Epidemiology of Morbid Obesity in the UK
Morbid obesity, defined as having a Body Mass Index (BMI) of 40 or higher, is a growing concern in the UK. According to recent studies, approximately 28% of adults in the UK are obese, with morbid obesity accounting for around 3-4% of this population. Contributing factors include sedentary lifestyles, poor dietary habits, and genetic predisposition. These epidemic places a significant burden on individuals’ health and the healthcare system.
Body Mass Index (BMI) is a numerical value derived from a person’s weight and height to categorize their body weight. It is calculated using the formula:
- Average Heights in the UK
- Female: Approximately 5’4″ (162 cm)
- Male: Approximately 5’9″ (175 cm)
Weight Estimates for BMI > 40
- A woman of 162 cm would need to weigh more than 105 kg to have a BMI over 40
- A man of 175 cm would need to weigh more than 123 kg to have a BMI over 40.
These estimates illustrate the threshold at which BMI exceeds 40, categorizing individuals as morbidly obese, which may require medical attention or intervention.
Complications of Morbid Obesity
Obesity significantly impacts physical, emotional, and social and psycho-sexual well-being. Common complications include:
- Reduced Mobility
Excessive body weight places an undue burden on the musculoskeletal system, leading to:
- Joint Damage: Obese individuals are at a higher risk of developing osteoarthritis, especially in weight-bearing joints like the knees, hips, and lower back.
- Limited Movement: Simple activities, such as walking, climbing stairs, or bending, become challenging, reducing independence and quality of life.
Secondary Conditions: Reduced mobility often leads to a sedentary lifestyle, further worsening obesity and muscle weakness.
- Hypertension and Cardiovascular Disease
Obesity significantly increases the risk of high blood pressure and other cardiovascular complications, including:
- Heart Disease: Excess fat around the heart increases strain on this vital organ, leading to conditions like heart failure, coronary artery disease, and arrhythmias.
- Stroke Risk: Hypertension caused by obesity is a leading cause of strokes.
- Chronic Inflammation: Obesity is linked to systemic inflammation, contributing to atherosclerosis (hardening of the arteries).
- Diabetes
Obesity is the most significant risk factor for diabetes.
- Insulin Resistance: Excess fat, especially visceral fat, reduces the body’s ability to respond to insulin, leading to elevated blood sugar levels.
- Complications of Diabetes: Poorly managed diabetes increases the risk of kidney disease, nerve damage, vision problems, and cardiovascular issues.
- Infertility in Young People
Obesity affects hormonal balance, which can impair reproductive health in both sexes:
- In Women: Hormonal imbalances can disrupt the menstrual cycle, lead to polycystic ovary syndrome (PCOS), and reduce the chances of conception.
- In Men: Obesity is linked to lower testosterone levels, reduced sperm quality, and erectile dysfunction.
- Psychological Effects
The emotional toll of obesity is immense and often overlooked.
- Low Self-Esteem: The stigma associated with obesity can lead to feelings of inadequacy and low confidence.
- Depression and Anxiety: Many obese individuals struggle with mental health issues, driven by societal pressures and limitations on daily activities.
- Social Isolation: Concerns about appearance and mobility may cause individuals to withdraw from social interactions.
- Hygiene and Odour
Maintaining personal hygiene can be challenging for individuals with morbid obesity due to:
- Skin Folds: Excess skin creates warm, moist environments that can trap sweat and bacteria, leading to body odour, fungal infections, and rashes.
- Difficulty Reaching Certain Areas: Limited mobility can make proper cleaning difficult, further exacerbating hygiene issues.
- Impact on sex life and relationship/ marriage
Morbid obesity can significantly affect intimacy and relationships. Physically, reduced mobility, fatigue, and hormonal imbalances can lead to decreased libido and sexual dysfunction. Psychologically, low self-esteem, body image concerns, and social stigma can create emotional distance between partners. These challenges may strain relationships and impact marriage satisfaction.
Non-Surgical and Surgical Treatments for Weight Loss
Non-Surgical Options
Non-surgical treatments are often the first line of intervention and include lifestyle modifications and pharmacological aids.
- Intermittent Fasting and Regular Exercise
- Intermittent Fasting (IF): Involves structured eating windows, such as 16:8 (16 hours of fasting with an 8-hour eating window), promoting fat utilization while maintaining muscle mass.
- Regular Exercise: A balanced regimen of aerobic and resistance exercises enhances calorie expenditure, improves cardiovascular health, and supports muscle retention.
- Quality Diet
- A diet rich in whole grains, lean proteins, fruits, and vegetables helps in creating a calorie deficit without compromising nutrition.
- Reducing processed foods and sugars prevents insulin spikes and fat accumulation, improving long-term health outcomes.
- Weight Loss Injections
- Medications like GLP-1 receptor agonists (e.g., liraglutide or semaglutide) mimic natural hormones that regulate appetite and improve blood sugar control.
- These injections can lead to significant weight loss when combined with dietary and lifestyle changes.
Surgical Treatments
Surgical options are often recommended for patients with morbid obesity with associated health issues when non-surgical methods fail to achieve the desired results.
- Gastric Sleeve Surgery
- Procedure: Involves the removal of a large portion of the stomach, leaving a sleeve-shaped structure that holds less food.
- Mechanism: Reduces stomach size, curbs hunger hormones like ghrelin, and promotes early satiety.
- Hospitalization: Typically requires a 2-3 day stay in the hospital.
- Risks: Includes leakage at the staple line, blood clots, infections, and malabsorption of nutrients.
2. Gastric Balloon
- Procedure: A balloon is inserted endoscopically into the stomach and inflated, reducing the available space for food.
- Mechanism: Temporarily limits food intake and slows digestion to promote weight loss.
- Hospitalization: Usually performed as a day procedure.
- Risks: Nausea, balloon deflation, and minor digestive issues are potential complications.
- The risks factors and limitations:
- Risks of General Anaesthesia (GA): Includes breathing difficulties, blood clots, adverse reactions to medications, and cardiovascular stress, particularly in patients with morbid obesity.
- Post-Surgery Risks: Malabsorption syndrome, wherein the body struggles to absorb nutrients, is common in procedures altering the digestive tract.
- Recurrence: Weight regain is possible without adherence to long-term lifestyle changes.
- Aesthetic Disfigurement: Massive weight loss can result in loose, sagging skin, particularly around the abdomen, arms, and thighs, requiring further reconstructive surgeries like a body lift.
Challenges After Massive Weight Loss
Achieving massive weight loss, whether through lifestyle changes, medical interventions, or surgery, is a significant accomplishment. However, it often leaves individuals grappling with physical and emotional challenges related to excess skin and tissue redundancy.
1. Loose Skin
Rapid and substantial weight loss frequently results in skin that has lost its elasticity and fails to retract to the new body contours. This occurs because the skin’s collagen and elastin fibers, once stretched for extended periods, become weakened.
2. Specific Problem Areas
a) Breasts
- Impact: Significant weight loss often leads to a sagging or deflated appearance in the breasts for both men and women.
- Complications: Skin irritation, difficulty finding well-fitting clothing, and psychological discomfort.
- Solutions: Procedures like a breast lift (mastopexy) with volume replacement either with breast implants or multistage fat graft known as Augmented Mastopexy or male breast reduction surgery help restore shape and contour.
b) Arms (Bingo Wings)
- Impact: Excess skin hanging from the upper arms (commonly referred to as Bingo Wings or Bat Wings) is a common concern.
- Complications: Difficulty wearing short sleeves, friction sores, and a lack of confidence in arm appearance.
- Solutions: Liposuction assisted Brachioplasty (arm lift) or targeted liposuction may help address this issue.
c) Abdomen
- Impact: Loose skin in the abdominal area can form folds or an apron-like structure, known as a pannus and weaking of the abdominal muscles including divarication of recti(gaping between two rectus muscle).
- Complications: Hygiene problems, including rashes and infections, and discomfort during physical activities.
- Solutions: Abdominoplasty (tummy tuck) or body lift surgeries can help tighten and contour the abdominal area.
d) Thighs and Knees
- Impact: Sagging skin around the thighs and knees creates aesthetic and functional challenges, including discomfort during movement.
- Complications: Hygiene issues and chafing, especially in warmer climates.
- Solutions: Thigh lift surgery can address excess skin and improve leg contours.
e) Back and Buttock
- Impact:
- Banana Rolls: Loose skin along the lower back creates multiple folds that resemble “banana rolls.” These folds can cause discomfort, restrict clothing options, and pose hygiene challenges.
- Deflated Tyre Effect: The lack of elasticity and loss of underlying fat create a “deflated tyre” appearance around the lower trunk, which can affect the overall body contour.
- Loss of Buttock Volume: Significant weight loss often leads to a loss of fat in the buttocks, reducing volume and projection, resulting in a flat or sagging appearance.
- Complications: The reduction in buttock volume and the skin laxity compromise the natural contour and projection of the buttocks, impacting the balance of the lower body. This can also lead to discomfort while sitting and a diminished sense of achievement after weight loss.
- Solutions: Lower body lift, buttock lift with or without volume replacement.
- Emotional Impact
Even after reaching their weight-loss goals, many individuals feel self-conscious due to the presence of loose skin. This can diminish confidence, hinder social interactions, and prolong emotional struggles related to body image.
- Psychological Concerns: Persistent feelings of dissatisfaction, anxiety, or depression.
- Body Dysmorphia: The inability to appreciate the weight-loss success due to a focus on remaining imperfections.
- Other Considerations
- Physical Challenges:
Loose skin can interfere with physical activities, leading to reduced mobility, skin irritation, and difficulty maintaining hygiene in areas like skin folds. - Clothing Limitations:
Ill-fitting clothing due to uneven body contours can make it hard to enjoy fashion choices or feel comfortable in public settings.
Principles of Reconstruction Surgery Following Massive Weight Loss
Post-massive weight loss reconstruction is tailored to restore both functionality and aesthetics. The procedures are designed to remove excess skin, tighten tissues, and improve body contours.
Mr. Vadodaria has authored a chapter entitled ‘Body Contouring Following Massive Weight Loss’ in textbook of Aesthetic Surgery Techniques edited by Professor. Jim Frame and published by ELSEVIER
Common Procedures:
Abdominoplasty (Tummy Tuck) at MACS Clinic following post-massive weight loss
Abdominoplasty, commonly known as a tummy tuck, is a surgical procedure designed to remove excess skin and fat from the abdomen, transposing the tummy button and tightening of the underlying muscles.
Why Consider Abdominoplasty Post-Massive Weight Loss?
Following significant weight reduction, individuals often experience loose, sagging skin in the abdominal area. This redundant skin can create functional and aesthetic challenges, including:
- Skin Folds: Excess skin forms folds or an apron-like pannus.
- Hygiene Issues: Skin folds can trap moisture, leading to irritation, rashes, or infections.
- Physical Discomfort: Loose skin can cause discomfort during movement or exercise.
- Aesthetic Concerns: A lack of abdominal definition can diminish the sense of achievement from weight loss.
Which technique Mr. Shailesh Vadodaria uses to perform Abdominoplasty?
During your consultation with Mr. Vadodaria, he will evaluate your concerns and medical history. The procedure will be performed under general anaesthesia. Mr. Vadodaria makes an incision along the lower abdomen, typically hidden below the underwear line. Excess skin and fat are removed transposing the tummy button and the abdominal muscles are tightened. The remaining skin is repositioned, and the incision is closed with fine sutures. This surgery usually takes 2 to 4 hours, depending on the complexity.
Postoperative Care
- Mr. Vadodaria will apply dressings to the surgical site, and small drains may be used to remove excess fluid.
- You will be advised to wear compression garments for several weeks to reduce swelling and support healing.
- Regular appointments will be organised with Mr. Vadodaria to ensure proper recovery.
- Avoid strenuous activities, heavy lifting, and abdominal strain for 4–6 weeks.
Before and After Photos
Patient 1 – Abdominoplasty performed under general anaesthetics by Mr. Shailesh Vadodaria
Patient 2 – Abdominoplasty performed in a male patient following post-massive weight loss under general anaesthetics by Mr. Shailesh Vadodaria
Upper and Lower Body Lift at MACS Clinic
A body lift is a transformative surgical procedure aimed at removing excess skin and tightening tissues to achieve a more contoured appearance.
What is an Upper Body Lift?
An upper body lift focuses on removal of loose redundant saggy skin and soft tissue from the upper back. This procedure enhances the upper torso’s overall symmetry, restoring a firmer, toned appearance.
What is a Lower Body Lift?
A lower body lift targets the abdomen, hips, thighs, and buttocks, addressing excess skin and tissue laxity caused by massive weight loss.
The lower body lift consists of removal of loose redundant excess skin and soft tissue from lower abdomen as well as from the lower back in a circumferential fashion. It also involves tightening of the abdominal muscles as well as transposition of the tummy button. The procedure significantly improves the contour of buttocks as well as outer thigh
This procedure dramatically improves the lower body’s contours, creating a smoother and more proportional silhouette.
What to Expect During a Body Lift at MACS Clinic
Mr. Vadodaria, our senior consultant plastic surgeon will conduct a detailed assessment to understand your needs and will recommend the most suitable approach.
Depending on the areas being addressed, the surgery can take 3-5 hours and is performed under general anaesthesia. Liposuction may be used for additional contouring. Patients typically require 1-2 weeks off work and must avoid strenuous activity for 6-8 weeks. Wearing compression garments is essential to reduce swelling and support healing.
Who is a Candidate for a Body Lift?
Body lift procedures are ideal for individuals who:
- Have excess, sagging skin after massive weight loss particularly in the lower part of the torso.
- Are in good overall health with stable weight.
Before and After Photo
Patient 1 – Liposuction assisted total lower body lift, thigh reduction following massive weight loss
Patient 2 – Upper body-lift, revision lower body-lift, Breast lift, thigh reduction and liposuction outer thigh performed by Mr. Shailesh Vadodaria under general anaesthetics
Thigh Lift at MACS Clinic following post-massive weight loss
A thigh lift is designed to improve the shape and contour of the thighs by removing excess skin and fat. Thigh reduction is performed by removal of excess skin in the inner aspect of thigh assisted with liposuction. Outer thigh is contoured generally with liposuction to remove the resistant localised fat from the outer thighs. Thigh lift can be considered in selected patient by removing excess skin by placing scar in the groin crease. There is an inherent risk of unpredictable stretching of scar hence it needs to be considered with caution and requires careful counselling with the potential patients
Types of Thigh Lifts Offered at MACS Clinic
- Inner Thigh Lift
Targets the inner thigh area, addressing sagging skin and improving the shape and tone.
- Combination with Liposuction
Liposuction can be performed particularly on the outer thigh to remove the excess fat alongside a thigh lift to remove excess fat and enhance the overall result.
What to Expect During a Thigh Lift at MACS Clinic
Mr. Vadodaria performs this surgery under general anaesthesia and typically it lasts for approximately 2 hours. Incisions are strategically placed, often along the inner thigh or groin crease, to minimize visible scarring. Excess skin and fat are removed, and the remaining tissue is tightened for a smooth appearance. You will be advised to take 4-6 weeks off from strenuous activities. Wearing a compression garment is essential to reduce swelling and support healing. Mr. Vadodaria will advise you regarding appropriate time to resume normal activities and sports including use of gymnasium.
Breast Lift(Mastopexy) at MACS Clinic following post-massive weight loss
Massive weight loss often leads to significant changes in the breasts, including a loss of volume, skin laxity, and a sagging or deflated appearance. Breasts lift/Mastopexy restores the sagging, removes the excess skin and achieve firmness of the breast. The nipples are brought upwards and forward and surface area of the stretched areola is reduced at the same time making them proportionate.
Which technique is used by Mr. Vadodaria to perform Breast Lift/?
Mr. Vadodaria removes the excess skin is removes and reshapes the breast tissue to lift and firm the breasts. The nipple and areola are repositioned to a proportionate height. For patients experiencing significant volume loss, Mr. Vadodaria will consider adding implants or fat transfer in order to restore volume.
Mr. Vadodaria uses anchor incision in cases of significant sagging, especially after massive weight loss or he may use Vertical Incision (Lollipop) for moderate sagging. The breast lift surgery is carried out by Mr. Shailesh Vadodaria under general anaesthetic. It is generally done as a day case, but it may require overnight stay. It takes approximately 3 hours to perform the procedure. All the sutures are dissolvable hence it doesn’t require removal. Breasts are supported with a sports bra for a period of 6 weeks.
Before and After Photos
Patient – 1: Breast Lift (Mastopexy) performed by Mr. Shailesh Vadodaria under general anaesthetics
Patient 2: Augmented Mastopexy following post-massive weight loss
Arm Lift (Brachioplasty) at MACS Clinic following post-massive weight loss
Brachioplasty, commonly referred to as an Arm Lift, is a surgical procedure aimed at removing excess skin and fat from the upper arms, improving their shape and contour. Often referred to as “Bingo Wings” or “Bat Wings,” this condition is typically caused by massive weight loss.
Which technique is used by Mr. Vadodaria?
Mr. Vadodaria prefers liposuction assisted removal of excess skin and soft tissue from the inner aspect of both upper arm under general anaesthesia. The incisions are strategically placed along the inner arm to minimize visible scarring. Redundant skin and fat are removed, and the remaining skin is lifted and tightened for a natural contour. The procedure typically takes about 2 hours.
Recovery and Postoperative Care
- Pressure Garment: Patients are advised to wear a tight-fitting pressure garment for the first few weeks to reduce swelling and support healing.
- Activity Restrictions: Strenuous activities, including heavy lifting, should be avoided for 4 to 6 weeks.
- Wound Healing: Incisions usually heal within 1 to 2 weeks, though minor swelling and bruising may persist for a short time.
- Follow-Up Care: Regular follow-ups with Mr. Vadodaria and his team ensure proper recovery and optimal results.
Before and After Photos
Patient 1 – Liposuction assisted brachioplasty following massive weight loss performed by Mr. Shailesh Vadodaria
Gynecomastia surgery at MACS Clinic following post-massive weight loss
Significant weight loss is an incredible achievement, but it often leaves behind sagging skin and residual fat deposits, including around the chest. This can lead to gynecomastia, or the appearance of excess breast tissue in men.
Challenges After Massive Weight Loss
- Excess Skin and Residual Tissue: After weight loss, the chest may have sagging skin and pockets of stubborn fat that cannot be corrected with exercise or further dieting.
- Low Self-Confidence: Many men feel self-conscious about their chest appearance, which can affect personal relationships and confidence.
- Chafing and Discomfort: Loose skin can lead to irritation and discomfort during physical activities.
What is Gynecomastia Surgery?
Gynecomastia surgery involves the removal of excess fat, glandular tissue, and skin to restore a firmer, more masculine chest contour. For post-massive weight loss patients, this procedure is often customized to address significant skin laxity and the unique shape of their chest.
What to Expect During a Gynecomastia Surgery at MACS Clinic
During your free video/face to face consultation, Mr. Vadodaria will evaluate your chest’s skin elasticity, glandular tissue, and overall body proportions. The treatment plans will be decided and discussed by Mr Vadodaria based on his analysis.
Technique used by Mr. Vadodaria
The surgery is performed under general anaesthesia with the intention of removal of excess redundant skin and soft tissue along with repositioning of the nipple areola complex. It may require a liposuction at the same time. The surgery typically takes 2-3 hours, depending on the complexity of the case.
Postoperative Care
- The patients are advised to wear a compression vest for 6 weeks to reduce swelling and support the new chest contours.
- Antibiotics and painkillers are prescribed for 5-7 days, and Arnica homeopathic pills may be recommended.
- Avoid heavy lifting, upper body workouts, swimming, and contact sports for 4-6 weeks.
- Regular check-ups with Mr. Vadodaria at 7-10 days and 6 weeks post-surgery to ensure proper healing and results.
Before and After Photo
Facelift and Necklift at MACS Clinic following post-massive weight loss
Massive weight loss leaves behind excess sagging skin and tissue on the face and neck. This can result in a prematurely aged or tired appearance.
Why Consider a Facelift and Neck Lift After Weight Loss
Following significant weight loss, the skin may lose elasticity, leading to:
- Facial Sagging: Drooping cheeks and jowls, creating an aged appearance.
- Neck Laxity: Loose, hanging skin under the chin or along the jawline, often referred to as a “turkey neck.”
- Loss of Definition: The sharp contours of the face, neck including the jawline may diminish, reducing overall balance.
These changes can impact confidence.
Facelift and Neck Lift Procedure at MACS Clinic
During your free video/face to face consultation, Mr. Vadodaria will carefully examines the skin quality, fat distribution, and muscle condition. He will then discuss with you the procedure in detail.
Surgical Techniques:
- Facelift:
Targets sagging skin and tissues in the mid-face, jowls, and lower face. Excess skin is removed, and deeper tissues are lifted and tightened.
- Neck Lift:
Focuses on improving the contours of the neck by removing excess skin and tightening muscles. Liposuction may be added to address residual fat.
- Combination Approach:
Combining a facelift and neck lift ensures seamless, natural-looking results.
- Incision Placement:
Incisions are strategically placed along natural creases, around the ears, and under the chin to minimize visible scarring.
Mr. Vadodaria generally performs this procedure under local anaesthesia with sedation or under general anaesthesia depending on the complexity and patient preference.
A facelift and neck lift typically take 3-4 hours, depending on the extent of correction needed.
Postoperative Care
- Bandage is applied to reduce swelling and support healing.
- Vadodaria will prescribe antibiotics and pain relief to reduce swelling and prevent infection.
- Avoid heavy lifting, strenuous activities, and sudden head movements for 4-6 weeks.
- You will be seen by Mr. Vadodaria for a wound check within 7-10 days and a follow-up review at 6 weeks to monitor progress.
Before and After Photo
Minifacelift performed by Mr. Shailesh Vadodaria under local anaesthetics
Procedures Available at MACS Clinic Following Massive Weight Loss:
