Obesity treatment – why does it fail?

Obesity has been described as an epidemic of modern times – an outcome of junk food, poor exercise and unhealthy lifestyle. Though Obesity, as a disease, was initially considered a rich man’s disease, affecting the population of the developed Western world, it was soon realized that countries like India, that have a rising population of prosperous individuals, was competing with the West for the total number of people suffering from Obesity. Unfortunately, the authorities are yet to realize this fact and hence attention to this health problem is highly inadequate.

Enough has been written about the severity of the possible problems that develop due to Obesity, the need to correct the problem, and the potentially life threatening issues that may develop. Thus once the given person/their doctor conclude that there is a problem that needs treatment, the person is usually asked to reduce food intake, do exercise and lose weight! That’s it. As if everyone knows how to rule out underlying problems that may have caused the fat accumulation, revamp their diet OR identify problems or limitations related to physical exercise! It is now easy to see why ‘asking someone to loose weight and control intake is doomed to fail’

So, how does one go about to ensure that these efforts to tackle the problem will move in the right direction?

Identify if any underlying diseases have caused the weight gain: For people with Morbid Obesity – BMI > 36-37 In Indians – a clinical and hormonal screening is needed for this purpose. Trying to reduce intake or doing exercise in this scenario is utterly useless.

Have a discussion with a dietician: Once background problems are ruled out, people with mild to moderate Obesity – BMI between 27 – 37 – need a discussion with a dietician decide details about a diet that cuts down on the caloric intake, without loss in the nutrition or satiety value. Calories can be reduced without decreasing the quantity of food, which is needed to ensure the person does not get fed up with the diet and give up his efforts. Simply trying to cut down the food intake cannot be continued for long.

Identify problems in exercising: before exercise is recommended, it is essential to see if the deformity due to the obesity permits the person to exercise at all! There have been people with huge ‘pot bellies’ who cannot be expected to begin exercising at all – unless they are able to bend and move about with reasonable comfort. Another person, a lady with normal body weight, but excess fat in just the arms, had a very awkward feeling of heaviness just below the shoulders – she was unable to lift even the lightest variety of dumbbells at the gym. Obviously, both these groups of people need something else.

Generalized measures for local obesity: options such as diet control, exercise or even the medicines to loose weight work by shedding excess fat from the entire body. Neither of these can work on one specific area – as in someone with local fat excess – say tummy, hips, arms or thighs (called local Obesity) – OR with General Obesity by disproportionate fat excess in some areas. Such cases need reliable measures to tackle local fat. This is what the Body Reshaping procedures can offer, once approved by a competent Plastic Surgeon. Depending on whether the local fat excess is super added to Generalized obesity, these Cosmetic surgery procedures may be done alone or in coordination tin Bariatric Surgery.

Thus simple measures can be effective when used in the right situation – if not, treatment failure is very likely,  and and bad name resulting to the physicians involved, the person using it and even the treatment itself!

             Cosmetic Surgery - Is it really worth the Risk?

Medical reviews have proved beyond doubt the rising popularity of Cosmetic Medical Services, especially Cosmetic Surgery. It is a fact that a physically attractive or smart person has better opportunities in life, is judged more positively and gets preferential treatment in situations such as marriage and employment. This can significantly impact the person's life as a whole.

At the same time, there are reports in media of complications after Cosmetic surgery procedures – “Patient dies after Liposuction surgery”. This has led to a confusion among the layman about whether to consider Cosmetic Surgery at all . The man on the street hears of either stories of cosmetic surgery involving glamorous people, OR ‘horror’ stories of Cosmetic Surgery gone wrong. Neither of these is something the common man can relate to. Is there nothing in between these two extremes? Can Cosmetic Surgery or procedures not be done safely for the layman?

Cosmetic procedures can certainly be done safely, ensuring both cost effectiveness and patient satisfaction, very often giving a new lease of life to the person concerned. All that is needed is to take care of a few issues. Let us see what they are.

1. Patient expectations

2. Procedure related risk

3. Procedure benefits – extent and duration

4. Health care facility

5. Surgeon involved

6. Procedure Costs

7. Decision making

What is a reasonable expectation? Reasonable is one that matches with common opinion. In case of a Cosmetic problem, there exists a consensus opinion (scientific impression) about what is beautiful and what is not, which also has a scientific basis. This can be confirmed by the surgeon, who will accurately tell how different from the normal the present condition is.

When the opinion of the surgeon and the patient match each other, the expectation is considered reasonable. Sometimes, this does not match-seen usually as the patient referring to a minor problem (minor in the Surgeon’s opinion) as very severe, enough to upset the person significantly and interfere in their daily life. This is called an unreasonable expectation. This is a tricky situation, with high chances that the patient is unhappy even when the cosmetic treatment is successful.

In such a situation, the surgeon will discuss frankly with the patient the amount of correction possible, most importantly whether complete correction is possible or not. This varies with each different type of problem; based on his personal experience with similar cases, the surgeon will explain the likely result by keeping the procedure risks low.

A reasonable person is usually willing to accept that in certain situations, a minor problem may be very difficult to correct perfectly OR that complete correction of a major problem is difficult. If the person still refuses to understand, the surgeon should realize that chances of an unhappy patient or complications are high.

How does the risk severity change with the procedure? Usually, the less invasive (deeper) the procedure, lesser are the risk of complications. However, long lasting and better corrections can be achieved only with invasive procedures, for problems that have more than one treatment option. Thus, a balance has to be kept between the amount of correction desired and it’s longevity to keep the risk reasonable.

Further, there is an inherent risk in every procedure that a surgeon usually will explain to the patient. This risk depends how well established the procedure is worldwide and how familiar the surgeon is with the procedure.

To illustrate, liposuction procedure for body reshaping is extremely safe when done to a reasonable extent. However, If extensive liposuction is planned-called Mega liposuction-the risk of complications increase - depending on the patient’s general health, the surgeon’s experience, the availability of intensive post op care, etc.

Similarly, when correction for a sagging face is planned, it can be done as a minimally invasive procedure called thread lift with minimal risks as an office procedure. Alternatively, a face lift procedure is a major surgery under general anaesthesia with definite risks of nerve injury, face swelling-bruising and needs a few days to recover both in hospital and at home. Also, the surgery needs a skilled and experienced person to keep risks low. However, with severe sagging problem, thread lift cannot help; face lift surgery is needed.

Further, with mild to moderate problems, risks may be kept low by choosing a minimally invasive procedure if available, such as thread lift; but keeping in mind that results will last only about half as long as a face lift surgery where results will last about 12-15yrs or more.

Does the choice of the health care facility really matter while opting for Cosmetic Surgery? Usually those undergoing major Cosmetic Surgery are healthy or have minor medical problems that are under good control; the stay after surgery in hospital lasts about 2-3 days. A health care setup with basic safety facilities in the Surgical Suite will suffice, more so if no major anaesthesia is involved and patient will not stay overnight. Sometimes, a setup with an ICU facility is essential, as when doing a Megaliposuction procedure, OR when doing a regular procedure but for a person with definite medical problems.

Training and experience of the Physician (Surgeon) are very essential. With the presence of self proclaimed experts in Cosmetic Medical Care, how does one choose/identify the right Physician?

Basic considerations in choosing a Surgeon include

1. Qualification

2. Association/professional body memberships

3. Experience of the surgeon with the procedure

4. Approval by Hospital to surgeon

5. Hospital approval

A trained Plastic Surgeon completes at least 6 years of surgical training with at least 3 years intensive training in Reconstructive & Plastic Surgery. In India , this earns the qualification of either a M.Ch. or a DNB in Plastic Surgery and the membership of the Specialty Association – association Plastic Surgeons of India – www.apsi.org.in . Similar qualification in the UK is a FRCS in Plastic Surgery and in US the person will be a Board Certified Plastic Surgeon.

What makes a Plastic Surgeon competent to handle Cosmetic Medical Care?

Plastic surgeons work with patients at all stages of life, evaluating health, medical, psychological history, and body type to provide comprehensive advice according to their personal cosmetic medicine goals. They help explain the specific results a procedure can and cannot deliver and its associated risks; how to choose the right course of action depending on our age, needs, and wishes; and what we can expect to look like after the procedure.

Unlike others who may be trained in only a few cosmetic procedures, plastic surgeons are educated in the full spectrum of cosmetic surgical and non-surgical care. They hone their skills and techniques through one of the lengthiest and most comprehensive training programs in all of medicine.Besides delivering great results for patients through comprehensive cosmetic procedures, our focus as plastic surgeons is on patient safety. We believe that patients deserve the highest quality of care and safety, which is delivered in our accredited facilities. Also, Plastic surgeons are actively involved in research to develop new techniques and improve existing procedures that will deliver scientifically proven outcomes for patients undergoing cosmetic or reconstructive procedures.

Are procedure costs related to risks or outcomes in any way?

With increasing demand for Cosmetic Surgery, patients and physicians look for cheaper services.However, cutting costs beyond a point can compromise safety . Practical ways to keep costs less include choosing a non-Metro city (such as Mangalore) OR choosing a surgeon who is less busy, provided he meets your satisfaction and gives you time.Chances of complications are high with physician or others who undertake procedures without the suitable training, knowledge or experience. It leads to disappointment, loss of time and money besides bringing disrepute to the specialty

How quickly can a decision for Surgery be made?

Though a quick decision can be made about treatment for a common problem, a second consultation is usually helpful – whether with the same or another surgeon. Collecting information on the matter from websites and discussion forums will give you a better idea of what to expect with the procedure. Popular stories of disasters after cosmetic surgery result from inappropriate/hasty decisions or poor surgical technique. examples of inappropriate decisions include agreeing for an over-sized breast implant (high risk of wound breakdown and implant removal) OR excess liposuction (leading to skin necrosis, fat embolism or death). A popular quote among physicians says “A Good Surgeon knows how to operate, The Better one knows When to operate, The Best one knows when not to operate” A competent surgeon knows the shortcomings of a procedure well.

Keeping these issues in mind will ensure Cosmetic procedures stay safe and cost effective, while more people avail these benefits and improve their lives.

The responsibility of creating this awareness lies with the Plastic Surgery Fraternity.

http://www.plasticsurgerymangalore.com

Health benefits of Modern Cosmetic Medical Care - The Healthy and The Beautiful

The Healthy and The Beautiful –

Health benefits of Modern Cosmetic Medical Care

Beauty Enhancement by Cosmetic Medical Care is rapidly gaining popularity over the last few decades. Skeptics view this as purely an exercise to cater to a person’s vanity, to satisfy their whim and fancy. Is this true or is there some scientific basis behind the purpose of trying to look more beautiful? Let us see.

Beauty lies in the eyes of the Beholder. 

In reality, beauty is not a personal opinion alone; there is a consensus opinion about beauty as well. Scientific research has proved and identified the physical features in a person that are universally accepted as attractive or beautiful. What is not so well known is that most of these features when present actually reflect a healthy status of the person. Nature has gifted the healthy person with features that the human mind perceives as attractive; thus beauty is the parameter to identify a healthy person. Identifying beautiful/attractive features is Nature’s way of identifying the person with the best health

This is why humans are naturally attracted to beautiful persons, whether we are looking for partners or colleagues. Following Nature’s policy of ‘survival of the fittest’, a beautiful person the best chance of finding a partner, thus ensuring that the best of qualities in the species are passed on to the next generation.

The best example of this is the female figure. A hip to waist circumference ratio of less than 1.1 is associated with an appropriate body fat content and healthy fertility (reproductive health). A ratio greater than this is associated with overweight problems, menstrual irregularities; when the ratio is significantly high, the person will have or is likely to develop problems such as Diabetes, Hypertension, Heart problems and stroke.

Does it mean that a person who is not beautiful is unhealthy? To an extent this is true. Also, it is well known that Cosmetic Medical Care can significantly enhance/restore beauty of the individual. Does it mean that the person’s health also improves at the same time? This is also true, though partly. Let me explain both the points: people who are significantly unattractive (eg. out of shape) are at very high risk of having health problems (if they do not already have), while those who are minimally unattractive may very well be healthy. Once Cosmetic treatment restores beauty to both these groups of people, the latter group will have both beauty and health. What about the people who did not have sound health to begin with? Does the cosmetic Surgery procedure improve their health as well? This is likely to be true and is in fact the focus of medical research at present. 

Certain Cosmetic Surgery procedures certainly result in improved health. Reduction in body fat by Body Contouring Surgery or Bariatric Surgery has beyond doubt been proven to control or even eliminate the same problems seen with excess fat-Diabetes, Hypertension, Heart Disorders, Stroke, etc. classic examples are people with diabetes who undergo surgery – after surgery they dramatically manage sugar control without medicines. Another example is people with hypertension with irregular control of Blood Pressure OR needing multiple drugs for control; after surgery, in addition to the surgical benefit, their Blood Pressure stays under control with fewer/single drugs or rarely without medicines as well.

Certain other cosmetic issues, associated with local health problems, can be corrected permanently by Cosmetic Surgery with significant benefit to the associated health problem. One Classic example is excessively large breasts causing skin, shoulder and neck problems. Large breasts (for the person’s frame) may occur developmentally (in teenage) or after childbirth (the breast that enlarges at time of breast feeding fails to go back to the original size) or oven after menopause. Obvious problems include the embarrassment caused, the limitation in the choice of clothes and the problems due to undue sweating in the skin crease beneath the breasts. If uncorrected, over time other serious problems that develop include strap marks on the shoulder due to the brassiere, arthritis of the shoulder or neck joints even leading to neck disc problems. Successful surgery has been proven to correct all the obvious problems immediately and will stop or even reverse the serious problems in the neck and shoulder over a period of time.

Similarly, tummy tuck surgery to correct the pot belly problem will correct the obvious problems of a ugly/awkward looking tummy, and problems due to the skin fold. Studies have proven the favourable benefit of muscle tightening (done in the tummy tuck procedure) on the problem of disc prolapse and nerve compression in the lower back. Improved muscle tone on the front of the trunk helps increase the intervertebral space on the back of the trunk and relieves pressure on the damaged disc-this leads to an improvement in the symptoms.

Finally, there are distinct psychological benefits from successful Cosmetic Surgery. even when cosmetic problems are not associated with health problems, such as bulky nose without breathing difficulty OR small/underdeveloped breasts in a teenage girl OR feminine chest in an adolescent boy, permanent safe surgical correction of the problem leads to a significant improvement in the person’s body image, self-esteem and self-confidence. In today’s competitive world, smart looks are likely to open new doors of opportunity, to give a person the edge over others and help a person achieve one’s goals in personal or professional life. It has the potential to be the turning point in a person’s life, the break that one seeks for in difficult times to tackle life with renewed vigour and enthusiasm.

The biggest gain from these psychological benefits is a remarkable decrease in the risk of depression problems. People with Depression have a higher risk of Cardiovascular Diseases, stroke and high Blood Pressure. Also, a successful procedure has an overall positive impact on the person’s health by making him/her more likely to exercise. 

 

Along with these potential benefits lurks the danger from the risks of associated complications. Risks are an inevitable part of every action that we do in life, but are kept low by doing it the recommended way. Just to illustrate, there is a risk even in crossing a road; if we stick to the rules, the chances of a problem are negligible. In fact, we don't realize the risk exists unless brought to our notice. Similarly, the trained physician, with his knowledge and experience, is able to identify the risks specific to the person, procedure, and either take steps to minimize them or clearly decide that benefits from the procedure are not worth the risk. He will also disapprove of unjustified expectations. The Trained Surgeon will thus keep the risk very low. Risk of Surgical complications becomes high when such Risks have not been anticipated by the surgeon. A common cause for this is a physician who undertakes procedures without the suitable training, knowledge or experience. It leads to disappointment, loss of time and money besides bringing disrepute to the procedure and specialty.

Instances of such Complications, that result from inappropriate decisions or poor surgical technique, lead upto disasters stories in media. Inappropriate decisions include agreeing for an over sized breast implant (high risk of wound breakdown and implant removal) OR excess liposuction (leading to skin necrosis, fat embolism or death).

Thus, improved awareness among the common man will help in choosing the suitable Physician, thereby avoiding complications and keeping Risks low. This will ensure the health benefits of the procedure in addition to the benefits of Beauty Enhancement can be enjoyed by a greater number of people.

More information can be found online at http://www.plasticsurgerymangalore.com