Vertical banded gastroplasty (VBG) was the most common bariatric surgery prior to the advent of laparoscopy, but fell out of favor due to poor weight loss and the emergence of less invasive procedures. As many as 54% of patients with VBG have sought revision surgery, either for complication or for weight regain/failure. Surgical revision in this population is often complicated by surgical history, medical comorbidity, and persistent or recurrent obesity. We present an innovative technique developed for a patient with gastric outlet obstruction in the setting of prior VBG.

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A 24-year-old unmarried female came to our Yoga and Nature Cure Hospital 6-year back in the month of June 2008. Our subject came with the complaint of increasing in body weight from the age of 14-year especially after appendectomy done in a private hospital. Within 4 years (at the age of 18 years), she reached a body weight of 101 kg from the baseline of 65 kg. She got admitted in our hospital and received integrated Naturopathy treatment (90-120-min/day) and Yoga (60-min/day) for the period of 15 day. Her weight reduced from 101-kg to 94.9-kg on 15 ^th day, and she was discharged from the hospital. She was maintaining her weight (94.9-kg) for the period of 2-year. In the years 2010, 2012 and 2014 she got admitted in our hospital. The period was 10-day at each time for further weight reduction. We assessed weight and body mass index before and after the admissions in hospital. There were gradual reductions in weight which showed the changes in World Health Organization's (WHO) obesity classification grading from class-II obesity in 2008 to class-I obesity in 2010. There were no changes in 2012. In 2014, the grade of class-I obesity was changed to overweight or preobese. The results in this case suggest that Naturopathy and Yoga intervention can be effective in treating obesity. Despite this encouraging result, further case series and a larger sample size in prospective study are necessary as a rational follow-up of this case report.

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Hypothalamus plays a key role in satiety and food intake. Damage to the ventromedial nucleus of the hypothalamus bilaterally can lead to a syndrome of "hypothalamic obesity." This condition is characterized by hyperphagia and obesity along with other endocrinal and neurological manifestations. Suprasellar tumors like craniopharyngioma can often damage the hypothalamus leading to such a syndrome. Here, we report a case of a middle age male who presented to our endocrinology outpatient department with complaints of hyperphagia and massive weight gain over a period of 4-5 years. On hormonal evaluation, he was found to have panhypopituitarism along with central diabetes insipidus. Magnetic resonance imaging was suggestive of a suprasellar craniopharyngioma. Patient underwent craniotomy with subtotal resection of the tumor followed by radiotherapy for the residual lesion. Hypothalamus as a cause of obesity, though rare should be considered in patients who present with characteristic signs and symptoms of hypothalamic obesity.

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Background: The psychosocial impact of obesity is of concern in the present world but remains less studied compared to its physical consequences. There is a lack of sufficient data from Asian and Indian population in particular. Objectives: To study the prevalence of psychiatric morbidity among the obese. To demonstrate the association of psychiatric morbidity with obesity and lipid profile. Settings and Design: A cross-sectional study at a tertiary care center, Kerala, India. Methodology: One hundred and twelve subjects, both male and female, who attended the obesity clinic from May to December 2013 participated in the study. Sociodemographic data and clinical history were collected from each individual. Psychiatric diagnosis was made using MINI-Plus. Hospital Anxiety and Depression Scale (HADS) was rated in all subjects. Statistical Analysis: Done using SPSS version 18 (Chicago IL, USA). Results: Thirty-seven (33%) subjects were assessed to have a psychiatric disorder. Depressive disorder (17.9%) was the most common diagnosis. The mean body mass index (BMI) of the study group was 31.4 ΁ 4.1. No significant association was found for psychiatric disorders with BMI and lipid profile. HADS depression score was significantly associated with triglycerides (TG), low density lipoprotein (LDL) and very low density lipoprotein (VLDL). HADS anxiety score was also found to have significant but weak relationship with VLDL (P = 0.054). Conclusion: Obesity is associated with high risk for psychiatric disorders. Management of obesity requires a multidisciplinary approach. Further explorations are needed to ascertain the cause or effect nature of obesity with psychiatric disorders.

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Introduction: Obesity and type 2 diabetes mellitus (T2DM) are a complementary threat around the globe. Deranged body fat distribution in T2DM needs serious attention, starting from its measurement up to guiding appropriate intervention. We tried to associate parameters of body fat distribution T2DM patients with body mass index (BMI), Lipidemic control and preventive pharmacotherapy using bio-electrical impedance analysis (BIA) method. Materials and Methods: We recruited 78 sedentary (42 males, 36 females) T2DM subjects with known glycemic and Lipidemic lipidemic control. Whole body scan was done using BIA principle with Omron Karada Scan (China) to derive total body fat, subcutaneous fat, visceral fat, ratio of subcutaneous fat to visceral fat and BMI. These parameters were compared among group based on BMI, lipidemic control and use of statin/angiotensin-converting enzyme (ACE) inhibitors for difference and statistical significance. Results: Type 2 diabetes mellitus subjects had high mean age, high BMI and fair lipidemic control. All measures of body fat distribution derived by BIA were statistically significantly different among t groups separated by BMI cut-off 25. However, there was small, statistically insignificant difference of body fat parameters amongst groups based on control of high- density lipoproteins, low-density lipoprotein and triglycerides except for subcutaneous fat. Those taking statins or ACE inhibitors did not have significantly better body fat distribution than those not taking it. Conclusion: Deranged body fat distribution in T2DM measured by BIA correlated with BMI. These parameters are improved neither by lipidemic control nor by preventive pharmacotherapy. This suggests the use of other interventions like weight reduction and optimum use of BIA for monitoring utilizing primary health care resources.

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Background: Obesity in rising in the adolescent population of India. The third National Family Health Survey (NFHS-3) national family health survey (NFHS-3) of India revealed increasing obesity in north Indian states more than other parts of the country. Family plays a key role in shaping young adolescents. There is a paucity of literature regarding family risk factors for adolescent obesity in the north Indian population. Study Design: Cross-sectional survey type study. Methodology: A total sample of 5993 school going adolescents (10-19 years of age) was taken into the study from urban area of Ambala district, Haryana, India. The data were collected using self reporting questionnaires. Various questions were used to evaluate the parental demographic factors: parents' education, parents' occupation, family income and obesity in the family. Anthropometric measurements such as height and weight of each student were measured and documented. Statistical evaluation was done by Chi-square (χ2) test to analyze the differences between proportions. P < 0.05 was considered statistically significant. Results: Overall prevalence of obesity was 2.4%. Prevalence of obesity was highest in the 16-19 yrs age group (4.4%). Parental obesity, high literacy and high income of parents were significantly associated with adolescent obesity. Conclusions: Adolescent obesity is influenced by parental obesity, socioeconomic status of family and increase in age.

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Objective: The objective of this study was to devise an intervention program to improve body mass index (BMI) and serum lipid profile of obese school children in the age group of 10 to 15 years. Materials and Methods: The study comprised of a survey and pretest and posttest experimental design and was conducted over the course of a year. The total of 4289 children from 11 schools were screened for obesity based on age and gender specific cut-off values for BMI. Of the 193 children found to be obese, 49 children enrolled for the intervention program and were assigned to three specific groups using purposive sampling. Group I (Control), Group II (Nutrition Counseling) and Group III (Nutrition counseling and Exercise) comprised of 13, 19, and 17 children-at-risk, respectively. Descriptive analysis was used for assessing details regarding their dietary and physical activity pattern. Paired t-test was used to assess data pertaining to anthropometric measurements such as height, body weight, BMI, waist circumference and serum lipid parameters (total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-C], low-density lipoprotein-cholesterol [LDL-C], very low-density lipoprotein cholesterol, ratio of TC/HDL-C and serum triglycerides). Results: Post intervention, BMI was found to be stable, and there was a significant increase (P < 0.01) in serum HDL-C levels and a significant decrease (P < 0.01) in the ratio of TC/HDL-C in Group III and a significant increase (P < 0.05) in serum HDL-C levels alone in Group II subjects. Conclusion: The intervention study highlights the maintenance of BMI and improvement in serum lipid parameters of children-at-risk who received periodic nutrition counseling.

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Background: Obesity is a risk factor for many diseases and health problems. Furthermore, waist circumference (WC) because of being strongly associated with the accumulation of fat in the abdominal area is a simple way to show obesity associated with adiponectin secretion produced by adipose tissue. Aims: This study aimed to investigate the association between WC and adiponectin levels, dietary intake and blood pressure (BP) in normal weight, overweight and obese women. Materials and Methods: This cross-sectional study was performed on 180 women aged over 20 years including 57 women with normal weight body mass index (BMI = 18.5-24.9 kg/m ² ), 61 overweight women (BMI = 25-29.9 kg/m ² ), and 62 obese women (BMI ≥ 30 kg/m ² ). Serum adiponectin level, BP, WC, and dietary intakes of all subjects were determined. The collected data were analyzed using SPSS for Windows, version 17.0 (SPSS, Chicago, IL), ANOVA test, and Pearson correlation analysis. Results: Mean anthropometric and biochemical variables significantly increased with mean weight gain (P < 0.05). The relationship between WC and adiponectin level was strongly negative (P < 0.05, r = 0.350). Dietary intake and BP factors had significant positive correlation with WC and obesity increase. In contrast, they were inversely associated with adiponectin levels (P < 0.05). Conclusion: Dietary intakes of fat and eating high-calorie food considerably increased WC. On the other hand, due to the inverse relationship between adiponectin level and WC, adiponectin level reduced. Besides, due to the effect of dietary intake on BP, BP also plays an important role in the likelihood of obesity.

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The presence of excess body fat with absence of markers of metabolic syndrome is referred to as "metabolically healthy obesity". It is thought to be a distinct subtype and by the very name denotes a type of obesity found to be associated with less morbidity. A literature review was undertaken to find out if it is true. Over the years, it is known that 40% of this distinct group goes on to develop the classical features of metabolic syndrome associated with increased morbidity as compared to people with normal weight and no metabolic syndrome. Due to absence of the features of metabolic syndrome, therapeutic management of this group should be no different than the conventional metabolically unhealthy obesity group.

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Background: Noninsulin dependent diabetes mellitus (NIDDM) is a menacing life-style disorder; in Ayurveda, it is equated to Madhumeha. The concept of Prakriti (Ayurvedic constitution) can be applied for manifestations and prognosis of diseases like diabetes. Aim: The aim was to study the biochemical and anthropometric profiles of different Sharirika Prakriti (bodily constitution) in NIDDM patients. Material and Methods: Prakriti of 100 patients of NIDDM was assessed as per a tested Prakriti assessment proforma. Vata, Pitta and Kapha-dominant Prakritis were analyzed according to the characteristics found in patients. Biochemical and anthropometric variables were measured and interpreted as per the individual Prakriti. Biochemical variables of patients were compared in different Prakriti groups in the parameter of mean ± standard deviation. Results: Kapha-dominant Prakriti patients were found to have higher level of fasting blood sugar, postprandial blood sugar, serum cholesterol, serum triglycerides, high density lipoprotein, serum urea and serum creatinine than in other Prakriti. Alkaline phosphatase, SGPT and SGOT levels were higher in the Pitta-dominant Prakriti but the values were in the normal range. Patients with Vata dominant Prakriti had higher level of serum protein, serum albumin and serum globulin, but the values were in the normal limits. All these variables were compared with the dominant Dosha Prakriti and discussed vis-à-vis Ayurvedic features accordingly. Conclusion: Dosha dominant Prakriti has an influence on the biochemical and anthropometric parameters of NIDDM patients, which need to be explored in a sample.

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