Obesity, NASH and Bariatric Surgery

Obesity has become a worldwide problem these days because of excessive consumption of saturated fat and processed food along with sedentary lifestyles. The syndromes that are deemed risk factors of arteriosclerotic diseases, abnormal glucose tolerance, dyslipidemia, and hypertension, have proliferated along with obesity in the developed world. Non-alcoholic fatty liver disease (NAFLD) along with obesity is diagnosed more often these days and is a liver variant of metabolic syndrome

Non-alcoholic fatty liver disease is the commonest cause of liver problems and obesity is as big a risk factor for this disease. It is prevalent in populations with metabolic conditions, such as obesity, diabetes mellitus type II and dyslipidemia. NASH is diagnosed incidentally and can be linked with other diseases, such as hypopituitarism, hypogonadism, hypothyroidism, polycystic ovarian syndrome, and obstructive sleep apnea syndrome.

Gastric Bypass surgery helps in improving diseases linked to obesity in addition to weight loss as a result a newer name is coined to this surgery known as “metabolic surgery.”

NASH the pre-existing thought:
We have known by various studies in the past that lifestyle changes, such as dietary, exercise and behavior modification results in weight loss of 5-10%, which have shown that these factors can improve steatosis in some individuals. A weight loss of about 10% has also shown to improve inflammation.

NASH and Gastric Bypass surgery

The aim of gastric bypass surgery is to achieve weight loss as well as to get intended benefits in obesity-related comorbidities, including diabetes mellitus type II, obstructive sleep apnea syndrome, dyslipidemia, and hypertension.

Metabolic effects:

Bariatric surgery has a tremendous effect on diseases related to obesity along with weight loss. Because of this, it has been more recently termed metabolic surgery. Roux-en-Y gastric bypass surgery (RYGB) has a significantly beneficial effect on T2DM than restrictive procedures. Post-surgery, patients who undergo RYGB have shown a significant drop in fat content of liver.

These positive effect is evident in cases where pre-existing NASH is documented with liver biopsy or a liver fibroscan and a sleeve gastrectomy is performed in morbidly obese patient. On follow-up liver fibroscan show marked improvement in lobular steatosis, necro-inflammatory changes, and fibrosis.

Bariatric surgery as treatment for NASH/ NAFLD:

We know that the development of NASH is due to obesity and insulin resistance. Bariatric surgery should be considered for type II diabetics having difficulty in medical treatment and are susceptible for deterioration and complications related to diabetes.

This day, the only recommended effective treatment for NAFLD is weight loss. Gastric bypass surgery is safe and effective for weight loss, improves quality of life, decreases diseases related to obesity and increasing life expectancy.

Recent studies suggests that bariatric surgery for individuals with severe obesity brings down the grade of steatosis, liver inflammation and fibrosis.

Gastric bypass surgery in India has brought about positive results with number of obesity and liver disease cases growing day by day. Gastric bypass surgery, Metabolic surgery has been recommended by the researchers and governing medical bodies as safe and offers a permanent cure for diabetes along with weight loss, improvement in liver related problems due to obesity. The cost effectiveness of the surgery is significant with more and more people choosing to accept gastric bypass surgery as a modality to cure obesity and prevent obesity related diseases.

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