Friday, July 29, 2011

Obesity


As many are aware, obesity is a major issue in America and the problem is getting worse. More than 33% of Americans are obese ( defined as a BMI > 30 ). More than 64% of Americans are overweight (BMI>25).

It costs America approximately 100 billion dollars a year to treat obesity and the complications that arise from it. This is in addition to hidden costs, such as days missed from work and early death( less taxes).

There are several well documented health hazards with obesity, such as diabetes, heart disease, stroke, cancer, arthritis, liver disease, sleep apnea, and depression. The risks increase with the degree of obesity.

The most practical means of measuring obesity is the body mass index. This is calculated by dividing the weight in kilograms by the height in meters( kg/m).

BMI Categories :   25-29 overweight; 30-34 obese; 35-39 moderately obese; 40-49 severely obese; >50 super ( morbidly) obese.

Well, what to do? The hallmark solution will forever be diet and exercise, but for most people there has only been limited success and not for a lack of desire or effort. Surgery has come into medical community acceptance over the last several years due to studies showing the improvement in obesity complications.

Weight loss surgery (called bariatric from Greek word baros meaning weight) works by either malabsorption or restriction. Restriction procedures limit the amount of calorie intake by reducing the stomachs reservoir capacity or via creation of a blind stomach outlet. Gastric banding is a purely restrictive procedure. This limits solid food intake by restricting the stomach size as its only mechanism of action. The small intestine must then absorb nutrients. The weight loss with purely restrictive procedures is more gradual.

Malabsorptive procedures work by shortening the length of the small intestine. This is done by shortening of the small bowel or by diverting around it. Examples include jejunoileal bypass or duodenal switch operation. The weight loss can be huge, but the complications many such as protein loss or micronutrient deficiencies.

The famous Roux-en-y gastric bypass is both restrictive and malabsorptive. In this operation you are left with a small stomach pouch; however, the small bowel is rerouted favoring additional weight loss via dumping and mild malabsorption.

So, does surgery work? It does, especially for those with BMI >40. The mean weight loss percent of excess weight loss was 61%. Diabetes completely resolved in 77% and either improved or resolved in 84%. Also look at these results: high cholesterol improved 70%; high blood pressure improved 62%; sleep apnea resolved 86%; reflux improved as well as urinary incontinence. Because of these data, I am now a fan of weight loss surgery.

The amazing thing is that there is now data showing a decrease is overall mortality. The reduction of the complications of obesity reduces overall mortality by 29%. As always, if one can reduce BMI by diet and exercise this is the safest way. Otherwise talk to your doctor about weight loss surgery. There are several different types of surgery; an expert in the field will need be consulted.

Let’s review some of the indications for surgery intervention: Be motivated! Have a BMI>40. Or, have a BMI>35 with co-morbidities(other diseases or complications) such as diabetes, blood pressure, apnea, severe arthritis, heart condition etc. and having failed non-surgical programs.

The most common surgical technique is the laparoscopic gastric banding. The upper stomach is banded by a tight, adjustable soft silicone ring connected to an infusion port placed under the skin.

The port can be accessed with ease via a syringe and needle. The band is adjusted to deal with weight loss as well as nutritional issues. Data shows an expectation of about 40-75% weight loss at two years. But note! It is easier to cheat with the lap band! So, a comprehensive approach is needed as well as good motivation.

The decision to proceed with a surgery for obesity is a serious one as there are many potential complications. For this reason it is necessary to follow protocols.


We also have the BMI Calculator on our website. Check it out here: Eastside Family Health.


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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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