Bariatric surgery is undoubtedly the most effective treatment for morbid obesity. It has also proven to be a boon for obesity-related co-morbidities, especially, type 2 diabetes as many patients achieve remission of diabetes after bariatric surgery. But how does bariatric surgery work? Most people understand that bariatric surgery works by reducing food intake alone, but there are many role mechanisms which play crucial roles both in weight loss as well as improvement of associated diseases like type 2 diabetes. These mechanisms include a reduction in food absorption, increase in energy expenditure, eating behavior changes, various intestinal hormonal alterations and changes in adipocytokines (cell signaling proteins produced by fat cells) like Leptin, Adiponectin, and Omentin.

Today we will talk about the adipocytokine Leptin and its bit in the puzzle of bariatric surgery. Leptin is secreted by white fat tissue of the body, and it plays an important role in energy balance. What has been found about leptin in non-obese individuals is that high leptin levels are associated with satiety and low leptin levels are associated with hunger. However, it is striking to find that obese individuals tend to have high leptin levels. This has brought us to understand that obese individuals have leptin resistance, similar to insulin resistance, and thus, they have increased hunger and reduced energy expenditure in spite of high leptin levels. After bariatric surgery, leptin levels fall as weight loss progresses, and so does the leptin resistance. Changes in leptin levels after bariatric surgery is a clear example of the complex interplay for various chemicals contributing to the benefits of bariatric surgery.

India is a country of paradoxes. On the one end, a large population of this country suffers from the ill-effects of undernourishment, and on the other hand, we are third in the highest number of obese individual in the world following the USA & China (1). Not only that, we rank second only to China in childhood obesity(2). Lack of physical activity and westernization of diet have contributed vastly to this ever-increasing problem in India. So obesity is certainly an Indian problem.

An important aspect about this disease (Obesity has been declared a disease by the World Health Organization) (3) is that it does not occur in isolation but comes along with a whole gamut of associated chronic diseases like type 2 diabetes, hypertension, heart disease, various types of cancers, sleep apnea, arthritis, infertility and many more which not only affect the longevity of the suffering individual but also affects his/her quality of life (3). Obesity and its associated diseases put a huge economic burden on the family in particular and increase the health care cost of India, overall.

Thus prevention and treatment of obesity is the need of the hour. Preventing childhood obesity is the best step parents can take to fight against this problem. Simple measures like encouraging children to play outside and restricting junk food intake go a long way in this effort. Such steps not only prevent obesity in childhood but also protect such children from becoming obese adults, as the habits they develop in their formative years remain with them throughout life.

For those who are suffering from this disease, it’s not the end of the world. There are many treatment options available, starting from lifestyle changes to Bariatric (weight-loss) surgery. What every patient requires is treatment under a specialized multi-disciplinary team including doctors, dieticians & fitness trainers. The treatment approach can be tailored to each patient’s disease and requirements. The goal for such patients is to live a long, happy, and healthy life. To this end, we Indians have the advantage of having strong family support to get us through the thick and thin of life.

1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The lancet. 2014 Aug 30;384(9945):766-81.
2. Ranjani H, Mehreen TS, Pradeepa R, Anjana RM, Garg R, Anand K, Mohan V. Epidemiology of childhood overweight & obesity in India: A systematic review. The Indian journal of medical research. 2016 Feb;143(2):160.
3. WHO: 10 facts about obesity