Get the Facts
A healthy weight is what your body naturally weighs when you consistently eat a nutritious diet and balance the calories you eat with physical activity you do. Weight, however, is only one measure of your health. People who are thin, but don’t exercise or eat nutritiously aren’t necessarily healthy. Likewise, a person who is overweight may be healthy if he or she eats healthfully and exercises regularly.
Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. According to the National Institutes of Health (NIH), 97 million Americans (more than one-third of the adult population) are overweight or obese today. An estimated 5 to 10 million of those are considered morbidly obese.
Morbid obesity is a chronic disease, meaning that its symptoms build slowly over an extended period of time.
It is typically defined as being 100 lbs. or more over ideal body weight or having a Body Mass Index (BMI) of 40 or higher. According to the NIH Consensus Report, morbid obesity is a serious disease and must be treated as such.
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 can result either in significant physical disability or even death. An estimated 5-10 million Americans are considered morbidly obese.
Causes of Morbid Obesity
The reasons for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Studies have demonstrated that dieting and exercise programs have a limited ability to provide effective long-term relief for morbid obesity. Research has shown that in many cases, there is a significant, underlying cause of morbid obesity, including, but not limited to:
- Genetics. Studies show that your genes play an important role in your tendency to gain excess weight. Adopted children, for example, show no correlation with the body weight of their adoptive parents, but an 80 percent correlation with their genetic parents, whom they have never met. We probably have several genes directly related to weight. Just as some genes determine eye color or height, others affect our appetite, our ability to feel full or satisfied, our metabolism, our fat-storing ability, and even our natural activity levels.
- Environment. Environmental and genetic factors are 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.
- Metabolism. We used to think of weight gain or loss only as a function of calories ingested and burned, but now we know the equation isn't that simple. Researchers talk about the "set point" theory, a sort of thermostat in the brain that makes people resistant to either weight gain or loss. Try overriding the set point by drastically cutting calories and your brain responds by lowering metabolism and slowing activity. You then gain back any weight you lost.
- Medical Conditions. Medical conditions, such as hypothyroidism, as well as eating disorders, 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.
Science continues to search for answers, but until the disease is better understood, controlling excess weight is something people must work at their entire lives. As such, it’s important to understand that all current medical interventions – including weight loss surgery – should not be considered medical cures.
Obesity-Related Health Conditions (Co-morbidities)
Whether alone or in combination, these health conditions are commonly associated with morbid obesity. Your doctor can provide you with a more detailed list:
- Type 2 Diabetes. Obese individuals develop a resistance to insulin, which regulates blood sugar levels. Over time, the resulting high blood sugar can cause serious damage to the body.
- High blood pressure/Heart disease. Excess body weight strains the ability of the heart to function properly. Resulting hypertension (high blood pressure) can cause strokes, as well as inflict significant heart and kidney damage.
- Osteoarthritis of weight-bearing joints. Additional weight placed on joints, particularly knees and hips, results in rapid wear and tear, along with pain caused by inflammation. Similarly, bones and muscles of the back are constantly strained, resulting in disk problems, pain and decreased mobility.
- Sleep apnea/Respiratory problems. Fat deposits in the tongue and neck can cause intermittent obstruction of the air passage. Because the obstruction is increased when sleeping on your back, you may find yourself waking frequently to reposition yourself. The resulting loss of sleep often results in daytime drowsiness and headaches.
- Gastroesophageal reflux/Heartburn. Stomach acid seldom causes any problem when it stays there. When acid escapes into the esophagus through a weak or overloaded valve at the top of the stomach, the result is called gastroesophageal reflux. "Heartburn" and acid indigestion are common symptoms.
- Depression. Seriously overweight people face constant emotional challenges: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, cannot fit comfortably in theater seats or ride in a bus or plane.
- Infertility. Morbidly obese women have a diminished ability to get pregnant. Those who do have a higher risk of miscarriage.
- Menstrual irregularities. Morbidly obese individuals often experience disruptions of the menstrual cycle, including interruption of the menstrual cycle, abnormal menstrual flow and increased pain associated with the menstrual cycle.
- Urinary stress incontinence. A large, heavy abdomen and relaxation of the pelvic muscles, often associated with childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing.
Weight Loss Surgery
As the advantages of weight-loss surgery become more apparent, it is being prescribed by more physicians than ever as a viable treatment for patients with morbid obesity. And while there are risks associated with any major surgery, including weight-loss surgery, in many cases, the risks from not having the surgery may be greater. In most cases, weight loss (bariatric) surgery is recommended by your physician when:
- All other attempts at weight loss have failed
- Health conditions (co-morbidities) have created a medical need for surgery
- Surgery seems to be the only option to achieve necessary weight loss
- The patient is physically and mentally stable enough for major surgery
Sarasota Memorial performs two bariatric surgery procedures that are recognized and approved by the American Society for Bariatric Surgery and the National Institutes of Health.
- Roux-en-Y Gastric Bypass
- Adjustable Gastric Band, utilizing the Lap Band® and the Realize Adjustable Band®.
Each procedure is highly specialized and has its own physiological method of achieving weight loss in the body. As with all medical procedures, each has its own advantages and risks. For detailed information about Sarasota Memorial’s gastric bypass and adjustable band surgeries, click on the procedure you want to know more about.
Roux-en-Y Gastric Bypass
In the health care industry today, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States.
In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.
Patrick Fitzgerald, MD and John Nora, MD perform the Roux-en-Y procedure at Sarasota Memorial Hospital.
- Higher Average Weight Loss. Patients generally lose more weight after the Roux-en-Y procedure than other procedures or pure dietary restriction methods. One year after surgery, patients weight loss can average 77% of excess body weight.
- Maintained weight loss. Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by most patients.
- Reduced or Resolved Co-morbidities. A study of 500 patients showed that 96% of certain associated health conditions known as co-morbitity factors, including back pain, sleep apnea, high blood pressure, diabetes and depression were improved or completely resolved.
All of the following deficiencies can be managed through proper diet and vitamin supplements. Poor absorption of iron and calcium can result in a predisposition to iron deficiency anemia. Women already at risk for osteoporosis after menopause should be aware of the potential for heightened bone calcium loss. Some patients can experience metabolic bone disease resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones.
Other negative side effects of gastric bypass surgery can include chronic anemia due to Vitamin B12 deficiency (manageable with Vitamin B12 pills or injections). A condition known as "dumping syndrome " can occur as the result of rapid emptying of stomach contents into the small intestine (sometimes triggered when too much sugar or large amounts of food are consumed). Not generally considered a serious risk, it can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
Adjustable Gastric Banding
At Sarasota Memorial, the gastric band procedure is available to patients using either the LAP BAND® by Allergan, Inc., or the REALIZE® Personal Banding System from Ethicon Endo-Surgery, Inc.
Both gastric bands serve to reduce stomach capacity and restrict the amount of food that can be consumed at one time. In both cases, this minimally invasive procedure does not require stomach cutting and stapling or gastrointestinal re-routing to bypass normal digestion.
In gastric banding surgery, an implanted medical device, a silicone ring, is placed around the upper part of the stomach and filled with saline on its inner surface. This creates a new, smaller stomach pouch that can hold only a small amount of food, so the food storage area in the stomach is reduced. The band also controls the stoma (stomach outlet) between the new upper pouch and the lower part of the stomach. When the stomach is smaller, you feel full faster, while the food moves more slowly between your upper and lower stomach as it is digested. As a result, you eat less and lose weight.
During this procedure, surgeons usually use laparoscopic techniques to wrap the band around the patient’s stomach. A narrow camera is passed through a port so the surgeon can view the operative site on a nearby video monitor. Like a wristwatch, the band is fastened around the upper stomach to create the new stomach pouch that limits and controls the amount of food you eat. The band is then locked securely in a ring around the stomach.
- Minimally Invasive. A laparoscopic procedure with no gastrointestinal rerouting, band surgeries are considered the safest, least invasive, and least painful of all weight-loss surgeries.
- Quick Recovery. Like most minimally invasive surgeries, hospital stays are shorter and patients recover quickly.
- Adjustable. The band’s diameter can be modified to meet the patient’s individual needs. Pregnant patients can expand their band to accommodate a growing fetus, while patients who aren’t experiencing significant weight loss can have their bands tightened. If for any reason the band needs to be removed, the stomach generally returns to its original form.
Risks specific to this surgery include infection, spleen bleeding or injury, gastric perforation (a tear in the stomach wall), and access port leakage. Beyond surgical risks, most patients experienced at least one side effect during recovery. Common side effects include nausea and vomiting, heartburn, abdominal pain, and slippage of the band.
Scott Stevens, MD performs the Roux-en-Y procedure at Sarasota Memorial Hospital.