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A family recently made news as nine of the family members underwent weight loss surgery in the course of seven years. The most recent surgery was that of a 19-year-old, who previously weighed a whopping 120 kilos; it took place at Bhatia Hospital, Tardeo. In an interview with a renowned media house, the mother of the young girl said, “She weighs 110 kg now, and should continue losing weight for the next few months."
The mother herself was the second in the family to go under the knife and said that the family was motivated after her husband’s nephew, who weighed over 200 kgs in his 20s underwent surgery and lost 30 kgs post-surgery. Her elder daughter also underwent the surgery and went from a 100 kg to 63 kg. The family members consulted bariatric surgeon Dr Sanjay Borude, who reportedly revealed that he has up till now operated on 13 members of the family. “The oldest member was 60 years at the time of operation, while the youngest was 13 years. 11 of them weighed over 100 kg and had a BMI of over 35," he added.
Speaking with the OnlyMyHealth team, Dr Sanjay Borude, Consultant-Obesity & Bariatric Surgery at SL Raheja Hospital, Mahim, shares that the primary cause of obesity in the family was epigenetics, adding, “Dietary and lifestyle patterns were quite etiological in our opinion; dietary patterns and choices, disruption of the circadian cycle (sleep cycle), to name a few.”
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What Does Genetic Predisposition To Obesity Mean?
According to Dr Borude, obesity is a complex, multifactorial disease, defined as abnormal or excessive fat accumulation that presents a risk to health. A Body Mass Index (BMI) over 25 is considered overweight, and over 30 is obese, as per the World Health Organization (WHO).
Obesity has been closely linked to genetics and environmental factors. Dr Borude says, "Genetic predisposed obesity is a broad term for epigenetics and its relation to obesity. Nutrition and lifestyle have the ability to change gene expression without affecting the DNA sequence, which is a phenomenon known as Epigenetics." They influence and co-relate with genetic causes of obesity. These include:
Monogenic causes: These are caused by a single gene mutation, which include leptin deficiency, Leptin Receptor Deficiency, MC4R Mutations.
Syndromic obesity: Severe obesity associated with other phenotypes such as, neurodevelopmental abnormalities, and other organ/system malformations.
Polygenic obesity: A large number of genes whose effect is amplified in a ‘weight gain promoting’ environment.
“Genetic and epigenetic variations contribute to obesity by influencing the function of metabolic pathways in the body and regulating neural pathways and appetite centres,” the doctor added.
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Factors That Influence Epigenetics
The US Centers for Disease Control And Prevention (CDC) describes epigenetics as the study of how your behaviour and environment can cause changes that affect the way your genes work. "Unlike genetic changes, epigenetic changes are reversible and do not change your DNA sequence, but they can change how your body reads a DNA sequence," the CDC explained. Dr Borude lists a few factors that influence epigenetics. These include:
- Maternal nutrition-both maternal over and under-nutrition
- Maternal exposure to toxins
- Maternal stress
- Younger maternal age, low pre-pregnancy weight, maternal Diabetes
- Nutritional disturbances in the postnatal environments
- Early childhood nutrition
- Altered gut microbial flora due to antibiotic use in the first year of life
- Paternal nutrition or overnutrition, low protein diets, and prediabetes
- A high intake of fried foods, sugary beverages, high saturated fats, inadequate sleep or sleep disturbances, and following a sedentary lifestyle
Role Of Bariatric/Weight Loss Surgery
“Beside diet and exercise trials, bariatric surgery is another weight loss strategy with long-term benefits such as enhanced insulin sensitivity, metabolism, and cardiovascular function,” says Dr Borude, adding, “Post-bariatric, there is a reduction of visceral fat along with dietary changes, which aid in the reduction of genetic alteration reducing hyperphagia (excessive hunger) among many other things.”
According to Mayo Clinic, bariatric surgery is done when diet and exercise don't work or when you have serious health problems because of your weight.
"Bariatric surgeries have been done for the past 70 years, and have improved over a period of time. Reduced volume and appetite with early satiety is the principle of bariatric surgery," Dr Borude adds.
Also Read: Weight Loss: 6 Low-Calorie Lunch Foods To Help You Cut 500 Calories
Is Surgery A Safe Approach?
Dr Borude notes that weight loss surgeries carry a risk similar to any other surgery. “Bariatric surgeries are safe when they are performed by experienced surgeons and in specialised hospitals,” he adds. Since it’s a multifactorial issue, it should be managed by a multidisciplinary team.
Up until now, the doctor has had patients as young as 11 months infant weighing in at 19 kgs in 2011, who is now leading a healthy lifestyle, and as old as 78-year-old lawyer who wanted to live the next 20 years of his life fullest and happiest. He is now 89 years old.
How To Prepare For A Bariatric Surgery
Preparing for bariatric surgery can be complex. “First and foremost, it is important for the patient to self-prepare themselves for the lifetime alteration for a good lifestyle. Once ready we advise at least 3-5 days of low-calorie liquid diet to reduce intra-abdominal fat and the size of the liver. In the meantime, they are thoroughly investigated for the fitness for surgery.”
“Generally, the hospitalisation is for 2-3 nights. Since these are laparoscopic surgeries and are minimally painful, we mobilise the patients on the same day of surgery. Not even a urine catheter,” he concluded.
