BMN Blog

AUG 31
Don’t Wait to Lose Weight

Obesity is no longer considered a cosmetic issue caused by overeating and a lack of self-control. The World Health Organization (WHO), along with national and international medical and scientific societies, now recognizes obesity as a chronic progressive disease resulting from multiple environmental and genetic factors.

In its latest report, the Centers for Disease Control and Prevention (CDC) estimates that 42.4 percent of U.S. adults were obese with 9.2 percent of these severely obese, which is the highest incidence ever recorded in America. 

Thirty-two states had prevalence equal to or greater than 25 percent, with Alabama’s rate exceeding 30 percent. Obesity costs the U.S. about $147 billion annually. Between 1998 and 2006, the prevalence of obesity increased by 37 percent. Obesity is now responsible for 9.1 percent of annual medical expenditures, compared with 6.5 percent  in 1998.

BMI

Body Mass Index (BMI) takes into consideration an individual’s height and weight and is calculated according to one of the following formulas:

(1) Weight in kilograms divided by height in meters squared (BMI = kg/m2)

Or

(2) Weight in pounds divided by height in inches squared and this value multiplied by 705 (BMI= [(lbs/in2) x 705])

Category

BMI Range

Normal Size

18.9 to 24.9

Overweight

25 to 29.9

Class I, Obesity

30 to 34.9

Class II, Serious Obesity

35 to 39.9

Class III, Severe Obesity

40 and greater

 

Obesity and health

Obesity is linked to more than 40 other diseases, including Type 2 diabetes, hypertension, heart disease, respiratory disorders, cerebrovascular disease, stroke, acid reflux disease, bone/joint damage and certain types of cancer. Combined with obesity, these diseases may lead people to poor health, poor quality of life, disability, or early death.

Weight loss surgery or Metabolic and Bariatric Surgery

The National Institutes of Health (NIH) recommends bariatric surgery for obese individuals with a BMI of at least 40, and for individuals with a BMI 35 and serious coexisting medical conditions such as diabetes, sleep apnea, hypertension, degenerative joint disease, etc.

Why Surgery? 

Many patients with obesity have tried to treat it on their own with diet and exercise. Many have experienced some success only to eventually regain the weight. Often, patients have little-to-no success with diet and exercise alone; however, this is not a result of lack of willpower or the wrong diet. When a patient has a BMI greater than 35,  his chances of reaching a normal body weight for a lasting period of time is less than 1 percent. This is why surgery is another option for patients with severe obesity. Unfortunately, many patients who could benefit from surgery don’t know if it is right for them. An estimated 256,000 bariatric surgeries were performed in 2019, which represents less than 1 percent of the currently eligible surgical population based on BMI. In other words, less than 1 percent of people who qualify for surgery actually have it performed in any given year. As a result, metabolic and bariatric surgery is significantly underutilized.

How Does Weight Loss Surgery Work? 

Bariatric procedures such as gastric bypass, sleeve gastrectomy and duodenal switch work by changing the anatomy of the stomach and small intestines. This causes changes in appetite, satiety and metabolism. Many of the hormonal signals that cause weight gain or inability to lose weight are affected by these procedures, ultimately leading to weight loss. Life post-surgery still requires a healthy diet and a good exercise routine, however. Bariatric surgery is a tool to treat obesity, but it does not work alone.

Importance of weight loss surgeries

The NIH recognized metabolic and bariatric weight loss surgery as the only effective treatment to combat severe obesity and maintain weight loss in the long term. A 2014 literature review published in JAMA Surgery showed that bariatric surgery had sustained effects on weight loss with continued loss of BMI five years after surgery.

Long-Term Weight Loss Success

Bariatric surgeries result in long-term weight loss success. Most studies demonstrate that more than 90 percent of individuals previously affected by severe obesity are successful in maintaining 50 percent or more of their excess weight loss following bariatric surgery. Among those affected by super severe obesity (BMI above 50), more than 80 percent are able to maintain more than 50 percent excess body weight loss.

Improvement/Resolution of Coexisting Diseases

Bariatric surgery is associated with significant weight loss. Hence, it improves or even resolves obesity-related co-morbidities including, but not limited to, high blood pressure, sleep apnea, asthma and other obesity-related breathing disorders, arthritis, lipid (cholesterol) abnormalities, gastroesophageal reflux disease, fatty liver disease, venous stasis, urinary stress incontinence and pseudotumor cerebri.

Bariatric surgeries also lead to improvement and remission of Type 2 diabetes mellitus (T2DM). Previously, diabetes was considered to be a progressive and incurable disease. Treatments include weight loss and lifestyle changes for those overweight or obese and antidiabetic medication, including insulin. These treatments help to control T2DM but rarely cause remission of the disease.

However, there is now a large body of evidence showing remission of T2DM following bariatric surgery. A large review of 621 studies involving 135,247 patients found that bariatric surgery causes improvement of diabetes in more than 85 percent of the diabetic population and remission of the disease in 78 percent. Remission of T2DM was highest for the bilio-pancreatic diversion with duodenal switch (BPD/DS) with a remission rate of 95 percent, followed by the Roux-en-Y gastric bypass (RYGB) with remission in 80 percent of patients. Other studies comparing remission of diabetes between surgeries found comparable rates between the laparoscopic sleeve gastrectomy (LSG) and RYGB, i.e., at 80 percent.

Causes of improvement or remission of diabetes have not been completely identified. It occurs early after surgery, well before there is significant weight reduction. In fact, some bariatric patients with T2DM leave the hospital with normal blood sugar and without the need for antidiabetic medication.

Improved Longevity

Several large population studies find that individuals affected by severe obesity who have had bariatric surgery have a lower risk of death than individuals affected by obesity who do not have surgery. One of these studies found up to an 89 percent reduction in mortality throughout a five-year observation period for individuals who had bariatric surgery when compared to those who did not. Another large population study comparing mortality rates of bariatric and non-bariatric patients found a greater than 90 percent reduction in death associated with diabetes and a greater than 50 percent reduction in death from heart disease.

The mortality rate for bariatric surgery (3 out of 1000) is similar to that of a gallbladder removal and considerably less than that of a hip replacement. The exceptionally low mortality rate with bariatric surgery is quite remarkable considering that most patients affected by severe obesity are in poor health and have one or more life-threatening diseases at the time of their surgery. Therefore, the benefits of surgery far exceed the risks.

Changes in Quality of Life and Psychological Status with Surgery

In addition to improvements in health and longevity, surgical weight-loss improves overall quality of life. Measures of quality of life that are positively affected by bariatric surgery include physical functions such as mobility, self-esteem, interactions at work, social interactions and sexual function. Furthermore, depression and anxiety are significantly reduced following bariatric surgery.

Summary

Obesity is a chronically progressive disease that can affect almost every system in the human body. Metabolic/bariatric surgery is the most effective and long-lasting treatment for severe obesity. Weight loss surgery is as safe or safer than some of the most commonly performed surgeries in the United States, including gallbladder surgery, appendectomy and knee replacement. Ultimately, many patients believe the risks of obesity far outweigh those associated with potentially lifesaving metabolic/bariatric surgery.

 

Venkat Kanithimathinathan, MD practices bariatric medicine at Cullman Regional Medical Center.

 

 

 

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