 ہی بیووزان Heroes by Money Part Hospital بے ہی بیوز کی خوبات بہت تک ہوں ہی بیوز جو بہت میں مر 행ہ بھلک رہا ہوں تو ہی جب کسی اندلیوں کے ساتھ آپ کی فرماک ہوتے کے لیک سکتے ہیں تو ہی بہت بہت میں رہے ہیں ہی حرام یہاں مطالعے کی نوازی اردویت لیکن today ہنانا جو سواریٹی سے ممنعیی جو سواریٹ outبے بیوز میں آپ کو حیرت جو انکتر وہاں پہنے میں اکل کو لی試ہ today we have a chairmen of the electric surgery department of money power hospitals doctor sumit dalwar so i'd like to welcome doctor sumit dalwar to this show so doctor we already have lots of questions lined up we have 148 questions lined up for today's show meanwhile i'd like to tell you to all the viewers today's show will be live from 2 to 3pm so all the questions related to weight loss surgery, obesity you can type your questions on facebook and doctor will try to answer all the questions as much as possible so main towards the first question i'm from crystal and concerned about my overweight child what can i do about it child obesity or overweight children is actually a very real problem and a very difficult one to deal with there are multiple reasons for children becoming obese and some of them are related to hormones so i would suggest that you consult a pediatric endocrinologist about your child first a pediatric endocrinologist is a child specialist who specializes in the hormones of children once they have carried out the tests and examined the child in detail they will be able to suggest a proper treatment or remedy for child obesity doctor i had a question what is the definition of obesity like when do we know that we are crossing our limits and some treatment is really important for this that's a very good question, very pertinent question so nowadays we don't classify people by their body types like apple shape or pear shape or things like that so what we measure is called a body mass index or BMI BMI is the relationship of your weight to your height it's measured by calculating weight in kilograms divided by height in meters squared so a BMI of 18.5 to 22.5 is considered normal for Indians and ancient populations between 22.5 and 27.5 is considered overweight above 27.5 is considered obese above 32.5 is considered morbid obesity because that is the time when the overweight actually starts to lead to problems which are medically important like diabetes or problem in the knees, blood pressure etc so the basic tool for measuring obesity or defining obesity is body mass index it's a fairly accurate tool but it cannot be applied to certain group of people like very muscular or athletic people or to pregnant women so didicially applied BMI is a very accurate and a very good guide towards your weight and height we have a next question from Sachin how can childhood obesity be prevented and there is one more question what is meant by childhood overweight is that the same as childhood obesity so I think for children we also measure BMI's but the limits of the BMI are not fixed like in adults in children there are charts which relate the BMI to the age of the child so according to age the normal BMI changes similarly the range in which the child would be considered overweight also changes and the range in which the child would be considered obese will also change so for children the charts have to be referred to the best point of reference would be again a pediatric endocrinologist who will be able to help you in deciding whether your child is overweight or obese so basically obesity is just a severer form of being overweight I hope that answers the question about prevention of childhood obesity I think most important is to be careful about the diet and keep a check on the amount of carbohydrates or sugars that your child is taking maintain a reasonable level of activity the child should be playing but again if the child is gaining weight despite everything it is best to consult a pediatric endocrinologist there may be an hormonal problem at play which is causing all the harm this is the next question from BMI is obesity a disease a lifestyle or social concern phenomenon and is treatment required for this very good question this is in fact the biggest philosophical change that has happened in medicine in the past 20 to 30 years obesity was initially considered to be the affected person's fault it was thought that it is a lifestyle disorder and it is a lifestyle problem and the person who is overweight is actually completely responsible for his condition but now we know that this is no longer true obesity is a disease just like high blood pressure just like diabetes just like asthma just like any other disease that you may like to compare it to it has been proven that the person we overweight is not actually the fault of the person himself it is a complex hormonal problem which is regulated by a number of hormones which are being secreted by our body so people are prone to obesity they have a predisposition towards being overweight and obese whenever there is a trigger like disturbed sleep or stress at work or stress at school the environmental triggers trigger the obesity in people who are predisposed to obesity so now that we know that obesity is a disease so definitely the question arises whether we need to treat it or not definitely we need to treat it not because it is a disease but also because it is difficult to control with just diet and exercise and more importantly it gives rise to many life-threatening conditions like diabetes, high blood pressure, high cholesterol obstructive sleep apnea or excessive snoring and choking in sleep many joint problems the knee joint and the back problems it is also associated with a number of cancers it increases the risk of uterine cancer and breast cancer by 2-3 times in susceptible people therefore obesity definitely needs to be treated and it needs to be treated aggressively because it reduces the lifespan of the person affected so it is really important for us to be healthy and with a healthy lifestyle have a healthy food absolutely now doctor I had a question what exactly is bariatric surgery or weight loss surgery because many people are not aware what it is actually I wanted to know what exactly is bariatric surgery so before I tell you what bariatric surgery is all about let me start by explaining why people are overweight so the concept that we now believe in is called the set point concept that means a person has is of a certain weight because his brain and his body has decided or it has decided that this is the correct weight for that particular person that particular weight becomes the physiological set point for that person so when you try to find that set point your body starts to compensate if you exercise the body will start to conserve more energy you become lethargic your basal metabolic rate will slow down and you will start to store more food and spend less energy which is a protective mechanism against starvation therefore what we need to do is actually we need to change this concept that means we need to change the hormonal environment inside so that the set point is lowered to a healthy good for this currently the only treatment that works is called bariatric surgery or weight loss surgery in bariatric surgery we change the stomach and the intestines we operate on them and change their configuration in such a way that the body hormonal changes start to happen by which the set point is lowered so when the set point is lowered the patient or the person will start to lose weight gradually and naturally over the next one to one and a half years and will come down to his normal weight okay now so we have other question from Reshma it's a very funny question actually why don't some people get fat even if they eat a lot well that's exactly what I'm trying to say not everybody has the same hormonal environment inside so people who do not gain weight despite eating as much as other people who are overweight or obese because their body the set point of weight of their body is lower or is in the healthy aspects so they are likely to spend more and save less with the same amount of food that they are eating even if they don't exercise as much as people who are trying to lose weight they will probably remain thin because that's how their bodies are designed so we have to understand this difference there are some people who are prone to obesity and they will become obese or overweight once if there is a trigger and there are some people who are persistent to this tendency of obesity that explains the difference that is exactly why we think obesity is a disease which needs to be treated medically or surgically for that example and it cannot be just managed by diet or exercise so there is one more question from Sumet Singh why is surgery the only long term solution for most of the people a very good question and a very very pertinent question right now the only treatment option which can change the set point of weight of a particular person permanently is bariatric surgery or weight loss surgery there are two types of surgeries that we do we will talk about that later so when we do the surgery the hormones which increase hunger which increase the preference of the person towards carbohydrates and foods that lead to weight gain goes down automatically the hunger goes down the preference to such foods goes down the energy level actually goes up even though the person is eating much less than what he was eating before the operation and a lot of other beneficial things start to happen even before the weight loss starts therefore currently the only permanent long term and effective solution to the problem or disease of obesity is bariatric or weight loss surgery so there is a question from Vishnu can yoga help in weight loss well all exercises will help you to lose weight to a certain extent and yoga is just another type of exercise the other advantage of yoga is that it will make your body fitter it will make you more flexible and it will make you healthier in a fitness sort of way most exercise and weight loss regimens diet weight loss regimens are not effective in losing more than 5-10% weight so what you should be aiming at is just a loss of 1-2 kilos a month it should continue for maybe 7-10 kilos that is a very achievable and a very fair target to aim at if you are aiming at anything more than that you are likely to be disappointed because it has been shown that not more than 5% of people can actually lose more weight than this the other thing is maintenance so whatever you do to lose weight you will have to continue to do it for the rest of your life only then you will be able to maintain the weight loss if you give up dieting and exercise once you lost weight the weight is likely to come back and usually it comes back to the maintenance that is why we have what is called the yo-yo effect your weight bounces back it goes back to usually a higher level than what it was before and I got one more question in my mind actually whenever it comes to weight loss everyone prefer easier weight or losing weight so there are lots of products you can see lots of ads on TV maybe slim weld there are lots of products with a green tea there are many things so what do you say is it beneficial doing using such products so I don't think that we have too many scientific studies on many of these products like green tea or green coffee or slimming pearls or other external slimming treatments to treat the fat under the skin the logic that they propose is that they have to find fat under the skin because that is what they can actually affect the thing to understand is that the fat that has been deposited it's not deposited only under the skin that is not the only thing which is making you look fat you gain weight in every part of your body and most of the weight especially in people who have central obesity is actually on the internal organs there is no way that any external device can reduce that fat reduce that fat regarding the products which need to be ingested or eaten or drunk for example like green tea or any other medicines I am not sure we have too much data on these products so I won't be able to comment on these products I hope that answers your question so the next question is from Aparna santh which option is better to reduce weight slimming or gym where any exercise for about 45 minutes to 1 hour 5 to 7 days 5 to 6 days a week is actually equally good anything more than that you may be able to lose more weight in the shorter it will be difficult to maintain any exercise which is brisk and which is vigorous brisk walking gym in or swimming the level of activity has to be high and it has to be regular at least 5 to 6 days in a week 45 minutes to 1 hour that is a realistic achievable target that can be maintained for a prolonged period of time how important is water for weight loss well I don't think water itself can cause weight gain or weight loss so if you drink a lot of water maybe you will be a kilo or so heavier just after taking the water ultimately your body will take care of the excess water it will be excreted in one way or the other and you will come back to your stability so the variation that we get during the day of 1 to 2 kilos is basically the movement of water so deheadweighting yourself or reducing the amount of water is a very common trick that people use to reduce weight in the short term but it's not a good thing because it doesn't actually reduce the fat reserve of the person which is actually what is bothering us in terms of disease production so reducing water is a good short term trick to lose a couple of kilos but it's not good for him drinking more water also I don't think really helps in any way to reduce weight because whatever extra water you drink whatever the body needs it will retain and the rest of it will be just excreted in one way or the other there's a question from Sneha why am I losing weight but not really fat so there could be many reasons for that one is that the amount of overweight that you are will actually determine that how much weight you need to lose to lose the belly fat or come back into the shape that you desire the other reason could be that your muscles may be loose and that is why it is giving the balance of central obesity or merges around the tummy the most important thing to realize is that unless you lose if you are significantly overweight then you need to lose a significant amount of weight for your shape to come back to the desired shape or for you to lose belly fat so 2, 3, 4, 5 kg will not help you to lose a significant amount of belly fat this is one more question how effective is weight loss surgery and if I am looking for a weight loss surgery what are the different types which I can out call very good question so how effective is weight loss surgery as I just said weight loss surgery is the only effective and long term durable solution for the problem of for the use of obesity that is I think we have proven it beyond any doubt weight loss surgery in general is very effective the target that we keep for ourselves to consider a particular patient's result that whether the surgery has been effective if this patient is not or not is that we should lose at least 50% of the excess body weight that means if somebody is supposed to be 70 kg and he is say 150 kg so the excess 80 kg he should be able to lose at least half of that that means 40 kg must be able to lose for us to say that this surgery has worked in this 40 kg person on an average the common surgeries that we do they cause a loss of 60% and upwards and most of the people would lose somewhere around 70% of the excess body weight going by saying for example if 70 kg person is weighs now about 150 kg he would be able to lose maybe 50, 60 or 70 kg of that extra weight by weight loss surgery come into the types of weight loss surgery there are two main types of weight loss surgery that we do there are in both or that are considered effective today one of them is called a sleep gastectomy or stomach sleeping the other is called bypass there are two types of surgeries there was a surgery called gastric banding which was in both few years ago but it is now not considered to be as good as these surgeries because of the results not being that good and the weight coming back after a few days in sleep gastectomy we remove a large part of the stomach the stomach is the organ where you store food after eating and where the digestion begins so the part of the stomach that we remove actually secretes most of the organs which cause hunger so once you remove the stomach the hunger goes down and because the capacity is reduced the person feels full after a very small bit but there are other complex hormonal changes which also occur which are secreted by the small intestine even in sleep gastectomy so the other type of surgery is called a bypass there are many types of bypasses that we can do the most popular or the most common one is called a roma y and gastric bypass in that we make a small pouch of the stomach and also bypass a small part of the small intestine from the food so the food that we eat becomes less in quantity and also some of that doesn't get digestive and it is passed out as it is but more important than that because of the rearranging of the intestine the hormonal changes which are causing the person to be more hungry to be more prone to eating carbohydrates and other obviously causing foods it goes down and also it affects positively the various problems that are associated with this there is one such interesting question and it's as in almost all the medical firms so they are drinking more the consumption of more beer leads to increasing belly fat well beer is not any bad any words are any better than any other form of alcohol so all alcohol that we consume is basically calories so whatever amount of alcohol we consume it actually they are all empty calories and they just get deposited in our products so beer or any other alcohol in any form would definitely give rise to increased injection of total number of calories and these calories are basically empty useless calories they just add to the fat deposit the other thing that goes with beer is or any form of alcohol is the snacks so if we are taking a lot of carbohydrate snacks and adding extra calories to our diet so that also adds to the fat deposit in the body so drinking this beer doesn't affect I am getting a beer belly this end there is a term of beer belly there is a term called beer belly I am sure there will be other people who have a whiskey belly or a rock company as well so beer is not again what I am repeating is beer is not any worse or any better than any other form of alcohol it just adds calories to your system which you don't need there is a question from Aravind I drink 10 liters of 6 to 12% sugar where this is for a week how much does this affect my weight fat this is a question related question a very good question we have just begun to realize in the past 5 to 10 years that the actual culprit in 8K is the sugars of the carbohydrates that we take carbohydrates are either complex or simple carbohydrates simple carbohydrates are the sweet things the complex carbohydrates are the ones that we get through rice, chapati, potatoes and things like that so carbohydrates are the worst culprits for 8K and out of them refined carbohydrates like simple sugars or sugary beverages are the ones that are the top of the list they are the biggest culprits so if somebody is drinking any amount of carbohydrates sweetened beverages in routine in their time definitely it's going to add to their calorie load it's definitely going to add to the weight and fat does walking fast help you lose weight because I'm from Simran Simran I think I just answered that question any form of exercise I mean any form of exercise which is brisk and raises your heart rate by about 50% of your resting heart rate and makes you brisk is a good enough exercise to help you lose weight to help you keep fit so walking briskly 45 minutes to 1 hour a day for 5 to 6 days every is a very good exercise this is one more question from who we would do diet pills work for weight loss well there are 2 kinds of diet pills that we are talking about here one is the type of diet pills that are available of over the counter genetic diet pills by various companies which contain Ayurvedic or other herbal remedies I am not sure whether they work because they have not been studied in detail the results have not been proven so I do not recommend you to take those diet pills without supervision of a doctor there are some medicines that doctors will prescribe to you to help you lose weight but they are not a substitute for a healthy diet and a healthy lifestyle healthy exercise regimen they can help in losing weight in people who are doing following diet and exercise so right now there is only one type of medicine which is available in India some injectable is available which is still under sort of evaluation it is being used but only by people who are well versed with their use and problems so if you want to take any diet pills you must consult a weight loss specialist either a physician or a weight loss surgeon so what are the various risks associated with the weight gain that is a very good question why are we so concerned about weight loss we are not bothered just because it makes you look unattractive we are bothered because it actually affects your body in many many ways it gives rise to many diseases and it worsens many other diseases it actually has been shown that a person who is overweight will be actually living about 5-10 years less than what you would have lived if you were not overweight for peace so the list of diseases which are related or which are caused by obesity and which are worsened by obesity is of 20 august start with the biggest killer of all which is called diabetes or high blood sugar then comes high blood pressure then comes high cholesterol a disease called obstructive sleep apnea which is excessive snoring and choking during sleep at night is also directly related to obesity then there are multiple mechanical problems like joint problems in the knees back problems and there are problems of urinary incontinence especially in females which is directly related to the weight there are a number of cancers which are related to obesity it has been proven that the risk of many cancers like breast cancer endometrial cancer and colon cancer are related to being overweight there is another disease which is called fatty liver or non-alcoholic fatty liver disease which is also directly related to overweight and obesity and it can be it can give rise to chronic liver disease and liver cirrhosis or liver failure also in the long term why we are so confident that these diseases are caused by obesity or worsened by obesity is that when you do this when you do bariatric surgery and the patients start to lose weight many of these diseases actually just disappeared they will start becoming better and lot of people will these diseases will disappear actually but what I have heard that diabetes has no cure but I have also heard that by having weight loss surgery it's a cure for diabetes is it true doctor very very good question diabetes is specially of two types the childhood diabetes or type 1 diabetes is something which is because of deficiency of insulin produced by the time care so that is a different disease from adult diabetes or type 2 diabetes adult diabetes especially in people who are overweight this is actually directly related to the obesity or overweight therefore when we treat obesity the diabetes also starts becoming better so there are multiple mechanisms by which this works there is insulin resistance in the periphery in the fat which becomes less means the production becomes better the way the insulin acts in the body it also becomes very very sort of thrifty and very efficient so bariatric surgery will lead to remission of diabetes I am not sure that I can say that diabetes will disappear or it will be cured but at least the diabetes will come down to such a state that the person will not require any medicines to maintain a normal blood sugar so that is actually pretty close to cure as we know about so bariatric surgery in fact actually leads to remission of diabetes in large percent of people who are overweight and diabetes so it's a better cure than other absolutely the drugs that you need to take will never give you that kind of 24 hour control which bariatric surgery will give it will give you natural control from the inside of the body because we have reset the whole hormonal mechanism inside the body which is giving rise to the effects and giving rise to raised blood sugars okay another question I would like to ask on all the viewers after having a weight loss surgery is it important that we maintain or diet again after it is important but it becomes much easier to maintain your diet see what happens is once you have had weight loss surgery your hunger will go down your drive to eat more food actually disappears so you will eat only that much food that your body actually requires one second is that the satiety that you feel after eating food comes up in a very short a very small amount of food so you will feel full very soon and with a very small amount the third most important thing is that your preference towards foods which are actually giving rise to obesity automatically goes down your preference towards sweet things your preference towards carbohydrate rich foods actually goes down it has been seen in humans it has been proven in experiments in rats if obese rats they are special type of rats which are prone to being obese these rats are operated and they are often carbohydrates or sweet foods they actually reject those kinds