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Patients

Questions & Answers

What is obesity?

The epidemic of obesity is now recognized as one of the most important public health problems facing the world today. Tragically, adult obesity is more common globally than under-nutrition. There are around 475 million obese adults with over twice that number overweight - that means around 1.5 billion adults are too fat. Over 200 million school-age children are overweight, making this generation the first predicted to have a shorter lifespan than their parents. Obesity is a medical condition described as excess body weight in the form of fat. When accumulated, this fat can lead to severe health impairments.

Health impact of obesity

Obesity is an important cause of morbidity, disability and premature death (WHO, 2004). Obesity increases the risk for a wide range of chronic diseases; BMI is thought to account for about 60% of the risk of developing type 2 diabetes, over 20% of that for hypertension and coronary-heart disease, and between 10 and 30% for various cancers. Other co-morbidities include gallbladder disease, fatty liver, sleep apnoea and osteoarthritis.

The disability attributable to obesity and its consequences in 2004 was calculated at over 36 million disability-adjusted life years (DALYs), due primarily to ischaemic heart disease and type 2 diabetes (WHO Global Health Risks Report, 2004).

Obesity shortens life expectancy. In 2004, increased BMI alone was estimated to account for 2.8 million deaths, while the combined total with physical inactivity was 6.0 million (WHO Global Health Risks Report, 2004) – surpassing the excess mortality associated with tobacco, and approaching that of high blood pressure, the top risk factor for death.

What causes obesity?

Obesity is caused by an energy imbalance; when intake of calories exceeds expenditure of calories, the surplus energy is stored as body weight. There are a multitude of ‘obesogenic’ factors contributing to the increased energy consumption and decreased energy expenditure that are responsible for obesity, including:

  • an increased intake of energy-dense foods that are high in fat, salt and sugars but low in vitamins, minerals and other micronutrients; and
  • a decrease in physical activity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization. Social, economic, educational and cultural factors are important underlying causes of obesity, although how they inter-relate to promote or protect against the development of obesity is complex and varies considerably by country.

 

Obesity in children

Childhood obesity is already common, especially in westernized countries. In 2004, according to IOTF criteria, it was estimated that ~10% of children worldwide aged 5–17 years were overweight and that 2–3% were obese (Lobstein et al., 2004). Prevalence rates vary considerably between different regions and countries, from <5% in Africa and parts of Asia to >20% in Europe and >30% in the Americas and some countries in the Middle East. Becoming obese earlier in life clearly amplifies certain health risks, particularly for type 2 diabetes.

How is obesity measured?

The most widely-used method of measuring and identifying obesity is Body Mass Index (BMI).

BMI = weight in kg/height in m2 Overweight, or pre-obesity, is defined as a BMI of 25–29.9 kg/m2, while a BMI >30 kg/m2 defines obesity. These BMI thresholds were proposed by WHO expert reports and reflect the increasing health risk of excess weight as BMI increases above an optimal range of 21–23 kg/m2, the recommended median goal for adult Caucasian populations (WHO/NUT/NCD, 2000)

Where can I read more about obesity?

http://www.who.int/topics/obesity

Why should someone consider a Bariatric/Metabolic surgery procedure?

Current research suggests that one in three Americans is obese. In this country alone, about 300,000 deaths per year can be linked to obesity. Obesity is associated with serious health conditions, including high blood pressure, heart disease, sleep apnea (serious sleep disorder), heartburn or reflux, cerebral artery disease (stroke), diabetes mellitus (sugar diabetes), asthma, osteoarthritis, infertility, or cancer of the breast, colon, prostate or uterus. Usually within the first six months after a Bariatric/Metabolic surgery procedure, patients will no longer need to take medications for these conditions.

What is the recovery time following weight loss surgery?

Most patients recover from a Bariatric/Metabolic surgery procedure without complications. Patients are encouraged to get out of bed and start walking by the next day. The hospital stay for patients who undergo the Roux-en-Y procedure is usually two to four days. Patients who have the LAP-BAND® procedure may stay one to two days. Most individuals return to work in two to three weeks following their Bariatric/Metabolic surgery procedure.

What are the risks?

All surgical procedures carry risks, even more so when a patient is obese. Different procedures involve different risks, and depending upon your individual circumstances, your risks may be higher or lower than average. Keep in mind that the more experience a surgeon has performing Bariatric/Metabolic surgery, the lower the complication and mortality rates will be. Your surgeon will discuss potential risks of surgery with you so you can make an educated and informed decision.

Uncommon Bariatric/Metabolic surgery risks include rare complications of leakage through staples or sutures, ulcers in the stomach or small intestine, blood clots in the lungs or legs, stretching of the pouch or esophagus, persistent vomiting and abdominal pain, inflammation of the gallbladder and failure to lose weight (very rare)

More than one third of obese patients who have weight loss surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid weight loss, the risk of developing gallstones increases. Gallstone formation can be lessened with medication taken for the first six months after surgery.

Approximately 30% of patients could develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease. These deficiencies are avoided by taking vitamin and mineral supplements as prescribed, life-long.

Women of childbearing age should avoid pregnancy for 18 months to two years until the weight stabilizes, since rapid weight loss and nutritional deficiencies can harm a developing fetus.

Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuporfen and many arthritis drugs that contain aspirin should not be taken after Bariatric/Metabolic surgery.

Smoking after weight loss surgery may cause ulceration in the pouch, in addition to other health problems.

Which medical conditions are improved after weight loss surgery?

  • High blood pressure
    At least 70 percent of patients who have high blood pressure, and who are taking medications to control it, are able to stop all medications and have a normal blood pressure, usually within two to three months after surgery. When medications are still required, their dosage can be lowered, with reduction of the annoying side effects.
  • High cholesterol
    More than 80 percent of patients will develop normal cholesterol levels within two to three months after the operation.
  • Heart disease
    Although we can't say definitively that heart disease is reduced, the improvement in problems such as high blood pressure, high cholesterol, and diabetes certainly suggests that improvement in risk is very likely. In one recent study, the risk of death from cardiovascular disease was profoundly reduced in diabetic patients who are particularly susceptible to this problem. It may be many years before further proof exists, since there is no easy and safe test for heart disease.
  • Diabetes
    More than 90 percent of Type II diabetics obtain excellent results, usually within a few weeks after surgery: normal blood sugar levels, normal Hemoglobin A1C values, and freedom from all their medications, including insulin injections. Based upon numerous studies of diabetes and the control of its complications, it is likely that the problems associated with diabetes will slow in their progression when blood sugar is maintained at normal values. There is no medical treatment for diabetes that can achieve as complete and profound an effect as surgery - which has led some physicians to suggest that surgery may be the best treatment for diabetes in the seriously obese patient. Abnormal glucose tolerance, or "borderline diabetes," is even more reliably reversed by gastric bypass. Since this condition becomes diabetes in many cases, the operation can frequently prevent diabetes as well.
  • Asthma
    Most asthmatics find that they have fewer and less severe attacks, or sometimes none at all. When asthma is associated with gastroesophageal reflux disease, it is particularly benefited by gastric bypass.
  • Respiratory insufficiency
    Improvement of exercise tolerance and breathing ability usually occurs within the first few months after surgery. Often, patients who have barely been able to walk find that they are able to participate in family activities, and even sports.
  • Sleep apnea syndrome
    Dramatic relief of sleep apnea occurs as our patients lose weight. Many report that within a year of surgery, their symptoms were completely gone, and they had even stopped snoring completely—and their spouses agree. Many patients who require an accessory breathing apparatus to treat sleep apnea no longer need it after surgically induced weight loss.
  • Gastroesophageal reflux disease
    Relief of all symptoms of reflux usually occurs within a few days of surgery for nearly all patients. We are now beginning a study to determine if the changes in the esophageal lining membrane, called Barrett's esophagus, may be reversed by the surgery as well—thereby reducing the risk of esophageal cancer.
  • Gallbladder disease
    When gallbladder disease is present at the time of the surgery, it is "cured" by removing the gallbladder during the operation. If the gallbladder is not removed, there is some increase in risk of developing gallstones after the surgery, and occasionally, removal of the gallbladder may be necessary at a later time.
  • Stress urinary incontinence
    This condition responds dramatically to weight loss and usually becomes completely controlled. A person who is still troubled by incontinence can choose to have specific corrective surgery later, with much greater chance of a successful outcome with a reduced body weight.
  • Low back pain, degenerative disk disease, and degenerative joint disease
    Patients usually experience considerable relief of pain and disability from degenerative arthritis and disk disease and from pain in the weight-bearing joints. This tends to occur early, with the first 25 to 30 pounds lost, usually within a month after surgery. If there is nerve irritation or structural damage already present, it may not be reversed by weight loss, and some pain may persist.

When is weight loss surgery considered successful?

Weight loss surgery is considered successful when a person loses 50 percent of his or her excess weight. Although few people lose all of their excess weight, they do gain numerous health benefits, which may be lifesaving. It’s important to remember that there are no guarantees with any method of weight loss, even surgical procedures. Success hinges on your ability to become part of the plan to support the surgical tool you’ve chosen and make lifestyle changes with exercise and dietary adjustments.

Are there any activity restrictions following a Bariatric/Metabolic surgery procedure?

Yes, strenuous activity after a Bariatric/Metabolic surgery procedure should be avoided until you are healed. Walking, however, is a required activity at this stage of recovery. You are advised not to drive if you are taking pain medication other than Stopayne. At your first follow-up visit, your doctor will determine when you can return to work, but most people return to work three to six weeks after the initial Bariatric/Metabolic surgery procedure.

How long will it take to lose excess weight after weight loss surgery?

Excess weight loss begins right after surgery and continues for 18-24 months after surgery.

Is it possible to gain the weight back after a Bariatric/Metabolic surgery procedure?

Bariatric/Metabolic surgery has an excellent long-term track record for helping morbidly obese individuals maintain weight loss. If you are committed to making permanent dietary and lifestyle changes, your chance of weight re-gain is minimized.

What are the Bariatric/Metabolic surgery risks?

All surgical procedures have risks, particularly when the patient is morbidly obese. Different weight loss surgery procedures involve different risks, and depending upon your individual circumstances, your risks may be higher or lower than average. It’s also important to know that surgeons with more experience performing Bariatric/Metabolic surgery techniques have fewer complications. Potential Bariatric/Metabolic surgery risks of weight loss surgery should be discussed with your surgeon so you can make an informed choice.

Can weight loss surgery be reversed?

Both weight loss procedures are considered permanent weight loss measures. However, the LAP-BAND® is removable via laparoscopic surgery. Gastric bypass surgery is potentially reversible. Reversal requires another operation of the same, or greater, magnitude with the same, or greater, risks. Reversal of this operation is very uncommon and the procedure rarely occurs beyond six weeks from the time of surgery.