WHAT IS OBESITY?
Obesity is a health condition, caused by both genetic and environmental factors, in which the accumulation of excess fat and alterations in body function are extremely detrimental to health. Life expectancy may be lowered by as much as 20 years. Many life-threatening (cause death) and life-limiting (cause pain and suffering) conditions are associated with obesity.
The Body Mass Index or BMI is the most common method for categorizing how obese someone is. It is in units of Kg/m2. The formula is:
705 X Weight (pounds),
then divide by Height (inches),
then divide by Height (inches).
The categories are as follows:
|BMI in kg/m2|
|Super Morbidly Obese||>50|
You may also see obesity categorized as:
|BMI in kg/m2|
|Class I obesity||30-35|
|Class II obesity||35-40|
|Class III obesity||>40|
What is my ideal body weight, my excess weight?
How does obesity affect health?
Life expectancy may drop by as much as 20 years in its worse form, morbid obesity. The average life expectancy in the US is 78. For morbidly obese individuals, it is 58. More than ¼ of life expectancy can be lost to obesity.
There are life-threatening (cause death), as well as life-limiting (cause pain and suffering) health conditions that occur more frequently with obesity. The mortality or death rate for morbidly obese people that then develop other life-threatening conditions such as those listed below, can be as high as 4.5% a year. This equates to nearly a 1 in 20 chance of death every year.
Life-threatening (cause death) conditions:
- Diabetes (high blood sugar)
- Hypertension (high blood pressure)
Cardiovascular disease (blockage of arteries of heart)
- Dyslipidemia (high cholesterol or triglycerides or fats in the blood)
- Obstructive Sleep Apnea (difficulty breathing and low oxygen while sleeping)
- Obesity Hypoventilation Syndrome (Low oxygen while awake due to less lung capacity)
- Liver disease (fatty liver, inflammation of liver and hardening of liver or cirrhosis)
- Cancer (Breast, Prostate, Colon, Endometrial or lining of the Uterus)
Life-limiting (cause pain and suffering) conditions:
- Osteoarthritis (joint pain, can cause disability)
- Gallstones (gallbladder issues often requiring surgery)
- Reflux (heartburn, sometimes not felt, causes damage to esophagus)
- Stress Urinary Incontinence (leaky bladder)
- Erythema Intertrigo (skin fold infections)
- Varicose veins
- Edema (legs and belly)
- Hernias (defect in belly muscles causing bulging and pain)
- Menstrual irregularity/Infertility
- Depression (from social stigmatization and discrimination)
How does bariatric surgery improve health?
“Many of the life-threatening and life-limiting conditions associated with obesity go into remission after bariatric surgery. Switch surgery has a 95% remission rate for type II diabetes. Patients often come off their insulin, stop taking blood pressure medications and drastically reduce their use of other prescription medications”
WHAT CAUSES OBESITY?
Simply put, obesity results from our (human) genetics in today’s environment. Our genetics determines our metabolism. We as humans do not require many calories to sustain ourselves. There was a selective advantage in the distant path for humans to hold on to as many calories as possible when food was not as abundant. In recent history our (human) genetics have not changed that much however our environment is very different. Readily available, high calorie foods are now abundant and cheap. The average American female’s baseline calorie burn at rest is 1,400 calories a day. For men it is 1,700 calories a day. The average fast food restaurant meal is 1,600 calories. Do we on average eat just 1 meal a day? The answer is no. When we look at what we burn and what is readily available for us to eat, it is easy to see how the average person can easily get in more calories than they are burning. What has caused the increase in obesity is… Our genetics in the face of today’s environment.
WHO IS HAVING A PROBLEM?
More than 2/3 of the US population (69.5%) is at least overweight (about 25 lbs. over). If you are not having a problem with your weight, you are part of the minority. More than 1/3 of the US population (36.3%) is at least obese (about 55 lbs. over). Severe obesity equates to about 80 lbs. over. More than 1 in 20 (6.9%) of the US population is morbidly obese (about 110 lbs. over). Women are more morbidly obese than men and our children are having obesity issues as well.
CAN DIETING WORK?
Dieting can work in the lower BMI categories however there are no long-term studies that show dieting is effective when BMI is 30 or above. When you diet you are fighting your genetics which is always a losing battle. The estimated success rate of diets being successful in the morbidly obese population is 5 out of 1000 (0.5%). It is not impossible but almost impossible for diets to be successful in the morbidly obese population. Weight loss can be achieved with diets, but your genetics takes over and you regain the weight almost every time. The role of dieting in the morbidly obese population is to improve health and shrink the liver in order to reduce risk prior to weight loss surgery. This can be done in 2 weeks.
What Does Work?
The only proven method to help someone that is morbidly obese to lose weight and to keep the weight off has been surgery. There are many surgeries available. Some older surgeries have been abandoned due to high failure rates. No surgery has a 100% success rate however modern bariatric surgery is much more effective than dieting, which has an almost 0 success rate. There are newer procedures that are being developed that are not surgeries but what are called EBTs (Endoscopic Bariatric Therapy). EBTs generally are not as effective as traditional surgery but there is much less risk involved as there is typically no incision and the procedures are done through the mouth with an endoscope (examples include the intragastric balloon and the Endoscopic Sleeve Gastroplasty) and they are performed on an outpatient basis. These therapies due to their very low risk are now being used to treat people that normally would not qualify for traditional surgery (BMI 30 -39), however, since they are considered investigational, they are not covered by insurance and are performed only on a self-pay basis.
WHO IS APPROPRIATE FOR SURGERY?
Criteria established by the National Institutes of Health (NIH), the World Health Organization (WHO) and the American Society for Metabolic and Bariatric Surgery (ASMBS) are below. These criteria were established more than 30 years ago and do need revising as the success rate and safety of all surgeries have improved dramatically over the years and there has been a need to expand coverage to patients with lower BMIs with traditional surgery and EBTs (Endoscopic Bariatric Therapy, through the mouth, no incision). Most insurance requirements mirror these criteria for traditional bariatric surgery.
- BMI 40 or above, automatically qualifies
- BMI 35 or above with some life-threatening comorbidities
- Evidence of diet attempts (outdated criteria that needs to be removed)
- No contraindications for surgery (not too high risk due to underlying health)
- Informed consent (Understanding what surgery involves, the risks and benefits and the need to follow other recommendations for diet and exercise and other behavior modifications to achieve the highest success rate. Need for life-long follow up/vitamins/lab evaluation)
Criteria for EBTs
- BMI 30-39, with or without other health conditions
- No contraindications for procedure (not too high risk due to underlying health and must be healthy enough to be performed as an outpatient)
- Informed consent (Understand these procedures are investigational and typically do not have as much weight loss as traditional surgery. Long term weight loss success is not known. Risk for EBTs are much lower than for traditional surgery)
- No coverage by insurance. Performed on a self-pay basis only