What is Morbid Obesity?

Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. According to the National Institutes of Health (NIH), an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk.  Obesity becomes "morbid" when it reaches the point of significantly increasing the risk for the development of one or more obesity-related health conditions or serious diseases (also known as co-morbidities) that result either in significant physical disability or even death. As you read about morbid obesity you may also see the term "clinically severe obesity" used.

Morbid obesity is typically defined as being 100 lbs. or more over ideal body weight or having a Body Mass Index of 40 or higher. According to the National Institutes of Health Consensus Report, morbid obesity is a serious disease and must be treated as such. It is a chronic disease, meaning that its symptoms build slowly over an extended period of time.

The reasons 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, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.   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 weight loss surgery, should not be considered medical cures. Rather they are attempts to reduce the health effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease.

Obesity-related health conditions are health conditions that, whether alone or in combination, can significantly reduce your life expectancy. A partial list of some of the more common conditions follows. Your doctor can provide you with a more detailed and complete list:

• Type 2 Diabetes
  Obese individuals start with resistance to insulin, which regulates blood sugar levels. Over time, they develop the disease Diabetes Type II – the chronic exposure of the body to high blood sugar levels overtime can cause serious damage to body organs and vessels.
  
  
• 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 disk 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.
  
  
• Depression
  Seriously overweight persons 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.
  
  
• Infertility
  The inability or diminished ability to produce offspring.
  
  
• 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
  Morbidly obese individuals often experience disruptions of the menstrual cycle, including interruption of the menstrual cycle, abnormal menstrual flow and increased pain associated with the menstrual cycle.

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Am I a Morbidly Obese?

Answering this question may give you the courage you need to take the first step. Below are tools you can use to determine if you are morbidly obese and potentially a candidate for weight loss surgery.

There are several medically accepted criteria for defining morbid obesity. You are likely morbidly obese if you are:

• more than 100 lbs. over your ideal body weight, or
• have a Body Mass Index (BMI) of over 40, or
• have a BMI of over 35 and are experiencing severe negative health effects, such as high blood pressure, sleep apnea or diabetes, related to being severely overweight
• unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting
• those who have physical, psychological, social, or economic problems that could be significantly improved by weight loss

Morbid obesity is usually defined as being 100 pounds over the ideal body weight. A better way of defining morbid obesity is by using the Body Mass Index (BMI). BMI is a calculated number that takes weight and height into consideration. A person weighing 250 pounds who is 5ft tall will have a higher BMI than a person weighing 250 pounds but is 6ft tall. A BMI above 40 indicates that a person is severely obese and therefore a candidate for surgery. Surgery may also be an option for people with a BMI between 35 and 40 who already suffer from cardiopulmonary problems or diabetes or other obesity-related diseases

For patients who remain severely obese after non-surgical approaches to weight loss, or for patients who have an obesity-related disease, surgery may be the best next step. But for other patients, greater efforts toward weight control, such as changes in eating habits, behavior modification, and increasing physical activity, may be more appropriate.

In spite of the high failure rate of non-surgical treatments such as drugs, diet, behavior modification and exercise to achieve documented long term weight loss in the morbidly obese, it is accepted practice to require that the potential candidate for surgical treatment have made good faith attempts to achieve weight loss by other means. Although the potential number able to do so remains miniscule, candidates for surgery must be given the opportunity to try prior to acceptance into a Bariatric Surgery Program.

A few people who meet above requirements may not be considered for weight loss surgery. In this group are:

• Those whose obesity is caused by a metabolic or endocrine disorder
• Those with an active substance abuse history or a major active psychiatric problem
• Those with severe medical problems for whom any surgery would be dangerous

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Risks and Benefits

As with all surgery, there are risks. Patients considering surgery must weigh the risks and benefits of surgery against the severity of the disease of obesity. The decision to proceed is based on the premise that the treatment should be less harmful than the disease being treated.

Benefits
Over time the benefits of weight loss surgery may include:

• significant sustained weight loss (amount will depend on procedure chosen and patient compliance)
• lower or normal blood sugar levels within 1 year of surgery
• lower or normal blood pressure
• lower or normal cholesterol levels
• relief from sleep apnea, acid reflux, and urinary stress incontinence
• less arthritis pain and improved mobility
• increased energy and ability to exercise
• improved mood and self-esteem
• arrested progression of heart disease
• improvement of many lung conditions
• exercise endurance

Complications of clinically severe obesity begin to resolve before complete weight loss occurs. These include better control or cure of diabetes; lowered or normalized blood pressure and cholesterol; relief from sleep apnea, severe acid reflux, and urinary stress incontinence; eased lower back, knee and hip pain. Patients also report enhanced mobility. Many conditions, such as evolving heart disease, have been arrested or its progression significantly slowed. The specific benefits and weight loss that can be expected from each weight loss surgery procedure are described under the specific weight loss surgery procedure.

Risks
Below is a list of some of the more common, potential complications that can occur with any type of abdominal surgery requiring general anesthesia, as well as potential complications specific to weight loss surgery operations.  The specific risks associated with a weight loss surgery procedure are described under the specific weight loss surgery procedure.

Potential general weight loss surgery complications:

• Perforation of stomach/intestine - a hole in the stomach/intestine
• Leakage at connections - spillage of intestinal contents into the abdomen
• Abdominal infections, abscesses
• Bleeding
• Wound infections
• Abdominal infections
• Bowel obstruction - from scar formation
• Stricture - narrowing of pouch outlet
• Incisional hernia - common with open surgery
• Development of gallstones and gallbladder attacks
• Pouch or pouch outlet ulcers
• Stomach prolapse/slippage - requiring possible re-operation
• Band erosion
• Port/tubing mechanical failure
• Nutritional deficiency
• Vitamin deficiencies
• Anemia – low blood count
• Osteoporosis - fragile bones
• Temporary hair loss
• Dumping syndrome
• Lactose intolerance

Potential complications that can be associated with any surgery:

• Pneumonia - lung infection
• Atelectisis - lung tissue collapse
• Plueral effusions - fluid in chest
• Pulmonary edema - fluid in lungs
• Pulmonary embolus (PE) - clot blocking blood flow in lung
• Heart attack
• Congestive heart failure - poor heart function
• Arrhythmias - abnormal/irregular heart beats
• Stroke - blockage of blood flow in brain
• Acute kidney failure - kidney unable to make urine
• Liver failure - liver malfunction
• Hepatitis - inflammation/infection of liver
• Urinary tract infection - urine infection 

Vitamin deficiencies
More common with malabsorptive procedures. Iron deficiency is secondary to lack of contact of food iron with stomach acid and thus reduced conversion of iron from the insoluble ferrous form to the absorbable ferric form. Vitamin B12 deficiency can result from food no longer coming in contact with adequate amounts of intrinsic factor from the stomach to allow absorption. Vitamin D and Calcium may also be reduced since the duodenum and proximal jejunum, the preferential sites of absorption, are bypassed by this procedure. These deficiencies are easily prevented by life-long daily multivitamins including minerals, iron, Vitamin B12 and calcium supplements. A complete detailed nutritional guide and instruction manual addressing vitamin supplements can be found in the Diet Guides for each procedure.

 

Dumping Syndrome
The malabsorptive procedures can cause the Dumping Syndrome, whereby sugar is absorbed too quickly and stomach contents moves too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, and occasionally, diarrhea after eating high sugar or fat content foods. It occurs in approximately 70% of patients. Some patients with this syndrome cannot eat sweets without becoming weak and sweaty to the point that they must lie down until the symptoms pass. This is perceived by surgeons as a desirable side effect to help enforce better eating habits, by reducing sugar intake.

Hair loss
Temporary hair loss can occur at the 4th or 5th month after surgery. It is common with the malabsorptive procedures.  It can last for one or two months. It occurs because of the drastic reduction of calorie intake and rapid weight loss. It is also reflective of a potentialy poor protein intake during the first few months after surgery. The hair loss or thinning is temporary, hair re-growth will be complete.

Pregnancy
Weight loss surgery does not interfere with the ability to get pregnant.  Pregnancy after weight loss will be safer. If you're infertile there is a 50% chance you may become fertile again with weight loss.  We do not recommend women of childbearing age to get pregnant during the active weight loss period after their operation. It is simply not a time to get pregnant when you are losing weight, particularly fast.  Wait till your weight loss is complete, or stable.  A waiting period of approximately 18-24 months after surgery is not unreasonable. Rapid weight loss and nutritional deficiencies can potentially harm a developing fetus.

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Life after weight loss surgery

After weight loss surgery, for the first time you will feel full and satiated with what you eat. Your hunger and portion size will be controlled.  This is a profound experience for many, being released from a prison of hunger. The new satiety mechanism between the stomach and the brain allows for more effective control of food consumption. But, this does not mean that you can eat whatever and whenever.  Weight loss surgeries are “TOOLS”.  How you use the tool will determine how well the weight loss operation will work for you. 

There is a lot of information in our website to help you understand weight loss surgery and what life will be like after surgery.  The Preparatory Guide is an excellent resource to guide and prepare you for your operation and the changes that the operation will have on your life.  Full details about each weight loss operation are available under Weight Loss Surgery Procedures.  The Diet Guides will explain the specific diet, eating habit, and life style changes for each operation.  The WLS Program will walk you thru the program process.

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