Dr Chinnadorai Rajeswaran, consultant endocrinologist explains all about investigations and treatment of obesity and effective weight loss.

Weight loss is commonly encountered and a talked about problem. So much so that every one has an advice to give and there is a new diet nearly every week. Despite this, the number of people who are overweight or obese is constantly increasing. There are now around 2 billion people with a weight problem.

Weight loss is not just about eating less and exercising.

It is not about taking pills like orlistat, Mysimba or the ones available on the internet like ketogenic pills. Even saxenda, which is also loosely called the “skinny jab” does not work on its own. Research has consistently shown that the long term efficacy is only possible when associated with life style changes.

Dr Chinnadorai Rajeswaran says “Weight is a symptom of a problem”

Unless the underlying problem is identified and tackled, weight loss will only be temporary. There are several reasons for weight gain, some of which are listed below:

• Altered hunger
• Problems with fullness
• Sleep disturbance
• Malabsorption
• Hormonal problems
• Medication related
• Life changing events
• Stress, anxiety and depression

and many more……….

In order to ensure sustained weight loss and to improve body image, self confidence, self esteem and most importantly health, one needs to have a holistic assessment followed by relevant investigations to determine the underlying issues.

Repeated dieting is also known to lower the Basal Metabolic Rate (BMR), thereby preventing future weight loss.

Effective weight loss helps prevent:

• Type 2 diabetes
• High Blood pressure
• Cancer
• Fatty liver (NAFLD) and cirrhosis
• Heart disease
• Kidney disease and many more medical problems

Now we know that obese people are more likely to develop complications of corona virus infection. Watch these Videos Part 1 and Part 2.

Most people who diet to lose weight regain the weight they have lost. Thereafter they proceed to weight loss surgery. It is important to assess the underlying problems and ensure they have been through a dedicated medical weight management programme before considering surgery.

There are several causes for weight gain. In one on my video series, I have mentioned 101 cause of weight gain.

Hormonal causes for weight gain

When it comes to checking for hormonal problems leading to weight gain, both doctors and nurses just check thyroid function and decide there are no hormonal problems. It is important to see your nearest endocrinologist and/or bariatric physician to get a thorough assessment. There are several hormonal disorders leading to weight gain in addition to hypothyroidism (underachieve thyroid), which include:

• Cushing syndrome
• Acromegaly
• Insulinoma
• Low Testosterone (Hypogonadism)
• Hypothalamic obesity
• Hypopituitarism
• Menopause

Hunger Management

Weight management is not just about eating less and exercising more. It is more about understanding your hunger and managing it in any circumstance. There are several types of hunger including hedonic hunger, emotional hunger, night eating syndrome and many more.

Identifying the type of hunger and managing that is the key. Please see simplyweight website for details on online medical weight management.

Post Bariatric Surgery weight gain

The most common weight loss surgery is Sleeve gastrectomy. Other weight loss surgeries performed in the UK include gastric band, gastric bypass surgery, intragastric balloon and rarely duodenal switch.

Weight loss surgery has an impact on the hormones and also on the neurohormones actions controlling fullness and hunger. However after a few years the fullness is reduced and people gradually can regain weight.

Weight loss surgery provides a window period to sort the underlying problems and change your life style. Those who do not use this period to change their lifestyle and get their underlying hormonal problems addressed, usually regain weight.

To read more about bariatric surgery and devices, please read my article in The British Journal of Diabetes.

Post Bariatric Surgery Hypoglycaemia

People who have had bariatric surgery do well, if they follow all the recommendations provided by the bariatric team including attending regular follow ups and taking all the supplements.

However some people have disabling hypoglycaemia or low blood glucose after bariatric surgery predominantly after gastric bypass surgery.

This needs to be investigated and treated soon. Repeated low blood glucose can have serious effects on the body. Low blood glucose after weight loss surgery  can also lead to weight regain.

Dr Chinnadorai Rajeswaran is a consultant Physician specialising in Endocrinology, Diabetes and Obesity. As a private endocrinologist he  has private endocrine, diabetes and weight loss clinics in Harley Street, London, Chennai (India), Claremont Hospital, Sheffield, Nuffield Hospital, Leeds and Simplyweight, Bradford.

He has face to face consultations with people from Barnsley, Rotherham, Chesterfield, Doncaster, Wakefield, Huddersfield, Bradford, Harrogate, Leeds, Sheffield, London and Chennai (India). He also offers video consultations.