Dr Timi Adenugais a bariatric surgeon at the Getslim Bariatric Center in Abuja. In this conversation with Sade Oguntola, he advocates for obesity to be considered a key national health issue, cautioning that without prompt measures, Nigeria's healthcare system will face significant strain from the chronic conditions linked to obesity. Excerpts:
Obesity is spreading rapidly around the world; how is it affecting Nigeria?
Obesity has become a significant issue in Nigeria. While there is considerable focus on malnutrition, undernourishment, and other health conditions, the prevalence of obesity is also increasing rapidly. Indeed, approximately 40% of Nigerian adults are either overweight or obese, particularly in urban areas such as Lagos, Abuja, and Port Harcourt. This condition affects people of all ages, including children. Many middle-aged adults are also struggling with obesity. Therefore, in the coming decades, we can expect a growing number of elderly individuals dealing with obesity.
In Africa, we believe that women should be large in size. We consider being large as an indicator of wealth. So, who is considered fat, who is big, or who is extremely obese?
The most widely used method for determining if someone is overweight or obese is the body mass index (BMI), which is calculated based on an individual's weight and height. Therefore, a person with a BMI ranging from 18 to 24.9 is considered to have a normal, healthy weight. An individual with a BMI between 25 and 29.9 is classified as overweight. Anyone with a BMI exceeding 30 is categorized as obese.
The common belief in Africa is that greater physical size equates to higher wealth, prosperity, or influence. This is a misinterpretation regarding obesity; it reflects an issue with our thinking and cultural values. Significant effort is required to shift this viewpoint that larger body size correlates with poor health. You may appear healthy to others, but your actual health condition might not be as good.
What are the typical health issues associated with obesity? In what ways does it impact lifespan?
Approximately 200 health conditions are linked to obesity. The list is quite extensive; nevertheless, the most frequently encountered ones in our clinic include high blood pressure, type II diabetes, joint problems, and sleep apnea. Individuals who are overweight often experience shortness of breath quickly and feel fatigued with minimal physical activity, such as climbing stairs.
Additionally, significant obesity can decrease life expectancy by as many as 10 to 20 years, due to its link with various health issues mentioned earlier and certain types of cancer, including endometrial, colorectal, prostate, pancreatic, and gastric cancers.
Is there assistance available for individuals who are overweight or obese?
In essence, the primary cause of weight gain is consuming more calories than one burns. Everyone expends energy and consumes food. Any surplus gets stored as fat. Therefore, when someone aims to lose weight, adjusting their diet is one of the initial steps. They should consume appropriate foods and steer clear of unhealthy options like fries, doughnuts, and pizzas, along with sugary and alcoholic beverages. It's important to focus on eating items such as vegetables, fruits, and proteins. Additionally, it's advised to engage in approximately 150 minutes of physical activity each week, which translates to at least 30 minutes of exercise on five days. This suggests that people should prioritize walking over using transportation.
What about injections for weight loss?
Weight loss injections function by mimicking a naturally occurring hormone known as glucagon-like peptide (GLP-1), which helps decrease the patient's hunger and cravings, making them feel less hungry. When they consume less food, the body starts accessing fat reserves and begins breaking them down, resulting in weight loss. These injections are highly effective for weight reduction, yet they come with certain disadvantages. First, they are quite costly. Second, weight regain is frequent. After discontinuing the injections, individuals might regain the lost weight because their appetite returns to its previous state. Additionally, there is a risk of misuse of these injections. They are being distributed by unqualified individuals, and some spas are administering these injections without considering the patients' medical history or potential complications. This practice is currently widespread among wealthy Nigerians in urban areas. I frequently encounter patients experiencing adverse effects from these injections.
What potential issues can arise if a weight loss medication or injection is misused?
The adverse effects resulting from the misuse of weight loss injections can be serious. Some individuals may experience stomach pain, nausea, and loose stools. I have treated several patients who received injections at a spa and subsequently collapsed, requiring immediate transport to our facility, as these medications were often administered incorrectly by someone without proper training. I strongly recommend that no one begins using weight loss injections without first undergoing a thorough evaluation by a qualified doctor, as the consequences can be very serious.
Numerous individuals consume lime along with tea; others engage in water therapy, thinking that it aids in shedding weight. What are your thoughts on these methods?
I'm certain there are numerous approaches that individuals assert help with losing weight. Some mention coffee, tea, and similar items. To be frank, there is no scientific proof indicating that consuming lime or water therapy reduces fat. All these claims are based on personal experiences. People develop ideas and claim they work for them, leading others to attempt them. However, to be honest, there is no scientific support for these assertions that they are effective.
How successful is bariatric surgery in managing weight?
Bariatric surgery is a highly successful choice. Based on the current scientific research, this procedure can lead to the remission or elimination of numerous health issues linked to obesity. This is why bariatric surgery is considered the top standard. It serves as the benchmark against which all other treatments are evaluated, particularly for various levels of obesity.
Bariatric surgery is a minimally invasive procedure, similar to what is shown on certain popular TV programs, where the surgeon aims to decrease the stomach's size in order to restrict the quantity of food consumed at one time and also lower the rate at which calories are absorbed. In addition to limiting food intake, it also affects the hormones responsible for controlling appetite. Therefore, it is highly effective and secure. Local data from our region indicates that most individuals experience no complications after undergoing weight loss surgery in Nigeria.
Are there widespread misunderstandings regarding weight loss surgery that you'd like to discuss?
Yes, when plastic surgery became more common, many individuals promoted liposuction and tummy tucks as methods for losing weight. These aesthetic procedures are not intended for weight loss and do not lead to lasting weight reduction or improvement in obesity-related conditions like high blood pressure and type II diabetes.
A common misunderstanding among many individuals is that bariatric surgery carries significant risks; some believe that undergoing the procedure gives a 50-50 chance of death. This is, however, entirely incorrect. According to the data available in Nigeria, fewer than 1% of patients experience serious complications following bariatric surgery. Therefore, it is typically considered a very safe procedure.
Can weight loss surgery impact a woman's ability to have children? What about the possibility of the person becoming soft and appearing disfigured?
In fact, weight loss surgery can enhance fertility. The greater the weight lost, the higher the chances of becoming fertile. Therefore, rather than asking, "Will I be able to give birth after weight loss surgery?" it's the reverse. Numerous individuals with PCOS and infertility find that after undergoing weight loss surgery, they become fertile and conceive.
Number two involves loose skin. Indeed, it is possible to experience sagging skin following weight loss. If an individual loses 30 to 40 kilograms or more, there is a likelihood of developing some loose skin. For certain patients, we advise consulting a plastic surgeon, who can then remove the excess skin and help restore their desired appearance.
Who is not eligible for weight loss surgery?
Individuals with serious medical conditions like unregulated high blood pressure and diabetes, sleep apnea, advanced age, or mental health issues are not eligible for weight loss surgery. Additionally, those who smoke or consume excessive amounts of alcohol are discouraged from undergoing the procedure due to an increased likelihood of complications. Moreover, individuals who continue to drink heavily are more prone to regaining weight quickly after the surgery if they do not cease drinking.
Therefore, would you claim that weight-loss surgery is a more effective choice compared to GLP-1 weight-loss medication for addressing obesity?
Both are effective methods for managing obesity. Weight loss injections are not a quick fix. They can be costly and are typically not advised for long-term use. In contrast, weight loss surgery offers a more lasting solution and is more likely to address various health issues such as uncontrolled high blood pressure and diabetes. While both approaches are supportive, bariatric surgery remains the most effective option for treating severe obesity.
Are there additional conditions that you manage as a bariatric surgeon?
All bariatric surgeons are trained as general surgeons, which means we also perform surgeries for issues like hernias, acid reflux, gallbladder problems, colon conditions, stomach disorders, thyroid diseases, breast ailments, and trauma.
Is there additional information you would like to convey?
In Nigeria, we continue to overlook the reality that obesity is a significant issue, which is, once more, a major challenge. Our healthcare system is inadequate to handle the impact of obesity. Obesity is associated with hypertension and diabetes, along with other long-term conditions. Therefore, an individual who is overweight is likely to consult numerous doctors and need frequent hospital visits, resulting in high health care costs. Addressing obesity can resolve many other issues at once.
Additionally, there are constraints on the application of bariatric surgery in Nigeria. There are fewer than 10 bariatric surgeons currently practicing in the country. We face a shortage of personnel and facilities to address the needs of individuals with obesity. Moreover, many people still view bariatric surgery as a cosmetic treatment. They are unaware that it can significantly transform lives. This misunderstanding is one of the reasons why no local health maintenance organization in Nigeria offers bariatric surgery as part of their services. It's time we began treating obesity with the seriousness it deserves.