clinical trials are awaited(1)

P.S. know your BMI by using the blog's tool on the right side of the page.

Ref-

1. M. Lucchese, 

M. Maggi 

Hypogonadism as a New Comorbidity in Male Patient's Selection for Bariatric Surgery: Towards an Extended Concept of Metabolic Surgery?
Obesity Surgery December 2013, Volume 23, Issue 12, pp 2018-2019

Modern day epidemic

We often tend to believe that obesity is a problem of the west. Even as doctors, we tend to ignore the risk we face today. We are often too overwhelmed solving today's problems to be concerned with what the future may have in store for us. Especially at tertiary centre like ours, where residents put in over 100 hours a week routinely and consultants are on call 24 x 7, an obese adult who is otherwise healthy tends to be passed off as a healthy adult.

While it may be true that the extent of the epidemic is not as immense as faced by the developed world, it is by no means a trivial issue. We are yet to overcome the challenges posed by infectious diseases. As a developing country, we have limitations and our set up is just not ready to face the plethora of non communicable diseases, which will present soon if we do not act against obesity now.

Often in our surgical OPD we see patients, who do not present to us due to their obesity. There is often a waiting period of a few months for benign diseases like GSD. Some patients may actually present due to their weight. In both such cases, the following protocol is followed-

 BMI calculator is on the
 right side of the screen.