What Is Obesity?

What is Your Body Mass Index?

What are the effects of obesity?
Who are candidates for bariatric surgery?
Who should not undergo bariatric surgery? 
How effective is surgery?

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. Today, 97 million Americans, more than one-third of the adult population, are overweight or obese. An estimated 5 to 10 million of those are considered severely obese.

Class 1	BMI ≥30 - 34.9
Class 2	BMI ≥35 - 39.9
Class 3	BMI≥40  (severe)

 

 

BMI = Body Mass Index

What are the effects of obesity?

Obesity is a chronic disease that has very serious health consequences, including early death. Obesity affects virtually every organ system:

• Cardiovascular (hypertension, atherosclerotic heart disease with myocardial infarction and cerebral vascular accidents, peripheral venous insufficiency, thrombophlebitis, pulmonary embolism)
• Respiratory (obstructive sleep apnea, asthma)
• Metabolis (type 2 diabetes, impaired fasting glucose or impaired glucose tolerance, hyperlipidemia)
• Musculoskeletal (back strain, disc disease, weight-bearing Osteoarthritis of the hips, knees, ankles, feet)
• GI (cholelithiasis, GERD, nonalcholic fatty liver disease)
• Urologic (stress incontinence)
• Endocrine and Reproductive (polycystic ovarian syndrome, infertility, male hypogonadism)
• Dermatologic (intertriginous dermatitis)
• Neurologic (pseudotumor cerebri, carpel tunnel syndrome)
• Psychologic (depression, eating disorders, body image disturbance)
• Neopastic (colorectal, hepatic, gallbladder, endometrial, breast, ovarian, prostate, pancreatic cancers)

There is a worldwide epidemic of obesity.  In the US, one-third of the adult US population is overweight, and another one-third is obese.  One out of four US adults are obese.  One-third of all US children are obese or at risk for obesity.  They are at a high risk for chronic disease and premature death.

Most obese patients will have comorbid conditions such as HTN, type 2 diabetes, IFG (FBS≥100 mg/dL) or IGT, metabolic syndrome, dyslipidemia, heart disease, sleep apnea, osteoarthritis, joint stress, and poor function.  in fact, metabolis syndrome, which is the clustering of the metabolis complications of obesity, is prevalent.  About 25% of the US adult population and one-third of overweight adolescents fit the criteria for the metabolis syndrome.  This syndrome is associated with developing type 2 diabetes and cardiovascular disease.  - back to top -

Who are candidates for bariatric surgery?

Surgery is recommended as a treatment option for a subset of the overweight population who have failed traditional, medically sound diet and exercise approaches and who are at high risk from the complications of obesity:

BMI≥40 (usually at least 100 pounds overweight);

BMI≥35  with at least one comorbidity such as diabetes, heart disease, sleep apnea, HTN, IFG/IGT, dyslipidemic, or lifestyle impairment.

Third party payees may have additional criteria for bariatric surgery, such as body weight more than 100% above ideal body weight, or failed attempts at medically supervised weight loss programs.   - back to top -

Who should not undergo bariatric surgery?

Psychotic illness, active substance abuse and noncompliance with previous medical care are all absolute contraindications to bariatric surgery.   - back to top -

How effective is surgery?

Bariatric surgery is the most effective available treatment for severely (morbidly) obese patients.  (BMI≥40 or BMI≥35 with high-risk comorbid conditions).  Surgical success is defined as losing 50% or more of excess weight, and maintaining this for at least 5 years.  Bariatric surgery markedly lowers body weight, improves or reverses many comorbid conditions, improves the quality of life, and can be an extremely valuable treatment for select obese patients.  In fact, type 2 diabetes is cured in about 90% of patients; HTN is cured in 60-75% of patients, and sleep apnea often resolves.  Almost 100% of patients will have reductions in their medications.

Having bariatric surgery requires major, lifelong changes and long-term monitoring.  Patients need to be motivated and compliant.  However, for the right patient who has not responded to weight and lifestyle management with diet and exercise, bariatric surgery will likely produce the most successful long term results.   - back to top -