WHAT CAUSES MORBID OBESITY?
The reason for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that, in many cases, a significant underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, effort such as dieting and exercise programs have a limited ability to provide effective long-term relief.
Science continues to search for answers. But until the disease is better understood, the control of excess weight is something patients must work at for their entire lives. That is why it is very important to understand that all current medical interventions, including bariatric surgery, should not be considered medical cures. Rather, they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional, and social consequences of the disease.
Bariatric surgery is only a “tool” to help you lose weight. If you look after this “tool” it will help you lifelong but if it is abused it will become less and less effective.
Bariatric surgery is not “cosmetic surgery”!
THE HEALTH THREAT OF MORBID OBESITY
Bariatric surgery in patients that qualify increases their life expectancy!
Morbid obesity brings with it an increased risk for a shorter life expectancy. For individuals whose weight exceeds twice their ideal body weight, the risk of an early death is doubled compared to non-obese individuals. The risk of death from diabetes or heart attack is five to seven times greater. Even beyond the issue of obesity-related health conditions, weight gain alone can lead to a condition known as “end-stage” obesity where, for the most part, no treatment options are available. Yet an early death is not the only potential consequence. Social, psychological, and economic effects of morbid obesity, however unfair, are real and can be especially devastating.
SIGNIFICANT OBESITY-RELATED HEALTH CONDITIONS
Obesity-related health conditions are health condition that, whether alone or in combination, can significantly reduce your life expectancy. A partial list of some of the more common conditions follows:
Type 2 diabetes: People with obesity develop a resistance to the insulin that regulates blood sugar levels. Over time, the resulting high blood sugar can cause serious damage to the body.
High blood pressure/heart disease: Excess body weight strains the ability of the heart to function properly. The resulting hypertension (high blood pressure) can result in strokes, as well as inflict significant heart and kidney damage.
Osteoarthritis of weight-bearing joints: The additional weight placed on joints, particularly knees and hips, results in rapid wear and tear, along with pain caused by inflammation. Similarly, bones and muscles of the back are constantly strained, resulting in disc problems, pain, and decreased mobility.
Sleep apnea/respiratory problems: Fat deposits in the tongue and neck can cause intermittent obstruction of the air passage. Because the obstruction is increased when sleeping on your back, you may find yourself waking frequently to reposition yourself. The resulting loss of sleep often results in daytime drowsiness and headaches.
Gastroesophageal reflux/heartburn: Acid belongs in the stomach and seldom causes any problem when it stays there. When acid escapes into the esophagus through a weak or overloaded valve at the top of the stomach, the result is called gastroesophageal reflux, and “heartburn” and acid indigestion are common symptoms. Approximately 10 to 15 percent of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett’s esophagus, which is a premalignant change in the lining membrane of the esophagus, a cause of esophageal cancer.
Depression: People with weight-related conditions face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, cannot fit comfortably in theatre seats, or ride in a bus or plane. No wonder that anxiety and depression may accompany years of suffering.
Infertility: The inability or diminished ability to produce offspring.
Fatty liver of hepatic lipidosis: Fatty liver disease is the accumulation of fat in liver cells. The greater the percentage of fat in the liver, the greater the risk of developing liver inflammation, fibrosis, or cirrhosis (moderate or severe scarring of the liver).
Skin breakdown: Skin hygiene can be a significant problem for people struggling with obesity, as the layers of skin can rub against each other, causing skin breakdown and infection.
Swollen legs/skin ulcers: Leg swelling is common and may be caused by blood clots in the leg veins. If untreated, skin breakdown can occur and the resulting wounds can be extremely hard to heal.
Urinary stress incontinence: A large, heavy abdomen and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing.
Menstrual irregularities: People with morbid obesity often experience disruptions of the menstrual cycle, including interruption of the menstrual cycle, abnormal menstrual flow, and increase pain associated with the menstrual cycle.
Lower extremity venous stasis: Heart or kidney disease brought on by excessive weight may also result in a condition known as venous stasis that affects the proper function of the veins in the legs that would normally carry blood back toward the heart. The common result is swelling in the lower legs and ankles.
Idiopathic intracranial hypertension (IIH): (also known as Pseudotumor Cerebri) is a condition of elevated cerebrospinal fluid pressure. Cerebrospinal fluid is the fluid that bathes the brain and spinal cord. IIH is most common in females of childbearing age. If untreated, IIH can cause chronic headaches, visual loss and even blindness.
Dyslipidemia (lipid metabolism abnormalities): Dyslipidemia means a disorder of fat-like substances in the blood. A common form of dyslipidemia is what people often refer to as “high cholesterol”. Dyslipidemia, however, is a term that refers to all lipid-related health problems that result from having either too much or too little of certain lipids. The danger is that when lipids start to build up inside the artery walls, scar tissue and other debris begin thickening and hardening the walls. Some arteries literally become clogged. Doctors call this condition atherosclerosis or hardening of the arteries.
Pulmonary embolus: A pulmonary embolus is caused by a clot from the venous circulation. Most are caused from clots originating in the lower extremities, known as deep vein thrombosis (DVT). Because people with weight-related conditions are more susceptible to circulatory problems, their changes of experiencing a pulmonary embolus are higher.
Cancer: People suffering from morbid obesity are at an increased risk for some types of cancer; e.g. endometrial, gallbladder, uterine, cervical, ovary, and breast in females; colorectal and prostate in males.
OPTIONS FOR THE MEDICAL TREATMENT OF MORBID OBESITY
Most nonsurgical weight loss programs are based on some combination of diet/behavior modification and regular exercise. Unfortunately, even the most effective interventions have proven to be effective for only a small percentage of individuals. It is estimated that less than 5% of individuals who participate in nonsurgical weight loss programs will lose a significant amount of weight and maintain that loss for a long period of time. Sustained weight loss for patients who are morbidly obese is even harder to achieve.
Serious health risks have been identified for people who move from diet to diet, subjecting their bodies to a severe and continuing cycle of weight loss and gain known as “yo-yo dieting.”
The fact remains that morbid obesity is a complex, multifactorial chronic disease. Bariatric surgery, when compared to other interventions, has provided the longest period of sustained weight loss in patients for whom all other therapies have failed.
For many patients, the risk of death from not having the surgery is greater than the risks from the possible complications of having the procedure. Patients who have had the procedure and are benefiting from its results report improvements in their quality of life, social interactions, psychological well-being, employment opportunities, and economic condition.
THE HOSPITAL STAY
Most patients stay in the hospital approximately 5 to 8 days after an open procedure and 3 to 5 days after a laparoscopic procedure.
You will be discharged when you are able to:
1. Take enough liquids and nutrients by mouth to prevent dehydration.
2. Have no fever.
3. Have adequate pain control with medication.
Depending on which procedure is performed, 1 or 2 small tubes may be placed around the stomach pouch and the bypassed stomach to drain body fluids after the surgery. These are usually removed in 3 to 10 days. To help prevent blood clots, anti-embolism stockings or other compression devices will be placed on your legs and your surgeon will require you to attempt to stand up and move around as soon as possible, usually within the first 24 hours.
Depending on your medical condition, there is the possibility of being placed in the intensive care unit to closely monitor your heart and lungs. Depending on the hospital, patients who use Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BiPAP) for sleep apnea may be asked to bring their machines with them for use immediately after the operation.