Morbid Obesity and Treatment Options

Morbid Obesity and Treatment Options

Obesity is a condition in which one has too much body fat (adipose tissue). Obesity is determined by calculating the Body Mass Index (BMI), which measures weight for height and is stated in numbers.

1. Health Hazards of Morbid Obesity

Severe obesity damages the body by its mechanical, metabolic and physiological adverse effects on normal body functioning. These “co-morbidities” affect nearly every organ in the body in some way, and produce serious secondary illnesses, which may also be life threatening. The cumulative effect of these co-morbidities can interfere with a normal and productive life and can shorten life as well. The risk of developing these medical problems is proportional to the degree of obesity.

• People who are obese do not live for as long as those who are not obese and the earlier a person become obese; the more years of life are lost.
• Heart Disease- Severely obese persons are approximately 6 times as likely to develop heart disease as those who are of normal weight. Heart disease is the leading cause of death today and obese persons tend to develop it earlier in life.
• High Blood Pressure- Hypertension is much more common in obese persons and leads to development of heart disease, and damage to the blood vessels throughout the body, causing susceptibility to strokes, kidney damage, and hardening of the arteries.
• Diabetes Mellitus- Overweight persons are 40 times as likely to develop Type 2, Adult-onset diabetes. Once diabetes occurs, it becomes even harder to lose weight, because of hormone changes which causes higher fat accumulation in the body.
• Sleep Apnea Syndrome- Sleep apnea – the stoppage of breathing during sleep – is commonly caused in the obese, by compression of the neck, closing the air passage to the lungs.
• Respiratory Insufficiency
• Heartburn – Reflux Disease and Reflux Nocturnal Aspiration
• Asthma and Bronchitis
• Gallbladder Disease – Gallbladder disease occurs more frequently in the obese, in part due to repeated efforts at dieting, which predispose one to this problem.
• Stress Urinary Incontinence
• Degenerative Disease of Lumbo-Sacral Spine (Backbone)
• Degenerative Arthritis of weight bearing joints like knee and hip
• Venous Stasis Disease in the lower extremities
• Emotional/Psychological Illness- Extremely overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, and remarks from strangers. They often experience discrimination at work. Stereotypes of obese people – such as that they are lazy – may result in lower self esteem and poor body image.
• Social Effects- Severely obese persons suffer inability to qualify for many types of employment and there tends to be a higher rate of unemployment among them. There is a general societal belief that obesity is a consequence of a lack of self-discipline, or moral weakness.

2. Surgical options for treating Morbid Obesity

The morbidly obese have to seriously consider surgery for reducing weight to avoid its ill effects. Surgery for Morbid Obesity is for the following situations

• The person’s BMI is over 40, or is 35 or higher and a serious medical problem (hypertension, diabetes, heart disease, joint problems, reflux) that is made worse by obesity is present.
• If it has not been possible to reduce or maintain weight under a medically supervised program.
• If the person has been obese for at least 5 years.

3. Surgical Treatment options available are

Laproscopic Adjustable Gastric Banding

• An Inflatable Gastric Band is used, thus creating an Hourglass structure to the Stomach.
• This procedure may lead to about 39% of the excess weight being reduced within 18 months after the surgery.
• This procedure needs a high level of compliance from patient regards lifestyle and diet post surgery.
• There is always a risk of the Band eroding into the stomach, slipping out of place, and can also produce vomiting, development of GERD or sometimes the device can also fail to function.

Laproscopic Sleeve Gastrectomy

• Laparoscopic Sleeve Gastrectomy is safer than other procedures.
• In this procedure, 80% of the stomach is stapled and removed which induces weight loss by restriction in food intake and early satiety, due to loss of hunger producing hormones.
• Digestion and absorption is normal.
• By eating less the body draws the required energy from its own fat stores and thus you lose weight.

The R OUX-EN-Y Gastric Bypass

• In this procedure, a small, 15 to 20 cc, pouch is created at the top of the stomach.
• The small bowel is divided. The bilio-pancreatic limb is reattached to the small bowel and the other end is connected to the pouch, creating the Roux limb.
• The small pouch releases food slowly, causing a sensation of fullness with very little food intake.
• The bilio-pancreatic limb preserves the action of the digestive tract.

Bilio Pancreatic Diversion with Duodenal Switch

• In this procedure, greater weight loss can happen with less dietary compliance from the patient.
• There may be an increased risk of malnutrition and vitamin deficiency and intermittent diarrhea can also occur.
• Constant follow-up is needed for this procedure in order to monitor for complications.