NEW DEVELOPMENTS IN OBESITY MANAGEMENT
Weight reduction and obesity management can be frustrating for both patients and doctors. Fortunately, there seems to be some silver lining on the horizon recently, giving hope to many.
According to Center for Disease control (CDC), four out of 10 Americans are overweight. Obesity is more of a problem in the Western countries, whereas malnutrition is an issue in many poor countries.
People can verify their obesity level by measuring body mass index (BMI). Nowadays, the cellphone can be used for easy calculation of BMI by entering the height and weight. BMI above 25 is considered as overweight and above 30 is considered as obese. Those with BMI above 30 must undergo treatment to reduce body weight.
The underlying reason for obesity is unclear. Often, it starts from childhood. It could have a genetic etiology such as Leptin deficiency, which is a genetic mutation that results in uncontrollable appetite. It could be due to an addictive behavior promoted by the brain seeking comfort from stressful issues in life. A baby stops crying when it is fed, irrespective of the initial causative factor. Ghrelin is a hunger hormone that makes us eat more, whenever food intake is restricted. The type of food we eat and quantity, the calories we consume, the frequency of eating, snacking between meals, use of ultra-processed food and cola drinks, and consumption of trans fat are factors to consider. Sedentary lifestyle with inadequate physical activity worsens the scenario.
Obesity carries higher risk for the individual to develop variety of medical problems such as diabetes mellitus, respiratory insufficiency, cardiac insufficiency, arthritis, joint and venous problems, leg and decubitus ulcers, thrombophlebitis, sleep disorders, hygienic issues, mental depression, suicidal tendency and alcohol addiction. It decreases longevity by about 20 years. Metabolic syndrome occurs when the muscle mass decreases and abdominal fat increases. In addition, it leads to various socio-economic and logistic problems in getting medical tests and treatments.
Initial treatment of obesity is through medical management, which includes dietary control, exercise, medications and psychosocial support. Many different diets are offered in the commercial world that promises to decrease the weight in a short time. One must eat healthy food and reduce intake of calories. Health spas promote various exercises and weight reduction strategies.
Those who are unable to lose weight with these measures are often recommended for surgical procedures, generally called bariatric. Several variations of the type of surgical procedures have enjoyed popularity from time to time. Gastric and intestinal bypass procedures were used previously. Currently, removal of a vertical length of the stomach called sleeve gastrectomy is the procedure of choice. This can be done via open surgery, laparoscopic method or robotic assistance. Endoscopic non-surgical stomach volume reduction techniques are also being tried.
A new development has been introduction of a class of drugs called semaglutide, otherwise known as glucagon-like-peptide 1 receptor agonists (GLP-1). The brand names are Ozempic and Wegovy manufactured by Novo Nordisk and Mounjaro by Eli Lilly respectively. Theywere found to be effective in managing Type 2 diabetes mellitus along with weight loss. Patients showed improvements in cardiovascular and physical functioning. The drugs work by reducing appetite and delaying stomach discharge. Patients lost 15 percent of the body weight shortly after taking these medications.
Public interest in consuming these drugs has become astronomical despite the cost. Insurance companies are not covering the medication yet. The cost of the drug can be up to a $1,000 a month. It is taken as a weekly injection, but pill form is expected to be available. Patients must continue weight reduction strategies such as exercise and dietary control along with the medications. When the drugs is stopped, they are likely to regain weight.
Side effects include nausea, vomiting, regurgitation and pulmonary aspiration during anesthesia, constipation or diarrhea. More serious complications are pancreatitis, gall stones, bowel obstruction and gastroparesis known as stomach paralysis. Anesthesiologists recommend stopping use one week before elective surgical procedures. Patients can also start the drugs at a smaller dosage and slowly advance the amount over a period. Moreover, the drugs do not work for everybody alike.
Obesity is a disease. It is best to avoid getting it from childhood onward. Of course, it is easier said than done for many who live with it. New excitement in obesity management is the use of semaglutide (GLP-1) drugs. It is not for everyone. Please consult with your primary care physician or a qualified bariatric specialist to discuss options.
Dr. Venkit S. Iyer, MD, FACS, is a retired General and Vascular Surgeon. He has authored four books – “Decision making in clinical surgery,” “Aging well and reaching beyond,” “The Clinic” and “Geriatrics Handbook.” They are available through Amazon or from the author. His website venkitiyer.com has necessary links and contact information.
Editor’s Note: Khaas Baat sincerely thanks Dr. Ravindra Nathan for his valuablecontributions through his monthly health column starting with our first year of publication.
EYE CARE
March is Workplace Vision Protection Month
Vision, a precious asset often overlooked until compromised, demands vigilant protection in the workplace. Be it a construction site, laboratory or office, proactive measures are indispensable to thwart potential eye injuries. This article explores the criticality of workplace eye safety, identifies prevalent hazards and offers preventive strategies.
Given their delicate nature and exposure to diverse risks, eyes are highly susceptible to injuries in work environments. Chemicals, projectiles, radiation, and digital screens are among the culprits contributing to workplace-related eye injuries, impacting personal well-being and productivity.
Common Hazards
1. Chemicals: Exposure to corrosive substances like acids or solvents can lead to severe eye damage if not promptly treated.
2. Flying particles: Dust, debris, or fragments from construction, machining, or grinding activities pose a threat of penetrating the eye.
3. Radiation: Welding arcs, lasers or UV light can result in eye burns or long-term damage without proper protection.
4. Impact: Mishandling of tools, machinery or equipment may cause blunt force trauma, ranging from minor scratches to severe lacerations.
5. Digital eye strain: Prolonged screen exposure can cause discomfort and dryness, collectively termed computer vision syndrome.
Prevention Strategies
1. Personal Protective Equipment (PPE): Ensure all personnel wear suitable eye protection such as safety glasses, goggles or face shields tailored to their work environment's hazards.
2. Hazard assessments: Regularly evaluate workplace conditions to pinpoint potential eye hazards and implement requisite controls such as machine guards or engineering solutions.
3. Training and education: Provide comprehensive instruction on eye safety practices encompassing proper PPE use, emergency protocols for eye injuries, and hazard awareness.
4. Eye care practices: Encourage periodic breaks, particularly during extended screen use, to alleviate digital eye strain. Emphasize prompt rinsing with water in cases of chemical exposure.
5. Regular eye exams: Advocate for routine eye checkups to promptly address any vision anomalies, ensuring optimal eye health for employees.
Management Options
Simple workplace accidents, including chemicals, foreign bodies or wind-assisted impacted particles can be addressed with minimally invasive treatments with your local eye doctor.
More invasive accidents and exposures need immediate treatment using advanced diagnostics and non-surgical or surgical interventions from ocular surface correction to corneal tear injuries, lens damage and or internal eye bleeding. These not only require management at the time of injury but also long-term follow-up, especially in situations like radiation or intense chemical exposures and possibly cause scarring in the future and adversely involves vision.
Preserving workplace eye safety necessitates proactive measures, education and sustained vigilance. By prioritizing preventive actions and fostering a culture of awareness, organizations can uphold employees' vision and well-being, fostering a safer and more productive work milieu. Remember, safeguarding eyesight today ensures a clearer, brighter vision for tomorrow.