The Weight Loss Surgery Program

Health Threat of Morbid Obesity

Morbid obesity brings with it an increased risk for a shorter life expectancy. For individuals whose weight exceeds twice their ideal body weight (that's about 2-6% of the U.S. population), the risk of an early death is doubled compared to non-obese individuals. The risk of death from diabetes or heart attack is five to seven times greater. Even beyond the issue of obesity-related health conditions, weight gain alone can lead to a condition known as "end-stage" obesity where, for the most part, no treatment options are available. Yet an early death is not the only potential consequence. Social, psychological and economic effects of morbid obesity, however unfair, are real and can be especially devastating.

What is Obesity?
“Obesity” specifically refers to an excessive amount of body fat.  “Overweight” refers to an excessive amount of body weight that includes muscle, bone, fat and water.  As a rule, women have more body fat than men.  Most health care professionals agree that men with more than 25% body fat and women with more than 30% body fat are obese.  These numbers should not be confused with Body Mass Index (BMI), however, which is more commonly used by health care professionals to determine the effect of body weight on the risk for some diseases.

How is Obesity Measured?
Because measuring a person’s body fat is difficult, health care professionals often rely on other means to diagnose obesity.  Weight for height tables have a range of acceptable weights for a person of a given height.  One problem with these tables is that there are many versions, all with different weight ranges.  Another problem is that they do not distinguish between excess fat and muscle.  According to the tables, a very muscular person may be classified obese when he or she is really not.  The BMI is less likely to misidentify a person’s appropriate weight to height range, therefore, that is the table that we choose to use for appropriateness for surgery.

What Is Morbid Obesity?
According to the National Institutes of Health (NIH), a person is considered “obese” when he or she weights 20% more than his or her ideal body weight. Obesity becomes "morbid" when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases (also known as co-morbidities) that result either in significant physical disability or even death. As you read about morbid obesity you may also see the term "clinically severe obesity" used. Both are descriptions of the same condition and can be used interchangeably. Morbid obesity is typically defined as being 100 lbs. or more over ideal body weight or having a Body Mass Index of 40 or higher. According to the National Institutes of Health Consensus Report, morbid obesity is a serious disease and must be treated as such. It is a chronic disease, meaning that its symptoms build slowly over an extended period of time.

What Causes Morbid Obesity?
The reasons for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that, in many cases, that genetic, environmental and other factors may all play a part. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise program have a limited ability to provide effective long-term relief.

  Genetic factors

Obesity tends to run in families, suggesting a genetic cause.  However, families also share diet and lifestyle habits that may contribute to obesity. 

  Environmental and Social Factors

Environment strongly influences obesity.  Environment includes lifestyle behaviors such as what a person eats and his or her level of physical activity.  Too often Americans eat out, consume large meals and high fat foods, putting taste and convenience ahead of nutrition.  Also, most people in the United States do not get enough physical activity.  Although you cannot change your genetic makeup, you can work on your eating habits, levels of physical activity and other environmental factors.  Here are some ideas you can try:

• Learn to choose sensible portions of food that are lower in fat
• Engage in at least 30 minutes of moderate intensity physical activity most or all of the days of the week
• Eat meals at a table and not in front of the television
• Keep a food diary

  Other Causes of Obesity 

Some illnesses may lead to or are associated with weight gain or obesity.

Hypothyroidism is a condition in which the thyroid gland fails to produce enough thyroid hormone.  It often results in lowered metabolic rate and loss of vigor.

Cushing’s syndrome is a hormonal disorder caused by high levels of cortisol in the blood. This can be caused by taking glucocorticoid drugs, or by tumors that produve cortisol or adrenocorticotropic hormone (ACTH) or CRH.

Lack of sleep may also contribute to obesity.  Recent studies suggest that people with sleep problems may gain weight over time.  On the other hand, obesity may contribute to sleep problems due to medical conditions such as sleep apnea, where a person briefly stops breathing at multiple times during the night.

Certain medications such as steroids, some antidepressants and some medications for psychiatric conditions or seizure disorders may cause weight gain.  These drugs may slow the rate at which the body burns calories, stimulate the appetite or cause the body to hold onto extra water.  Be sure that your physician knows about all of the medications that your are taking.

Polycystic ovary syndrome is a condition characterized by high levels of androgens (male hormones), irregular or missed menstrual cycles, and in some cases, multiple small cysts in the ovaries.

  Health Risks and Related Conditions (co-morbid conditions)

Obesity is more than a cosmetic problem.  Many medical conditions have been linked to obesity including:

• Type 2 diabetes
• Heart disease
• High blood pressure
• Stroke
• High cholesterol
• Certain types of cancer: colon, rectum, prostate, gallbladder, uterus, cervix and ovaries
• Depression
• Osteoarthritis of weight bearing joints
• Sleep apnea/ respiratory problems
• GERD/ heartburn
• Infertility
• Urinary stress incontinence
• Menstrual irregularities
• Lymphedema

  Psychological and Social Effects

Emotional suffering may be one of the most painful parts of obesity.  American society emphasizes physical appearance and often equates attractiveness with slimness, especially for women.  Such messages can make overweight people feel unattractive and uncomfortable.

Additionally, many people are insensitive and think that individuals with obesity are gluttons, lazy or both.  This is not true.  As a result, people who are obese often face prejudice or discrimination in the job market, at school and in social situations.  Feelings of rejection, shame or depression may occur.

While a healthier diet and exercise can result in weight loss, the real challenge is keeping the weight off. Unfortunately, studies show a nearly 100 percent failure rate during a five-year period for obese persons who diet for weight control. Even worse, a continuous cycle of weight loss and gain (yo-yo dieting) can cause serious health risks. If you’ve tried diet and exercise, but remain seriously obese, weight loss (Weight Loss) surgery may be the best way to regain your health.

Who Should Lose Weight?
Answering this question may give you the courage you need to take the first step. Healthcare providers generally agree that people who have a BMI of 30 or greater, can improve their health through weigh loss.  This is especially true for  people with a BMI of 40 or greater, who are considered 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 for defining morbid obesity. You are likely morbidly obese if you are:

• more than 100 lbs. over your ideal body weight, or
• have a Body Mass Index (BMI) of over 40, or
• have a BMI of over 35 and are experiencing severe negative health effects, such as high blood pressure or diabetes, related to being severely overweight
• unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting

Enter your height and weight to Calculate your BMI Index. The results of typical BMI calculations are displayed below. Note that these are approximate values, and are intended to be used only as a rough guide.

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