What is severe obesity?

Obesity is generally defined as excessive weight due to the accumulation of fat, above 20 percent of an individual’s ideal body weight based on age, gender and height. An individual is considered morbidly obese when he or she weighs 75 pounds or more above the ideal weight, with a Body Mass Index (BMI) of 40 or greater. A BMI of 35 or greater is considered severe obesity. Generally, a person must be about 75 pounds overweight to be severely obese. The BMI is calculated by dividing an individual’s weight in kilograms by the square of his/her height in meters.

Severe obesity is not solely a cosmetic problem. Medical science has clearly indicated that it is a critical health concern. According to the National Institutes of Health, obesity is the second-leading cause of preventable death in the United States. Statistics demonstrate that the life expectancy of a severely overweight person is dramatically shorter than that of an individual who is at a normal weight. Additionally, there are risks of developing heart disease, high blood pressure, diabetes, orthopedic problems and depression associated with severe obesity.

What is weight-loss surgery and how does it work?

The concept of surgery to control obesity grew out of the results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine. Because patients undergoing these procedures tended to lose weight after surgery, some physicians began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was the intestinal bypass.

This operation, first used more than 40 years ago, produced weight loss by causing something called “malabsorption” (failure of intestines to properly absorb nutrients from food). The idea was that patients could eat large amounts of food, which would be poorly digested or passed along too fast for the body to absorb many calories. Even though this surgery is no longer used in its original form, surgeons now use modified techniques that produce weight loss by limiting how much the stomach can hold. These restrictive procedures are often combined with modified malabsorbtive procedures that limit calorie and nutrient absorption and may lead to altered food choices.

Two ways that surgical procedures promote weight loss are:

  1. By decreasing food intake (restriction). Gastric banding, gastric bypass and vertical-banded gastroplasty are surgeries that limit the amount of food the stomach can hold by closing off part of the stomach. These operations also delay emptying of the stomach.
  2. By causing food to be poorly digested and absorbed (malabsortion). In the gastric bypass procedure, a surgeon makes a direct connection from the stomach to a lower section segment of the small intestine, bypassing the duodenum (the first part of the small intestine) and some of the jejunum (the second segment of the small intestine).

Each procedure is designed to limit the amount of food that can be eaten during a meal by reducing the size of the stomach. With a smaller stomach, you will feel full quickly and for a longer period of time, eliminating the need to eat larger quantities in more frequent intervals. The lower intake of calories will satisfy your appetite and will cause you to lose weight at the same time.

Who is a candidate for weight-loss surgery?

Although there may be some exceptions depending on each individual, the following criteria must be met before a candidate is accepted for a surgical weight-loss procedure:

  • Demonstrated previous efforts at weight loss that include mainstream dieting (no “fad” diets) and/or exercise programs.
  • Willingness to make necessary changes in eating habits and a demonstrated motivation toward weight loss.
  • Absence of medical problems that would make surgery/anesthesia hazardous.
  • Usually between the age of 18-70. Patients are accepted on a case by case basis if they are younger or older than this range.
  • At least 75 pounds over the recommended weight for your age, height and gender or have a Body Mass Index (BMI) of 40 or greater or 35 or greater with certain co-morbidities, such as hypertension, diabetes or sleep apnea.
Is weight-loss surgery right for me?

For those who remain severely overweight when non–surgical approaches to weight loss have failed, or for people who have obesity–related diseases, surgery may be the next step. Answers to the following questions can help in your decision to undergo weight-loss surgery.

Are you:

  • Unlikely to lose weight successfully with (further) non–surgical measures?
  • Well informed about the surgical procedure and the effects of treatment?
  • Determined to lose weight and improve your health?
  • Aware of how your life may change after the operation (adjustment to the side effects of the surgery, including the need to chew well and inability to eat large meals)?
  • Aware of the potential for serious complications, the associated dietary restrictions and the occasional failures that are associated with surgical weight-loss procedures?

Do you:

  • Have a BMI of 40 or above, or 35 above with co-morbidities?
  • Have an obesity–related physical problem such as body size that interferes with employment, walking or family function?
  • Have high–risk, obesity–related health problems such as diabetes, severe sleep apnea or obesity–related heart disease?

Though surgery may be a viable option for you, success is only possible with your fullest cooperation and commitment to behavioral change and medical follow–up for the rest of your life.

What are the long–range results of surgery?

With the altered size of your stomach and by eating only the amount of food recommended in your diet, your daily food intake will be decreased. With this decrease will come a weight loss of as much as five to six pounds per week for the first six weeks after gastric bypass surgery. Weight loss is usually slower with the adjustable gastric band, but may have similar results a few years after the procedure. With both procedures, you can continue to lose weight at a rate of one to two pounds, per week, for several months. The rate at which you will lose weight will decrease gradually until you reach a stable and healthy weight. Additional weight can be lost with a concentrated effort including the incorporation of exercise into your life.

In addition to looking better, weight loss improves most obesity–related conditions, including diabetes, sleep apnea, joint problems and hypertension. Many patients find they can reduce the number of medications they must take, or eliminate medications altogether. Many patients also report a greater feeling of personal development and job potential as a result of their renewed sense of self–esteem.

There are many factors that contribute to weight loss. Among the most important are your age, gender and initial weight at the time of your operation. Your willingness to make the necessary adjustments in your present habits is essential to the ultimate success of the procedure.

What are the potential risks?

Any surgery entails a certain amount of risk, and complications cannot always be avoided. Therefore, before making the decision to undergo surgery, it is important to consider all the potential risks. Your surgeon will explain the risks of each procedure with you. Some of the potential complications are listed below:

Immediate Risks

  • An obese person has a higher risk of complications from anesthesia than a non–obese person. An anesthesiologist will most likely want to meet with you prior to surgery to discuss possible complications.

Risks During Surgery

  • Possible bleeding.
  • Pulmonary embolism, or blood clots to the lungs. Prevention of this occurrence is made with the administration of certain medications that prohibit blood clotting.
  • Pulmonary atelectasis, or partial collapse of some segments of the lungs may occur and can develop into pneumonia if not treated properly.

Delayed Complications

  • Wound infection
  • Staple line disruption leakage
  • Vomiting
  • Abdominal abscess
  • Small bowel obstruction
  • Weight loss failure

It should be noted that the above listed complications are rare. However, if they do occur, a revision operation may be necessary. Other unforeseen complications, including death, are a possibility. Bariatric surgeries are not miracle procedures or an “easy way out.” It is possible to “eat through” the operation and fail to lose/regain weight at a later time.

What about nutrition and exercise following surgery?

Proper nutrition and exercise are essential to a successful weight-loss program. Following surgery, a dietician will teach you how to eat properly and will create a personalized nutrition program for you. In addition, any form of moderate exercise will help you lose weight faster, help you maintain your muscle mass and generally make you feel better.

A healthy level of exercise is important to your daily life pattern. After the first visit following your procedure, we encourage you to resume activities and begin exercises that you find enjoyable. Once you begin to lose weight, you will find that you have more energy than you did before the procedure and exercising will become more pleasurable.

Will I have to do this alone?

Like nutrition and exercise, a supportive network is important to the weight-loss effort. The team at the MemorialCare Surgical Weight Loss Center includes not just our skilled surgeons, but also internists, psychologists, counselors and dietitians to help you develop a program to achieve your weight-loss goal. In addition, there are support groups for those who have undergone surgical weight-loss, and patients are automatically linked into this network. This network includes a supportive group environment and regular meetings feature guest speakers who will discuss topics that deal directly with the daily issues you will face as you progress with your weight loss.

Is weight-loss surgery covered by health insurance?

Many insurance companies do cover these procedures. Insurance providers understand that severe obesity can contribute to multiple health problems. The knowledgeable staff at the MemorialCare Surgical Weight Loss Center will work with you and your insurance provider to help make the necessary financial arrangements.

What are the health benefits of sustained weight loss?

Significant weight loss can potentially reverse or prevent Type 2 diabetes, lower the chance of developing cancer, reduce joint pain, reverse upper-digestive issues, as well as prevent other life-threatening conditions. Socially and psychologically, the benefits are extensive. As people lose weight, they become more active and gain self-esteem.

How does surgical weight loss reverse comorbidities and Type 2 diabetes?

Weight-loss surgeries can improve diabetes, sleep apnea, hypertension, cardiovascular disease and other comorbidities. Surgically altering the gastrointestinal tract causes changes in the incretin system – a group of hormones that regulate glucose. Insulin levels often return to normal just days after surgery, before any significant weight loss.

How are the joints negatively affected by excess weight?

Obesity contributes to osteoarthritis – common wear-and-tear arthritis – by putting additional stress on weight-bearing joints. Every pound of excess weight adds one-and-a-half pounds of force to the knees. A sustained 10- to 15-pound weight loss in young obese people can mean a much lower risk of osteoarthritis later in life.

How does obesity affect cardiovascular health?

Body fat leads to higher blood volume. The heart works harder, which causes harmful changes in its structure and function over the years. Also, fat tissue – particularly in the abdomen – produces toxic, inflammatory substances that damage heart muscle.