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