Obesity- a disease to reckon with

by Ananda Kannangara

Dr.N.W.J.K. Nanayakkara	Dr. Usan Dalpadadu

Although obesity is recognised as one of the most prevalent diseases in the world, Sri Lankans do not take care of it, perhaps due to lack of awareness. If no proper treatment is given for those who are suffering from obesity, it is a proven fact that they would have short life expectancy. - Dr. N.W.J.K. Nanayakkara

Obesity has become a common disease among many Sri Lankans. According to statistics given by the World Health Organisation (WHO) 1/4th of the world population are presently suffering from obesity.

If a person does not have the standard weight according to his height there will be chances for him/her developing obesity. When a person has excessive weight he will have ‘raised’ blood pressure, diabetes, increased cholesterol in their blood, arthritis, psychological upsets and sleep apnoea (developing breathing difficulties in sleep).

Sri Lankan doctors say that undergoing the Bariatric surgery, commonly known as weight losing surgery is the best remedy to cure Morbid Obesity.

In an exclusive interview with the Gastro Intestinal Surgeon in the Kalubowila Teaching Hospital, Dr. N.W.J.K. Nanayakkara, he said that undergoing the Gastric bypass surgery is the acceptable first line treatment for the Morbidly Obese.

It is said that available facilities in our hospitals for patients who are suffering from obesity should be improved, so that early deaths could be avoided to a greater extent.

He said unlike in Sri Lanka, the accepted standard treatment is given for patients who are suffering from obesity in many other countries. In the USA alone around 300,000 surgeries are performed annually.

A recent WHO report indicated that smoking, which was earlier recognised as the number one avoidable killer has become second to obesity. According to statistics a large number of patients in the world die due to complications of obesity.

The College of Surgeons of Sri Lanka at its latest sessions revealed that 1/4th Sri Lankans are also suffering from obesity and majority of them do not seek proper treatment due to lack of awareness.

It is said that the importance of surgical treatment must be given pride of place by the health authorities as it largely benefits people in the country.

Asked whether the diseases could be overcome with medicines other than undergoing the Bariatric surgery, Dr. Nanayakkara said it depends on the extent of the severity of the obesity.

If the BMI (Body Mass Index) is below 35, the patients could attempt regular exercises, dieting and medicine.

Senior Registrar, GI Unit, Kalubowila Teaching Hospital, Dr. Usan Dalpadadu said particularly females who are suffering from Obesity are more likely to develop breast cancer, bowel and womb cancers and advised such patients to have regular medical checkups.

Dr. Nanayakkara also said the normal BMI of a person is between 18 to 26 and advised patients whose BMI is above this limit to seek treatment.

However, if it is above 40, the standard and acceptable treatment worldwide is the Bariatric surgery (Gastric bypass surgery) and therefore patients should check their BMI (Weight in kilograms divided by height in metres) regularly.

If a patient needs surgery he/she could first consult a doctor in the clinic at the Kalubowila Teaching Hospital, the only hospital at present performing the Bariatric surgery in Sri Lanka and seek registration according to advice.

Since some instruments that are required for surgical procedures are not available at times in the hospital (particularly the most expensive stapling gun), patients may have to purchase it outside before the surgery.

If such a surgery is done in a private hospital in Sri Lanka it costs nearly Rs. 400,000 and the same surgery costs around Rs. one million in the Western world including in America where a large number of patients are reported undergoing surgeries for obesity.

Dr. Nanayakkara finally said that any surgical procedure, though it is very rare, death is one of the complications and according to available statistics 0.3 per cent of the patients who undergo gastric bypass surgery may have the possibilities of mortality.

Gastric bypass surgery

Gastric bypass procedures (GBP) are any of a group of similar operation sused to treat morbid obesity—the severe accumulation of excess weight as fatty tissue—and the health problems (comorbidities) it causes. Bariatric surgery is the term encompassing all of the surgical treatments for morbid obesity, not just gastric bypasses, which make up only one class of such operations.

A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower "remnant" pouch and then re-arranges the small intestine to allow both pouches to stay connected to it.

Surgeons have developed several different ways to reconnect the intestine, thus leading to several different GBP names. Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and psychological response to food.

The resulting weight loss, typically dramatic, markedly reduces comorbidities. The long-term mortality rate of gastric bypass patients has been shown to be reduced by up to 40%; however, complications are common and surgery-related death occurs within one month in 2% of patients.

- Wikipedia

Depression significantly impacts survival rates among cancer patients

by Drucilla Dyess

Depression is a medical illness involving both the mind and body, and is known to be one of the most common health conditions worldwide.

Anyone can suffer from depression. In fact, clinical depression affects about 19 million Americans each year, and is estimated to play a role in half of all suicides. People who suffer from depression often feel that their lives aren’t worth living anymore.

Couple feelings of worthlessness with facing a battle for your life against cancer, and the likelihood of survival could be significantly diminished.

British Columbia graduate student Jillian Satin and colleagues gathered data from previous studies concerning the effects of depression on health among cancer patients.

Regarding the findings of the analysis, Satin said, “We found an increased risk of death in patients who report more depressive symptoms than others and also in patients who have been diagnosed with a depressive disorder compared to patients who have not.”

In all, a total of 26 studies involving 9,417 patients were found to meet the research criteria. These studies focused on a range of survival times, from one to ten years.

The findings of the analysis revealed that death rates were up to 25 per cent higher for patients who experienced depressive symptoms, and up to 39 per cent higher among patients diagnosed with major or minor depression.

The study was recently published in the journal Cancer. The research team considered whether people become depressed because they are sick with cancer, or whether cancer claims lives more often when patients suffer from depression independent of the cancer. Satin acknowledged, “That’s the million-dollar question.” She then added, “Even after correcting for that, we still see the positive relationship between depression predicting mortality.”

Satin remarked that the results prove the link is significant.

She noted, “In both of those groups, you can predict cancer mortality.” The findings raise questions about the need to screen cancer patients for signs of psychological distress. Satin explained, “I think depression should always be taken seriously.

It would be my wish that this line of research fuels adding psychological social treatment into standard cancer care.”

Although there is still no there is no firm proof that depression actually causes cancer patients to die prematurely, the possibility does exist that depression may affect hormones or the immune system.

In addition, patients who suffer from depression may become less compliant with treatment, which could impact life expectancy.

The researchers did point out that the risk of death associated with depression in cancer patients is small.

Therefore, patients need not feel that maintaining a positive attitude to beat their disease is necessary for their survival.

The team agrees that more research is needed to confirm the results of their analysis, as well as to determine whether depression has a greater impact on death rates among patients with specific types of cancer in comparison to various other cancers.

Early warning of a diabetic tsunami

by Edward Arambewala

World Diabetic Foundation’s Managing Director Dr. Anil Kapur last week credited Healthcare and Nutrition Minister Nimal Siripala de Silva for his far sighted vision in health matters, for giving a timely warning to be ready for a major outbreak of diabetes like a tsunami in this part of the world in the coming years, unless action is taken to give priority to control the disease now.

Dr. Kapur recalled this warning given by the Minister a few years ago at a medical conference when the tsunami struck several parts of the country causing heavy damage to life and property.

Dr. Kapur was speaking at the inauguration of Nirogi Lanka project of the Sri Lanka Medical Association held at the Lionel Memorial auditorium of the SLMA on Thursday September 3rd. The project was inaugurated by the Minister and Dr. Kapur was the guest of honour.

Dr. Kapur said that he too attended that tsunami conference and took the warning given by the minister seriously to give priority for diabetic prevention.

The Nirogi Lanka project is an outcome of that warning, as it is being funded by the World Diabetic Foundation. It has given this four year project US $ 625,000.

Dr. Kapur said he liked Sri Lanka and her people. Among the good friends he had here the Health Minister was one.

Minister Nimal Siripala de Silva inaugurating the project thanked Dr. Anil Kapur for the interest he took to help Sri Lanka in this project.

He said the Ministry could have easily taken this project for itself, and handled it.

But he thought otherwise. He thought of trying something new in healthcare here. He wanted to try competitiveness here in healthcare between the Ministry and the SLMA. He thought he would give this over to the SLMA, and see how it will work. He knew innovativeness comes in competition with the SLMA’s medical brains at work. With Prof. Chandrika Wijeratne of the Diabetic Prevention Task Force Coordinating the project. There is no doubt about its success.

While thanking the World Diabetic Foundation for the grant given the Minister said that we must not expect always for foreign funding, we must think of ways to do things on our own where possible. The media has a big role to play in health education as much as the doctors. Media knows the way how a message has to be carried to the people attractively and interestingly. This is very important in changing lifestyle of the people.

He was sure that the SLMA would get the fullest cooperation from the media for the Nirogi Lanka project. SLMA President Prof. Rezvi Sheriff welcoming the guests at the event said.

This is one of the largest health projects that the SLMA will be handling, with Prof. Chandrika Wijeratne as the primary mover. With her dedication to the cause, its success is assured. Prof. Ravindra Fernando Chairperson SLMA NCD committee said that this project would be handled by the SLMA Diabetic Task Force in conjunction with the Ministry of Health. Major part of the programme would be educating the public on diabetes, and how to deal with it, the correct way. He also thanked the World Diabetic Foundation for funding the project.

Sunday Observer associated survey on centenarians in Sri Lanka

by Edward Arambewala

The recently formed Sri Lanka Association for the Welfare and Health Study of Centenarians headed by Prof. Colvin Gooneratne would like to hear from families living in the Colombo district first who have Centenarians still living with them, to be included in this survey and study.

Please write to the Association President Prof. Gooneratne, with a copy to the Association Secretary Senior Journalist Edward Arambewala giving a brief account of the centenarian - Name; Age; Health condition; occupation done etc. with a photograph.

The Association would be visiting the Centenarian by appointment for a health status, study and interview with the family.

The Colombo district study will be done in association with the Sunday Observer.

A weekly article on the Centenarians will be carried in the Sunday Observer with pictures.

Centenarian families who wish to join the Association and others who wish to help in this study and help the needy Centenarians could also please write to us.

Address:- Prof. Colvin Gooneratne, President SLAWC, No. 117/3A, Koswatta Road, Nawala.

Address of Secretary:- Edward Arambewala, Secretary SLAWC, B2 1/10, De Soysa Flats, Moratuwa.