Breathing easy again
If you weigh so much that walking leaves you breathless, you need to lose weight fast to prevent chronic oxygen scarcity damaging your lung and heart.columns Updated: Mar 15, 2014 22:24 IST
A month ago, when Asha Devi, 47, told people she was a stay-at-home mum, she meant it literally. The mother of four barely stepped out of home for years because her excess weight made it impossible for her to go up and down three flights to her third-floor apartment in the northwest Delhi neighbourhood of Rani Bagh.
“The building doesn’t have a lift so I only stepped out of home when I absolutely had to, maybe two or three times a month,” said Devi, who stands 157 cm high and weighed 114 kg a month ago.
Six months ago, it got so bad that walking from one room to another left her breathless. “My blood pressure was sky high, I feared I had developed heart disease,” she said.
Her heart was fine. What Devi had was obesity hypoventilation syndrome (OHS), an obesity-related condition in which fat tissue restricts the normal movement of the chest and respiratory muscles, making oxygen levels plummet and carbon dioxide levels rise. Breathing becomes such an effort that any movement, however slight, leaves people breathless. It’s usually accompanied by obstructive sleep apnea — short pauses in breathing while sleeping.
“Chronic sleep loss and low oxygen levels in the blood causes acute shortness of breath, tiredness, lack of concentration, lethargy, hypertension and diabetes, in some cases, gives the lips, fingers, toes, or skin a bluish tint (cyanosis). In cases of right-side heart failure, legs or feet may swell up,” said Dr Arush Sabharwal, bariatric surgeon at Jeewan Mala Hospital, New Delhi, who operated on Devi on February 13. She has lost 12 kg in a month.
The damage happens when, to compensate for low oxygen levels, the small blood vessels in the lungs tighten to optimise blood distribution within the lungs. Persistent low blood oxygen cause chronic vasoconstriction (tightening of blood vessels), which puts pressure on the pulmonary artery, which carries deoxygenated blood from the heart to the lungs. This, in turn, strains the heart’s right ventricle that pumps blood to the lungs, making it distended and less efficient. This leads to accumulation of fluid in the skin (edema), and in more severe cases, in the liver and the abdomen. Over time, the lack of oxygen puts a strain on the heart, leading to heart failure.
One of the patients Dr Sabharwal operated on was a woman whose oxygen saturation level was 38% despite her being on non-surgical treatment for two years. “A day after surgery, her oxygen saturation went up to 92% and she was taken off all machine support, that she had been using for two years,” says Dr Sabharwal. She lost 50 kg in three months, which helped bring down her blood sugar and blood pressure.
Apart from a physical examination, tests used to diagnose OHS include arterial blood gas, chest x-ray or a CT scan to rule out other possible causes for disrupted breathing, pulmonary function tests, and a sleep study to rule out obstructive sleep apnea.
Surgery should be a resort only for those for whom eating healthy and increased activity hasn’t kept the weight off. “Surgical options should focus on clinically obese people looking to lose about 80% of their excess body weight to resolve obesity-related disease such as diabetes, hypertension, OHS and infertility,” said Dr Sabharwal, who runs a support group for people looking to lose weight.
Rajeev Tandon, 44, lost 47kg within 10 months and kept it off just by halving the amount he ate while sticking to an active aerobic schedule. He’s down from 123 kg on 12 Feb, 2013 — the day he started on his health plan — to 75.5 kg, which is healthy weight for someone who stands 180 cm. His weight has been stable for more than three months. “My Eureka moment came when I got my health report, which showed everything — cholesterol, blood pressure, blood glucose, lipids, you name it — was borderline. I realised that if I hadn’t act then, I would have gone downhill within two years,” says Tandon, who owns Ushnak Mal Mool Chand store in upmarket South Extension I in New Delhi.
Counselling from nutritionist Ishi Khosla of Wholefoods set him on the path to weight loss. “I eat smart and am careful about how much I eat. I don’t deprive myself of anything, I just eat less of it,” says Tandon, who also walks or runs 7 km each morning.
His healthy diet has had a domino effect, with his wife Jagriti and three children all losing weight too. “Even my mother, who is 68, has lost weight because of the healthier food choices we now make,” says Tandon.