PENINNAH Kalanji is a nurse at a busy hospital in Kaduna State. Peninnah, an evangelist, is a mother to three boys: Joseph 29, John 27, and Samuel 19, who she had through caesarean section (CS).
The 5.8 feet (1.768 metres)-tall housewife weighed 148 kilogrammes, with a Body Mass Index (BMI) of 47.2.
BMI is defined as the individual’s body mass (in kilogrammes) divided by the square of his or her height (in metres). BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.
The World Health Organisation (WHO) regards a BMI of less than 18.5 as underweight and may indicate malnutrition, an eating disorder, or other health problems, while a BMI greater than 25 is considered overweight, above 30 is considered obese and above 40 is severely obese.
According to the WHO, obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.
Several studies indicate that obesity increases the likelihood of various diseases, particularly heart disease, type 2-diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.
There is overwhelming evidence that obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illness.
Peninnah could hardly walk. Her two knees were ravaged by arthritis. No cloth could fit. In fact, she only wore flowing gowns.
Probably due to Peninnah’s weight, the suture point of her CS was giving way. She went for medical repair twice but the situation persisted. She was advised to lose weight.
Desperate to lose weight, Peninnah had tried all sorts of things from GNLD weight loss supplements, Tianshi Slimming Tea to local herbal concoctions; but she could not lose a kg.
After consulting with her hospital’s medical director and other medical experts, Peninnah was referred to Dr. Abuchi Okaro of Diagnostic & Therapeutic (D&Tec) Endoscopy Centre in Ikoyi, Lagos.
Okaro is also a Consultant General/Laparoscopic/ Upper Gastrointestinal (GI) surgeon at the Kent Oncology Centre, Maidstone, United Kingdom.
D&Tec is a one-stop centre providing accurate high quality diagnosis and treatment for GI, urological, gynaecological and respiratory disorders, using the very latest flexible fibre optic endoscopes.
Endoscopy is a minimally invasive diagnostic medical procedure. Using an endoscope, it is used to examine the interior surfaces of an organ or tissue.
When Peninnah met Okaro, she was advised to have a sleeve gastrectomy with the promise of losing up to 70 per cent of her excess weight in one year.
Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 25 per cent of its original size, by surgical removal of a large portion of the stomach, following the major curve. The open edges are then attached together (often with surgical staples) to form a sleeve or tube with a banana shape.
The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible.
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions, usually 0.5 to 1.5 cm, as opposed to the larger incisions needed in laparotomy.
Sleeve gastrectomy, also called gastric sleeve, is usually performed on extremely obese patients, with a body mass index of 40 or more, where the risk of performing a gastric bypass or duodenal switch procedure may be too large.
Peninnah went through gastric sleeve and dieting under the watchful eyes of Okaro on June 18, 2011. One year after the surgery, Peninnah now weighs 112 kg.
The excited Peninnah told The Guardian last week in Lagos: “I have been overweight for years; I am from a family of overweight people and with time I became fatter than everybody so to say maybe because my life was so comfortable or something, and I started struggling.
“Before I met this doctor I think I spent over N6 million. My company was helping me. I was so desperate to lose weight because I know that when I am old it will be difficult for me to move around.
“When I started seeing Okaro, after some few weeks he said before we do the operation I have to lose some weight. So he put me on yoghurt and this drinking soup. It was so funny, I am an African and we are not used to that kind of thing. But anyway because of my desperation I had to go through it and in six weeks I lost 6kg. My original weight was 148kg.
“So when I lost 6kg it was 142kg, at that point that was when we started talking about the operation. He gave me options; I went to the net and read them. At the end of the day we agreed on abdominal sleeve. I read about it online and I found that the side effect was not so serious and I could manage it.
“That was how we did the operation on June 18, 2012. Three weeks after the operation I lost eight kg because I was on only fluid diet. Even if they have to give me rice they blended it. Anything I was eating was blended and I couldn’t eat and in that two to three weeks I lost eight kg. So gradually from then till today I think I have lost 38kg and I am comfortable with my life. I even had arthritis that sometimes I wont be able to walk at all, the pain is almost gone, it is only when I stress the leg too much that have the pain.
“In fact, I am so happy with my life, I am looking better, I am finer and then my self esteem has increased.”
On whether she is feeling aide effects due to the procedure, Peninnah said: “Before this operation, everybody was like do not touch your stomach, what about the side effect and so on? After the operation I thought I was going to suffer. But the only thing I suffered was belching because there was a lot of air because through the process of operation and anesthesia there was a lot of air in my body. But after so time the thing stopped.
“In fact that was the only side effect I had. Again I cannot eat much. If I eat a little the stomach will be filled and when filled it will start giving me discomfort hat point I will know I am not supposed to go more. If I do, it will give me thorough pain. That is just it. I am fine but also the fact you have to arrange the little food to make it balanced with multivitamin.”
According to the WHO, dieting and physical exercise are the mainstays of treatment for obesity and diet quality can be improved by reducing the consumption of energy-dense foods such as those high in fat and sugars, and by increasing the intake of dietary fibre.
Several reports indicate that anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption together with a suitable diet. There is mounting evidence that if diet, exercise and medication are not effective, a gastric balloon may assist with weight loss, or surgery may be performed to reduce stomach volume and/or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food.
Okaro said the importance of weight loss in any patient is significant in terms of lifestyle, lower risk of hypertension, improving the risk of diabetes, helping with mobility, trying to keep joints such as knees and hips to survive longer having to carry fewer weight.
“So this particular patient situation, what is clear is that the benefit has been overwhelming. She has succeeded in this programme to lose enough weight to at least have significant impact on the potential risks of being overweight,” he said.
How was the feat achieved and what did she go through? Okaro explained: “In terms of actual procedure we chose for this particular patient, we decided to reduce the stomach capacity by the order of about 60 to 70 per cent through a procedure which is called a sleeve gastrectomy, which we did in this patients case laparoscopically, which is keyhole. So we were able to reduce her stomach which means her ability to eat and also the capacity to keep large quantities of food is reduced so the patient full quicker. So that over time will result in weight loss.”
Who needs gastric sleeve? Okaro explained: “I think more to the question, is what is the best option for overweight patients? How are they best dealt with?
“We have been running a weight loss programme here in Ikoyi, Lagos for about 18 months. Looking at the practice here in Nigeria, in my opinion, there are two procedures I am happy to do. One of them is the laparoscopically sleeve which is what this patient has had and the other one for patients that do not require to lose much weight but just 20 to 25kg, we can consider them for a temporary balloon which we put in the stomach. Gastric balloon, which will last something like six months. Patients will expect to lose about 15 to 25kg over that period. It is quite aggressive intensive programme so those are the two procedures I am offering at the period.”
Why should someone bother to go this far to lose weight taking into consideration that people are taking all sorts of things that could be injurious to their kidneys to lose weight?
Okaro said: “ Lets start with the facts. Fact number one; patients who are carrying around excess weight are at high risk of developing hypertension and diabetes.
“Fact number two; patients who are overweight have a higher risk of developing cancer related to the oesophagus, the endometrium if they are women and so on.
“Fact number three; patients who carry about excess weight has a shorter life expectancy of the of at least 10 to 30 years.
“Fact number four; patients who are overweight has poorer quality of life and possibly more incidence of image and confidence and low esteem, and consequently the ability to achieve all their life goals in general.
“Fact number five; patients who are overweight definitely have a higher incidence of having problem with their joint such as lower back, hips, knees. So these are the facts very clearly. So once you look and listen and reflect on those, there is no doubt that weight a significant impact on the patients overall well being.
“Now we have to remember diabetes is a prevalent situation. Diabetes affects many millions of people around the world. Being overweight, if you have a lot of weight you will have type 2-diabetes, which is diabetes that is caused not by lack of insulin but by the inability for insulin to be effective because of excess amount of weight. These patients as a fact benefits from weight loss procedures or weight loss programmes.”