About Morbid Obesity

What is Obesity?

Overweight, obesity and morbid obesity result 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. Body Mass Index (BMI), a number calculated from a person’s weight and height, can reflect a person’s level of body fat. The formula for calculating BMI is a person’s weight (in pounds) divided by their height (in inches)² x 704. Using BMI, overweight is defined as 25-30, obesity is 30-40 and morbid obesity is BMI over 40.

Morbid Obesity

Health Risks of Obesity

Overweight and obese people are at increased risk for many diseases and health conditions, including the following:

• Hypertension (high blood pressure)
• Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Sleep apnea and respiratory problems
• Some cancers (endometrial, breast, and colon)

Type 2 diabetes

Type 2 diabetes is the most common form of diabetes; 90% of all people with newly diagnosed type 2 diabetes are overweight.  In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use sugar. Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:

• Right away, your cells may be starved for energy.
• Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.

Having type 2 diabetes increases your risk for many serious complications. Some complications of type 2 diabetes include: heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy).

The Role of Weight Loss Surgery in Type 2 Diabetes

Current research shows that Bariatric surgical procedures have proven more successful helping morbidly obese people lose weight and control diabetes than conservative methods.
(Greenway SE, Greenway FL 3rd, Klein S. Arch Surg. 2002 Oct;137 (10):1109-17.)
 
According to a large research study on type 2 diabetics who had gastric bypass surgery conducted out of East Carolina University, the research team found that gastric bypass surgery, more than any other therapy, has produced lasting and complete control of diabetes. The operation provides long-term control of non-insulin-dependent diabetes. The patients who participated in the study maintained normal levels of plasma glucose, glycosylated hemoglobin, and insulin.
(Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, deRamon RA, Israel G, Dolezal JM, et al. Ann Surg. 1995 Sep;222(3):339-50; discussion 350-2.)

At the beginning of 2008, news headlines around the world read: “Obesity Surgery Can Cure Diabetes”. According to a study published in the Journal of the American Medical Association, the laparoscopic adjustable gastric banding (LAGB), demonstrated superior results for the treatment of type 2 diabetes. The complete remission rate of 73% for the surgery vs 13% for medical management is among the highest reported in literature. Dixon JB, Obrien PE, Playfair J. Chapman L. Schachter LM, Skinner S, Proietto J, Bailey M, Anderson M. JAMA 2008:299 (3): 316-323.

According to the National Heart, Lung and Blood Institute (NHLBI) about one in every four American adults has high blood pressure. Once high blood pressure develops, it usually lasts a lifetime. The good news is that it can be treated and controlled.

What is blood pressure?

Blood is carried from the heart to all parts of your body in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into the arteries. Your blood pressure is at its highest when the heart beats, pumping the blood. This is called systolic pressure. When the heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure. A blood pressure reading below 120/80 is considered normal. High blood pressure is a blood pressure reading of 140/90 mmHg or higher.  Pre-hypertension is defined as a systolic blood pressure of 120–139 mmHg or a diastolic blood pressure of 80–89 mmHg. Persons with pre-hypertension are at increased risk to progress to hypertension.

Who Gets High Blood Pressure?

More than 50 million American adults--1 in 4--have high blood pressure.
In the U.S., high blood pressure occurs more often in African Americans. Over half of all Americans age 60 and older have high blood pressure.
Your chances of getting high blood pressure increase if you:

• Are overweight
• Are a man over the age of 45
• Are a woman over the age of 55
• Have a family history of high blood pressure
• Have a "pre-hypertension” (120-139/80-89)

Heart Disease (Coronary Artery Disease = CAD)

Causes of Obesity

The reasons for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Obesity results from a complex interaction of genetic, behavioral and environmental factors causing an imbalance between energy intake and energy expenditure. Research has shown that in many cases a significant, underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.

Science continues to search for answers. But until the disease is better understood, the control of excess weight is something patients must work at for their entire lives. That is why it is very important to understand that all current medical interventions, including weight loss surgery, should not be considered medical cures. Rather they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease.

Contributing Factors

The underlying causes of severe obesity are not known. There are many factors that contribute to the development of obesity including genetic, hereditary, environmental, metabolic and eating disorders. There are also certain medical conditions that may result in obesity like intake of steroids and hypothyroidism.

Environmental Factors

"Genetics loads the gun—the environment pulls the trigger."  George Bray, 1996

Environmental and genetic factors are obviously closely intertwined. If you have a genetic predisposition toward obesity, then the modern American lifestyle and environment may make controlling weight more difficult.

Fast food, long days sitting at a desk, and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage.

For those suffering from morbid obesity, anything less than a total change in environment usually results in failure to reach and maintain a healthy body weight.

Metabolism

We used to think of weight gain or loss as only a function of calories ingested and then burned. Take in more calories than you burn, gain weight; burn more calories than you ingest, lose weight. But now we know the equation isn't that simple.
Obesity researchers now talk about a theory called the "set point," a sort of thermostat in the brain that makes people resistant to either weight gain or loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you lost.

Eating Disorders & Medical Conditions

Weight loss surgery is not a cure for eating disorders. And there are medical conditions, such as hypothyroidism, that can also cause weight gain. That's why it's important that you work with your doctor to make sure you do not have a condition that should be treated with medication and counseling.

Am I Morbidly Obese?

Below are tools you can use to determine if you are morbidly obese and potentially a candidate for weight loss surgery.

There are several medically accepted criteria from the National Institutes of Health for defining morbid obesity. You may be morbidly obese if you are

• more than 100 lbs. over your ideal body weight
• have a Body Mass Index (BMI) of over 40
• have a BMI of over 35 with serious health problems such as high blood pressure or diabetes, related to being severely overweight
• have not kept weight off despite past attempts at non-surgical weight loss

You can use our BMI calculator to find your body mass index.

A National Health Problem

If you are morbidly obese, you are not alone. In 2004 a study released by Health and Human Services Centers for Disease Control and Prevention shows that deaths due to poor diet and physical inactivity rose by 33 percent over the past decade and may soon overtake tobacco as the leading preventable cause of death.