Endocrinology

THYROID NODULES

Thyroid nodules are lumps that form within the thyroid, the small “butterfly” shaped gland at the base of the neck. These nodules may be entirely cystic, meaning there are no solid components detectable within the fluid. Alternatively, the nodules may be complex, and contain both fluid and solid components.

SYMPTOMS

In most cases, thyroid nodules do not cause symptoms and are not considered dangerous. However in some cases, these nodules become enlarged and make it hard to swallow or breathe. If the nodules produce extra levels of thyroxine the following symptoms can occur:

• Unexplained weight loss
• Heat intolerance
• Tremors
• Nervousness/anxiety
• Rapid or irregular heartbeat

TREATMENT 

For benign nodules, treatment includes:

• Thyroid hormone suppression therapy:This form of therapy involves treating the nodule with synthetic forms of thyroxine (thyroid hormone).

• Ethanol sclerotherapy:A procedure that involves injecting ethanol into the cystic cavity. This is performed every 1 to 3 months for 1 to 2 sessions.

• Thyroidectomy:An incision will be made in the base of your neck and the thyroid gland will be removed removed. In most cases, your surgeon will leave small bits of thyroid tissue around your parathyroid glands to reduce the risk of parathyroid damage.

DIAGNOSTIC SERVICES

Diagnosing thyroid nodules requires:

• Fine needle aspiration (FNA):This is a biopsy used to distinguish whether a nodule is benign or malignant. A thin needle is inserted into the nodule and removes a sample tissue for testing.

• Ultrasonography:This imaging test uses high-frequency sound waves to produce images to determine the shape and structure of the nodules.

THYROID CYSTS

If a thyroid nodule is filled with fluid, it is called a cyst. Thyroid cysts are lumps containing fluid that appear in regions, in and around the thyroid gland – Thyroid cysts are the enlarged fluid-filled regions that form within the thyroid gland. They may be small (less than 1 cm) or quite large and sometimes arise very suddenly. Thyroid nodules may be entirely cystic, in which case there are no solid components detectable within the fluid. Cystic nodules may get larger suddenly due to hemorrhage or bleeding within a smaller pre-existing nodule.

SYMPTOMS

Cysts range in sizes from small to large and can grow quite rapidly causing symptoms such as:

• Neck pain
• Trouble swallowing
• Compression of the vocal chords

TREATMENT

Treatments for thyroid cysts include:

• Thyroid hormone suppression therapy:This form of therapy involves treating the nodule with synthetic forms of thyroxine (thyroid hormone).

• Ethanol Sclerotherapy:A procedure that involves injecting ethanol into the cystic cavity.

DIAGNOSTIC SERVICES

Diagnosing thyroid nodules requires:

• Fine needle aspiration (FNA):This is a biopsy used to distinguish whether a nodule is benign or malignant. A thin needle is inserted into the nodule and removes a sample tissue for testing.

• Ultrasonography:This imaging test uses high-frequency sound waves to produce images to determine the shape and structure of the nodules.

PITUITARY ADENOMA

The pituitary gland consists of different types of pituitary cells and each of them produces special hormones that are released into the bloodstream that affect other organs in the body.

Pituitary adenomas are mostly benign tumors that develop in the pituitary gland. One characteristic of adenomas is that they only stay within the pituitary gland, instead of spreading to other parts of the body.

WHAT ARE THE DIFFERENT TYPES OF PITUITARY ADENOMAS?

The classifications of pituitary adenomas are separated into several different types depending on their properties:

• Size:Adenomas that are less than one centimeter in size are known as microadenoma. Adenomas that are one centimeter or greater are known as macroadenoma.

• Aggressiveness:Most pituitary adenomas are benign and grow at a slow rate. Atypical pituitary adenoma (the rarer type) grows more quickly and has a higher rate of recurring. Pituitary carcinomas (malignant tumors) can spread to other parts of the body. Thankfully, they are extremely rare.

• Hormone secretion:Pituitary adenomas that release an excessive amount of active hormones are known as hormonally active or functional tumors.

Pituitary tumors occur when tumor cells produce an excess of one or more hormones, it is known as functional adenoma. Pituitary tumors occur from one of these specialized cells:

• Prolactinoma: A tumor that overproduces prolactin
• Acromegaly (adults) andGigantism (child): Triggered by excess of growth hormone
• Cushing’s disease: An overproduction of cortisol stimulated by a pituitary tumor

If they do not release an active hormone, they are known as clinically non-functioning adenomas.

SYMPTOMS

Pituitary adenoma symptoms vary depending on whether they are hormone-producing or clinically nonfunctioning. Hormone-producing pituitary adenomas overproduce and release excessive amounts of active hormones into the bloodstream. Other symptoms include:

• Irregular menstrual cycle in women
• Lower libido
• Weak muscles and bones
• Joint pain
• High blood pressure
• Headaches
• Hair loss
• Visual disturbance

TREATMENT OPTIONS FOR PITUITARY ADENOMAS

There are a number of treatment options for pituitary tumors:

• Endoscopic transnasal transsphenoidal surgery: A method that allows surgeons to extract the tumor through the nose and sinuses without the need of external incision.

• Medical therapy: A proportion of pituitary adenomas respond very well to medical treatment and often surgery is not required. Close monitoring of the size and pituitary function is needed in this case.

• Radiation Therapy for Pituitary Adenomas: Radiation therapy can be effective in controlling the growth of these tumors when the tumors can’t be removed surgically and they don’t respond to medications. Stereotactic radiosurgery is an advance method of radiation therapy where carefully sculpted radiation beam delivers high dose of radiation to the tumor target. The surrounding brain structures receive only a fraction of the radiation. Typically, the healthy structures are unharmed with the exception of the pituitary gland. The down side of radiation treatment is that it may cause delayed pituitary failure years after the treatment. You will require hormone replacement if it happens.

 

DIAGNOSTIC SERVICES

Tests used for diagnosing pituitary tumors include:

• Blood and urine tests: Used to analyze whether there are excess levels or hormones or hormone deficiency.

• Brain imaging: Tests such as magnetic resonance imaging (MRI) and computed tomography (CT) scans are often used to help pinpoint the location and size of the pituitary tumor.

DIABETES MELLITUS

Diabetes Mellitus is a collection of disorders that affects the amount of glucose in the blood. Glucose is a vital source of energy for the brain and the body’s tissue cells. When someone has diabetes, they have excess levels of glucose in the blood. Chronic diabetes conditions include:

• Type 1 diabetes: Often called juvenile diabetes, Type 1 diabetes is a chronic condition in which the pancreas is not producing sufficient amounts of insulin- the hormone that allows glucose to enter cells in order to produce energy.

• Type 2 diabetes: A condition that affects how the body metabolizes glucose – an important source of energy for the body. Type 2 diabetes causes the body to either resist insulin or doesn’t produce nearly enough to support a normal glucose level.

WHAT IF MY DOCTOR CANNOT DIAGNOSE MY TYPE OF DIABETES

Latent autoimmune diabetes of adults (LADA diabetes): We had a patient, who was diagnosed to have diabetes for almost 10 years, survived after coma, did her best to manage the condition (counting carbohydrates, checking blood glucose level, etc.), but still failed to keep it under control. Within the 10 years period she went to see quite a number of doctors: endocrinologists, dieticians, some of them diagnosed 1 type of diabetes, meanwhile others said it was type 2.

The patient was very disappointed and even frustrated, because none of the recommendations could help her to control and manage her glucose levels and succeed in controlling the condition. She came to us for some other treatments, but at the same time she wanted to get a second opinion on her diagnosis. The doctor, who is one of the best endocrinologists in Singapore, active participant of scientific life, who is continuously being invited to speak in many international meetings all over the world, explained that the main problem was that she does not have either 1 or 2 type of diabetes, she has LADA.

HOW DOES LADA COMPARE TO OTHER DIABETES TYPES?

Sometimes, LADA is referred to as type 1.5 diabetes. Though it is not the official term but it perfectly illustrates the fact that LADA is a form of type 1 diabetes that shares some characteristics with type 2 diabetes.

As it is a type 1 diabetes disorder, the body’s immune system attacks and kills off insulin producing cells.

LADA is often mistaken for type 2 diabetes as it develops over a longer period of time in children or younger adults. On the other hand, type 1 diabetes in children tends to develop quickly (sometimes within the span of a few days) LADA develops on a slower rate, sometimes over a period of years.

A doctor may initially diagnose LADA as type 2 diabetes in patients over the age of thirty five due to the slower onset of diabetes symptoms.

LADA CAN BE MISDIAGNOSED? 

Yes, LADA can often be misdiagnosed as type 2 diabetes. This is due to the patient’s age and the slower onset of symptoms.

If LADA is incorrectly diagnosed as type 2 diabetes, this could lead to inappropriate treatment methods that could cause poorer diabetes control and could accelerate the loss of insulin producing ability.

Clues that can give rise to a clinical suspicion of LADA instead of type 2 diabetes include:

• Absence of metabolic syndromefeatures (obesity, high blood pressure and cholesterol levels)
• Uncontrolled hyperglycemia despite using oral agents
• Evidence of other autoimmune diseases (including Graves’ disease and Anaemia)

IMPORTANT:  Some patients with LADA can show features of metabolic syndrome. This may complicate or delay a diagnosis of LADA.

SYMPTOMS

Symptoms of diabetes can vary depending on the amount of blood sugar elevation.  For chronic diabetes (type 1 and type 2), the symptoms include:

• Extreme thirst (polydipsia)
• Frequent urination (polyuria)
• Extreme hunger (polyphagia)
• Fatigue
• Irritability
• Slow-healing sores
• Frequent gum and skin infections

TREATMENT 

Treatments for type 1 & 2 diabetes include:

• Insulin Injections: This is used to control blood sugar in patients with type 1 diabetes or patients with type 2 diabetes that can’t be controlled by medication alone.

• Insulin Pump:A small device is worn on the outside of the body. There is a tube that connects a supply of insulin to a catheter that’s inserted under the skin of the abdomen throughout the day. This device attempts to mimic the normal pancreas’s release of insulin, but you must tell the pump how much insulin is required. Insulin is delivered in two ways; (1) a basal rate where continuous, small trickle of insulin that keeps blood glucose stable between meals and overnight or (2) abolus rate which is a much higher rate of insulin is taken before eating to cover the food you plan to eat. What are the main advantages of insulin pump?_

• Increased flexibility in lifestyle
• Insulin delivery is predictable
• Insulin delivery is precise
• Ability to accurately deliver 1/10th of a unit of insulin
• Tighter blood glucose control (while reducing the risk of low blood glucose)
• Episodes of severe hypoglycaemia is reduced
• Wide fluctuations in blood glucose is reduced
• Help to manage the “dawn phenomenon”

Effective and safe use of the pump requires; commitment to checking blood glucose at least 4 times a day (every day), using carbohydrate counting and adjusting the insulin doses according to blood glucose levels, carbohydrate intake, and physical activity

• Blood sugar measuring:This helps you to monitor and understand the link between blood glucose levels, carbohydrate intake and physical activity.

• Carbohydrate counting: A diet consisting of lesser amounts of animal products and refined carbohydrates (e.g. white bread) is recommended. Learning how to count carbohydrates is essential for knowing how much insulin to administer. Managing type 2 diabetes includes:

• Eating healthy
• Exercising regularly
• Medication or insulin therapy
• Monitoring blood sugar

DIAGNOSTIC SERVICES

Treatment and screening of diabetes includes on site:

• Glycated haemoglobin (A1C): A test that shows the patients average blood sugar levels for the last 2-3 months. It measures the proportion of blood sugar connected to haemoglobin – the oxygen-carrying protein in the red blood cells.

• Urinary ACRL

• Digital retinal photography

• Diabetes foot screen

• Body composition and dietetic counselling

• Pre-diabetes screening

OSTEOPOROSIS

Did you know that your skeleton loses old bone and forms new bone? New bone forms quicker than old bone is lost during your childhood and teenage years. Around the age of twenty, your bones start to get denser and reach their peaks. You may start to lose more bone than you form and the process speeds up as you age. When this happens, the bone becomes less dense and weak. This may lead to conditions such as osteoporosis.

WHAT IS OSTEOPOROSIS?

Osteoporosis is the weakening of bones to the extent that mild physical stresses, such as bending or even coughing can cause bones to fracture. These fractures happen mostly in the hip, wrist or spinal region. The body constantly breaks down bone and then replaces it but with osteoporosis, the body can’t create enough new bone tissue fast enough to keep up with the removal of old bone tissue. The precursor to osteoporosis is osteopenia-when bone density is below normal peak density but not enough to be classified as osteoporosis.

WHO ARE AT THE HIGHEST RISK?

Generally, women are more prone to osteoporosis. This is due to the fact that they can lose up to twenty percent of their bone mass in the five to seven years after menopause. After menopause or after surgical removal of ovaries, the decrease in oestrogen (hormone that protects the bones) leads to bone loss and increases the risk of fractures.

Men can also be affected by osteoporosis although it is relatively less common. Both the oestrogen and testosterone are important for bone health in men. Poor lifestyle habits such as excessive alcohol intake, smoking or extreme thinness can lower the level of such hormones in your body leading to bone loss.

Building strong and healthy bones during childhood and adolescence can help to prevent or delay the disease later on in life.

SYMPTOMS

Symptoms of osteoporosis include:

• Fractures
• Back or neck pain
• Loss of height
• Stooped posture

TREATMENT 

The type of treatment that may be recommended is based on an estimate of the risk of breaking a bone in the next ten years using information such as the bone density test.

Treatment might not include medication and might focus instead on lifestyle, safety and modifying risk factors for bone loss if the risk is not high.

Treatment options for osteoporosis include:

• Hormone therapy: Estrogen is used frequently, shortly after menopause and can improve bone density. This treatment can increase a woman’s risk of developing endometrial cancer, breast cancer and heart disease and is generally only used if menopausal symptoms need treating also.

• Medication: Drugs such as Alendronate, Risendronate, Ibandronate and Zoledronic acid are often prescribed for men and women with increased risk of fracturing.

DIAGNOSTIC SERVICES

Diagnostic services for osteoporosis include:

• Bone density test (bone densitometry): A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of your bones and your chance of breaking a bone. You can find out whether you have osteoporosis or if you should be concerned about your bones by getting a bone density test. Some people also call it a bone mass measurement test. This test uses a machine to measure your bone density. It estimates the amount of bone in your hip, spine and sometimes other bones. Your test result will help your healthcare provider make recommendations to help you protect your bones.

• X-Rays: Used to measure how many grams of calcium and other minerals are present in a segment of bone. Generally this test is conducted on the spine, hip and forearm. This test is used in diagnosing osteoporosis and osteopenia.

POLYCYSTIC OVARIAN SYNDROME (PCOS)/HIRSUTISM

Polycystic ovarian syndrome (PCOS) is a disorder of the endocrine system and occurs commonly among women of reproductive age.

Patients with PCOS may have enlarged ovaries that contain small collections of fluid. They are known as follicles and are located in each ovary that can be seen during an ultrasound exam. The exact cause of PCOS is unknown.

To reduce the risk of long-term complications such as type 2 diabetes and heart disease, early diagnosis and treatment along with weight loss may be beneficial.

SYMPTOMS

Signs of polycystic ovarian syndrome generally occur shortly after a woman begins having her period (menarche). These signs include:

• Excess hair on the face, chest, stomach, thumbs or toes
• Decreased breast size
• Deepening voice
• Thinning hair
• Acne
• Weight gain
• Pelvic pain
• Anxiety or depression
• Infertility
• Balding
• Irregular menstrual cycles
• Increased muscle mass

WHAT ARE THE COMPLICATIONS THAT CAN APPEAR?

PCOS may make the following conditions more likely especially if obesity is also a factor:

• Type 2 diabetes
• High blood pressure
• Cholesterol and lipid abnormalities such as elevated triglycerides or low high-density lipoprotein (HDL) cholesterol (the “good” cholesterol)
• Metabolic syndrome (a cluster of signs and symptoms that indicate a significantly increased risk of cardiovascular disease)
• Non-alcoholic steatohepatitis (a severe liver inflammation caused by fat accumulation in the liver)
• Infertility
• Sleep apnea
• Depression and anxiety
• Abnormal uterine bleeding
• Cancer of the uterine lining (endometrial cancer) caused by exposure to continuous high levels of estrogen
• Gestational diabetes or pregnancy-induced high blood pressure

TREATMENT 

Treatment of PCOS tends to focus more on the management of the individuals concerns such as infertility, hirsutism- the abnormal growth of hair on a women’s face or body- , ache or obesity. For treatment of obesity a doctor might encourage:

• A low calorie diet
• Moderate exercise

Other treatments include:

Your doctor may prescribe medication to:

• Regulate your menstrual cycle:Your doctor may recommend combination birth control pills (contain both oestrogen and progestin) to regulate your menstrual cycle. They work to decrease androgen production and also give your body a break from the effects of continuous oestrogen. This will lower the risk of endometrial cancer and also correct abnormal bleeding.

Alternatively, a skin patch or vaginal ring that contains a combination of oestrogen and progestin may be used to treat the condition as well. You won’t be able to conceive during the time that you take this medication to relieve your symptoms.

Another approach to treat this condition if you’re not a good candidate for combination birth control pills is to take progesterone for ten to fourteen days every one to two months. This type of therapy helps to regulate your periods and offers protection against endometrial cancer. However, it doesn’t improve androgen levels and it doesn’t prevent pregnancy. If you wish to avoid pregnany, the progestin-only minipill or progestin-containing intrauterine device are better choices.

An oral medication known as metformin (Glucophage, Fortamet) may be prescribed for type 2 diabetes to improve insulin resistance and lowers insulin levels. This may help with ovulation and lead to regular menstrual cycles. It also slows the progression to type 2 diabetes if you already have pre-diabetes. It also aids in weight loss if you follow a diet and an exercise program.

• Help you ovulate:You may need medication to help you to ovulate if you’re trying to become pregnant. An oral anti-oestrogen medication known as Clomiphene (Clomid, Serophene) can be taken in the first part of your menstrual cycle to promote ovulation. If this medication alone isn’t effective, metformin may be recommended to induce ovulation.

If clomiphene and metformin doesn’t help you conceive, your doctor may recommend using gonadotropins. They are follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications that are administered by injection.

Another medication is letrozole (Femara). It is unclear how letrozole works to stimulate the ovaries but it may help with ovulation when other medications fail.

It’s important that you work with a reproductive specialist and have regular ultrasounds to monitor your progress and avoid problems when taking any type of medication to help you ovulate.

• Reduce excessive hair growth: Birth control pills may be recommended to decrease androgen production. Another medication called spironolactone (Aldactone) helps to block the effects of androgens on the skin. However, spironolactone can cause birth defects; effective contraception is required when using the drug. It is not recommended if you’re pregnant or planning to conceive. Another medication, Eflornithine (Vaniqa) is a cream that slows facial hair growth in women.

DIAGNOSTIC SERVICES

There’s no one-way to diagnose PCOS, however some testing methods include:

• History taking and physical exam: Your doctor will ask questions about your past health, symptoms, and menstrual cycles. A physical examination will also be performed to look for signs of PCOS, such as extra body hair and high blood pressure. Your height and weight will also be checked to see if you have a healthy body mass index (BMI).

• Pelvic exam: A doctor manually and visually inspects the reproductive organs for any indications of any abnormalities.

• Blood tests: Used to measure the levels of a number of hormones to rule out any causes of menstrual abnormalities or excess amounts of androgen that mimic PCOS.

• Ultrasound: A transvaginal ultrasound is used examine the appearance of the ovaries as well as the lining of the uterus.

DISORDER OF CHOLESTEROL

Cholesterol is the waxy substance found in fats in the blood (lipids). Although having some cholesterol is important for cell growth, having too much can increase the risk of heart disease.

If cholesterol levels are too high, fatty deposits can form in the blood vessels, making it hard for the blood to flow through the arteries. This is what is known as hyperlipidemia.

Hypolipidemia, on the other hand is when there are unusually low levels of fat in the blood. This is often referred to as low blood cholesterol.

SYMPTOMS

Typically, high cholesterol doesn’t cause any symptoms. In the vast majority of cases, the only real symptoms may cause an emergency event.

HOW DOES HIGH CHOLESTEROL CAUSE HEART DISEASE?

Atherosclerosis: A form of heart diseases occurs when there is too much cholesterol in your blood and it builds up in the walls of your arteries. When this happens, the arteries become narrowed and blood flow to the heart muscle is slowed down or blocked.

Blood carries oxygen to the heart and when not enough blood and oxygen reach your heart, you may experience chest pain. On the other hand, if the blood supply to a portion of the heart is completely cut off by a blockage, this can result in a heart attack.

Cholesterol and Coronary Heart Disease: Coronary heart disease is the main risk from high cholesterol. When your cholesterol level is too high, it can build up in the walls of your arteries. Over a period of time, this build-up known as plaque can cause atherosclerosis (hardening of the arteries). This causes arteries to become narrowed which will slow the blood flow to the heart muscle. A reduce in blood flow can result in angina (chest pain) or a heart attack if a blood vessel gets blocked completely.

Cholesterol and Stroke: Atherosclerosis may cause arteries that lead to the brain to become narrowed and even blocked. If a vessel carrying blood to the brain is completely blocked, you could have a stroke.

Cholesterol and Peripheral Vascular Disease: High cholesterol has also been linked to peripheral vascular disease. These are the diseases of blood vessels outside the heart and brain. Fatty deposits build up along artery walls and affect blood circulation in this condition. This mainly occurs in arteries that lead to the legs and feet.

Cholesterol and Diabetes: Diabetes can upset the balance between HDL and LDL cholesterol levels. Patients who have diabetes tend to have LDL particles that stick to arteries and damage blood vessel walls more easily. Glucose (sugar) attaches to lipoproteins (a type of cholesterol-protein package that enables cholesterol to travel through blood). Sugar-coated LDL stays in the bloodstream longer and may lead to the formation of plaque. Patients with diabetes tend to have low HDL and high triglyceride (another kind of blood fat) levels. Both of these conditions can boost the risk of heart and artery disease.

Cholesterol and High Blood Pressure: High blood pressure (hypertension) and high cholesterol also are linked. As your arteries hardened and becomes narrowed with cholesterol plaque and calcium, the heart has to strain much harder to pump blood through them. This results in blood pressure becoming abnormally high. High blood pressure is also linked to heart disease.

TREATMENT 

High blood cholesterol can be treated with:

• Healthy lifestyle: Eating foods with low levels of total fat and saturated fat, maintaining a healthy weight and regular exercise are all ways of lowering high blood cholesterol.
• Statins: Medication used to block a particular substance the liver needs to produce cholesterol. This in turn makes the liver remove cholesterol from the blood.
• Cholesterol absorption inhibitors: These substances lower the amount of dietary cholesterol absorbed by the small intestines.

Low blood pressure treatment focuses on the underlying cause.

ARE THERE FOODS OR OTHER DRUGS I SHOULD AVOID WHILE TAKING CHOLESTEROL-LOWERING DRUGS?

Talk to your doctor about the other drugs you are taking (including herbals and vitamins) and their impact on cholesterol-lowering drugs. You should avoid drinking grapefruit juice while taking certain types of cholesterol-lowering drugs. This is because it can interfere with the liver’s ability to metabolize these medications.

DIAGNOSTIC SERVICES

Blood tests: Lipid panel tests are the only way of diagnosing high cholesterol. These tests measure:

• Total cholesterol
• Low-density lipoprotein (LDL), otherwise known as “bad” cholesterol
• High-density lipoprotein (HDL), otherwise known as “good” cholesterol
• Triglycerides is kind of fat found in the blood

CT COROS: A computerized tomography (CT) coronary angiogram is an imaging test that explores health of the arteries that supply your heart with blood. This test is essential to determine severity of possible narrowings and blockages in your heart blood vessels

OBESITY

Obesity is a disorder characterized by high amounts of body fat.

HOW DOES IT OCCUR?

It occurs over a period of time when you consume more calories than you burn off. The balance between calories-in and calories-out is different for each person. The factors that might affect your weight include:

• Genetic makeup
• Overeating
• Eating high-fat foods
• Physically inactive

Although it affects many people on a cosmetic level, it can cause a lot of troubles within the body including:

• Heart disease
• Diabetes
• High blood pressure

WHAT IS BMI (BODY MASS INDEX)?

The body mass index (BMI) is a statistical measurement derived from your height and weight. It is considered an effective way to estimate healthy body weight and measures not only the percentage of body fat, but also muscles distribution in the body to give you the idea of your “problem” areas. The calculation of BMI is derived by dividing the patient’s body weight (kg) by their height in meters squared

SYMPTOMS

The diagnosis of obesity involves calculating the patient’s body mass index (BMI). A BMI of 30.0 or more is considered obese. A BMI of 40.0 is considered extremely obese.

TREATMENT 

Reaching a healthy weight and then maintaining it is the goal of any obesity treatment regime. A number of professionals can aid in this process, such as:

• Dietitian
• Behavior counselor
• Obesity specialist

Weight-loss regimes may consist of:

• Meal replacement therapy: Meal plans that recommend switching one or two meals a day with products such as low-calorie shakes or meal bars as well as eating healthy snacks.

• Exercise and physical activity: Obese people require at least 150 minutes of moderate-intensity exercise or physical activity to achieve the necessary amount weight loss.

• Change in behavior: With the aid of trained counselors and therapists, emotional and behavioral issues around over eating can be sorted out. Support groups are also another great form of support and understanding.

• Prescribed weight-loss medications: Prescribed weight-loss medication is intended to be used alongside a proper diet and exercise regime as well as behavior counseling.

• Bariatric surgery: This procedure may cause weight loss by restricting the amount of food the stomach can hold. This causes a malabsorption of nutrients or a combination of both gastric restriction and malabsorption. This procedure also often causes hormonal changes. Today, most weight loss surgeries are performed using laparoscopic surgery (minimally invasive techniques).

The most common bariatric surgery procedures are:

• Gastric bypass
• Sleeve gastrectomy
• Adjustable gastric band
• Biliopancreatic diversion with duodenal switch.

Each of these surgeries has its own advantages and disadvantages.

GASTRIC BYPASS

The Roux-en-Y Gastric Bypass also known as gastric bypass is considered the ‘gold standard’ of weight loss surgery.

HOW DOES IT WORK?

The procedure consists of two components, the first component involves a small stomach pouch that is approximately one ounce or thirty milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided and the end of the divided small intestine will be connected to the newly created stomach pouch.

The procedure is complete once the top portion of the divided small intestine is connected to the small intestine further down. The connection allowed the stomach acids and digestive enzymes from the bypassed stomach. The first portion of the small intestine will eventually mix with the food.

The gastric bypass works by several mechanisms. First of all, it is similar to most bariatric procedures. The newly created stomach pouch is much smaller and facilitates significantly smaller meals, which means fewer calories are consumed. There will be less digestion by the smaller stomach pouch and also a section of the small intestine will no longer have food going through it, thus there will be less absorption of calories and nutrients.

Most importantly, changes in the gut hormones due to the re-routing of the food stream will produce changes that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

WHAT ARE THE ADVANTAGES?

• Significant long-term weight loss (sixty to eighty percent excess weight loss)
• Amount of food that can be consume is restricted
• May lead to conditions that increase energy expenditure
• Favorable changes in gut hormones that reduce appetite and enhance satiety
• Typical maintenance of excess weight loss leas than fifty percent

WHAT ARE THE DISADVANTAGES?

• The operation is more complex than the AGB or LSG and has higher complication rates
• Potentially lead to long-term vitamin/mineral deficiencies deficits in vitamin B12, iron, calcium, and folate in particular.
• Typically has a longer hospital stay than the AGB
• Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance

SLEEVE GASTRECTOMY

The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.

HOW DOES IT WORK?

Firstly, the new stomach pouch holds a considerably smaller amount than the normal stomach does and it helps to significantly reduce the amount of food that can be consumed, which means less calories are consumed. However, the greater impact seems to be the effect on the gut hormones. A number of factors including hunger, satiety, and blood sugar control are impacted.

As shown by short term studies, the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. Evidence also suggests that the sleeve is effective in improving type 2 diabetes without weight loss. The rate of complication falls between the adjustable gastric band and the roux-en-y gastric bypass.

WHAT ARE THE ADVANTAGES?

• Amount of food the stomach can hold is restricted
• Rapid and significant weight loss induced (studies find it similar to the Roux-en-Y gastric bypass)
• Weight loss of less than fifty percent for three to five plus year data, and weight loss comparable to that of the bypass with maintenance of less than fifty percent
• No foreign objects (AGB) and no bypass or re-routing of the food stream (RYGB) required
• A relatively short hospital stay of approximately two days
• Favorable changes in gut hormones that reduce appetite and enhance satiety

WHAT ARE THE DISADVANTAGES?

• Procedure is non reversible
• Potentially lead to long-term vitamin deficiencies
• Higher early complication rate than the AGB

THE ADJUSTABLE GASTRIC BAND

This procedure is also known as the band. It involves an inflatable band that is secured around the upper portion of the stomach. This creates a small stomach pouch above the band and the rest of the stomach below the band.

HOW DOES IT WORK?

Consuming a small amount of food will satisfy hunger and promote the feeling of fullness in the smaller stomach pouch. The level of fullness depends on the size of the opening between the pouch and the remainder of the stomach. Adjusting the band with sterile saline (injected through a port placed under the skin) can alter the size of the stomach opening.

Repeated adjustments are done gradually to reduce the size of the opening. The view that the band is a restrictive has been challenged by studies that show that food passes quickly through the band. Food remaining in the pouch above the band was not related to the absence of hunger or feeling satisfied. It is also known that there is no malabsorption so the food is digested and absorbed as it would be normally.

The impact of the band seems to be that it reduces hunger which in turn helps the patients to reduce the amount of calories consumed.

WHAT ARE THE ADVANTAGES?

• Amount of food the stomach can hold is reduced
• Excess weight loss of approximately forty to fifty percent
• No cutting of the stomach or re-routing of the intestines
• A shorter hospital stay (usually less than twenty-four hours, some centers discharge patients on the same day as the surgery)
• Reversible and adjustable
• Lowest rate of early postoperative complications and mortality among all the approved bariatric procedures
• Lowest risk for vitamin and mineral deficiencies

WHAT ARE THE DISADVANTAGES?

• Slower and less early weight loss than other surgical procedures
• Greater percentage of patients failing to lose at least 50 percent of excess body weight compared to the other surgeries commonly performed
• Requires a foreign device to remain in the body
• Possible band slippage or band erosion into the stomach (in a small percentage of patients)
• Mechanical problems with the band, tube or port (in a small percentage of patient)
• Dilation of the oesophagus if the patient overeats
• Strict adherence to the postoperative diet and to postoperative follow-up visits
• Highest rate of re-operation

DIAGNOSTIC SERVICES

For patients with a BMI 30 and above the following tests apply:

• Health history: A doctor will ask questions regarded weight history, exercise habits, weight-loss attempts, eating patterns etc.
• Physical exam: The patient’s height and waist circumference is measured and all vital signs are checked.
• Checking for other health problems: If the patient has known health issues, the doctor will assess them as well as check for other conditions such as high blood pressure and diabetes.