Obesity-IV

MEDICATION FOR OBESITY
Only in extreme cases one should resort to medication and effort should be made to lose weight by controlling calories through diet. Medication is only one part of the programme for weight loss and to get lasting results, a long term change of lifestyle is required.
The blood contains the hormones and the chemical signals which influence hunger and these are controlled by hypothalamus which is a part of the brain. Drugs for weight loss like amphetamine increase the quantity of dopamine and noradrenaline hormones which are responsible for stopping the feeling of hunger. However they have serious side effects if used on a long term basis like high anxiety, high blood pressure and restlessness.
ORLISTAT TREATMENT
The Orlistat treatment should only be considered only after making significant efforts through exercises, diet or changing lifestyle. The orlistat capsule which is prescribed by the doctor is taken with the main meals with a dosage of maximum of three per day and it works by blocking or stopping the enzymes action on food which are responsible for digesting of fat as a result the undigested fat is passed out of the body along with the stools (faeces) and is not absorbed by the body. It is a long term treatment and it must be coupled with a diet which is low on fat including other weight loss techniques like exercises. If there is a weight loss of 5% or more in three months and 10% or more in six months only then the Orlistat treatment should be continued. The side effects include urgency for toilet, smelly fatty stool, flatulence and oily spotting on the underwear and they decrease if low fat diet is taken. If women on oral contraceptive pills develop diarrhoea while taking orlistat treatment they should go in for alternative method of contraception like condom etc. In case of children, pregnant or breastfeeding women orlistat is not prescribed.
SIBUTRAMINE TREATMENT
Sibutramine treatment should be taken only after it is prescribed by the doctor and it works on serotonin and noradrenaline the chemicals in the brain by working on them and affect by giving the feeling of satisfaction even with a small quantity of food. However the Sibutramine treatment should only be considered only after making significant efforts through exercises, diet or changing lifestyle. It is a long term treatment and it must be coupled with other weight loss techniques like exercises. If there is a weight loss of at least 2 kg or more in four weeks and 5% or more of the original weight in three months only then the Sibutramine treatment should be continued.
Side effects of Sibutramine are dry mouth, constipation, increased blood pressure and difficulty in sleeping. It is not prescribed to persons suffering from heart disease or having a history of strokes, arrhythmias (abnormal rhythm of the heart), high blood pressure, peripheral vascular disease (blood vessels becoming narrow normally in legs)
In both the cases of treatment by sibutramine or orlistat, advice, counselling and support for lifestyle change, exercises and diet are prescribed.

SURGERY FOR TREATMENT
Morbidly obese cases of BMI above 40 which are hard to treat are normally considered for surgery or is undertaken in persons with BMI ranging from 35 to 40 if these persons are suffering from cardiopulmonary problems which are life threatening and include severe sleep apnoea (sleep disorder caused by irregular breathing during sleep), diabetes or heart disease which are related to obesity. Surgery should only be considered only after making significant efforts through exercises, diet or changing lifestyle. Gastric Banding is the surgical treatment preferred in morbidly obese people and is only considered if there is no other alternative left.
GASTRIC BANDING
A band is placed on the upper part of the stomach which controls the intake of food. After placing the gastric band, the surgeon can loosen or tighten the band externally (from outside the body) to control the food intake. If salt water is added into the band, it tightens the band resulting in slowing down the quantity of food which can pass through the stomach resulting in a feeling of full stomach for a longer period. Similarly removing the salt water increases the speed of the food passing through the digestive system. Normally, the surgeon starts with a lose gastric band when the person develops the habit of eating less, it is tightened further.
The gastric band can remain permanently in the stomach however it can also be removed and has a very low risk of any permanent change to the stomach.
A certain degree of complications is involved which include the risk of developing an infection while fitting the gastric band through surgery and in very rare cases it may cause a leakage into the stomach.
Gastric band is not suitable for persons suffering from lung or heart problems where the procedure may become risky.