Obesity and Weight Loss Surgery
General overview:
If you weigh 100 pounds (approximately 45kg) or more than your ideal weight, you are considered obese. Obesity is a complex and chronic disease and not a cosmetic problem. The incidence of obesity is rapidly increasing and has reached epidemic proportions in the Western society. In the UK one in five adults are considered obese and obesity among children is also on the increase.
The cause of obesity is much more complex and is not only driven by our appetite but also by our genes interacting with many factors in our environment. On a more simplistic level, our weight is largely determined by how we balance our intake of calories from food with the energy we use in everyday activities. Therefore if more energy is consumed than spent, weight gain occurs and the body stores the excess energy as body fat. Excess body fat accumulation results in overweight and ultimately obesity.
Obesity is associated with many health and non-health related problems for the individual concerned as well as for the society at large. The direct and indirect costs of obesity to the UK economy is approximately £3.3 billion annually and results in 1.8million days off work a year.
Evaluation of Obesity:
One of the commonest ways of describing the degree of obesity is the body mass index (BMI) calculated by dividing the body weight in kilograms by the height in metre squared.
| BMI (kg/m2) | Description |
| Less than 18 | Underweight |
| 18-25 | Normal |
| 25-29.9 | Overweight |
| 30-34.9 | Obese class 1 |
| 35-39.9 | Obese class 2 |
| 40-49.9 | Morbid obesity |
| >50 | Super obese |
Consequences of Obesity:
Obesity is linked to many chronic health conditions some of which are outlined below:
- Type 2 diabetes mellitus - obesity remains the leading cause of type 2 diabetes here in the UK and world wide
- High cholesterol levels - Diets that are high in saturated fats such as red meat and fried foods can lead to obesity and the accumulation of the so called "bad" cholesterol (or low-density lipoprotein LDL) as opposed to the "good" cholesterol (or high-density lipoprotein HDL). Obesity is associated with low levels of the good cholesterol, and high levels of triglycerides. Over time the accumulation of the bad cholesterol in the body can lead to a build up of fatty deposits in the blood vessels (arteries) throughout the body, a condition referred to as artherosclerosis. Artherosclerosis increases the risk of heart disease and stoke.
- Heart disease (coronary artery disease) - obesity increases the risk of fatty deposits in the arteries of the heart which over time leads to narrowing of the arteries and therefore less blood supply to the heart. This diminished blood flow may lead to chest pain (angina) or heart attack.
- Increased risk of high blood pressure
- Increased risk of stroke
- Infertility
- Shorter life expectancy
- Chronic liver disease
- Asthma and other breathing problems such as obstructive sleep apnoea
- Arthritis affecting weight bearing joints such as the knees and hips
- Gallstones
- Increased risk of some cancers
- Low self-esteem
Benefits of Weight Loss:
Losing and maintaining even modest amounts of weight such as 5-10% of your weight can have significant and positive impact on your health such as lowering your blood pressure, better blood sugar control in diabetes as well as reducing your risk of stroke and heart disease.
Other benefits of weight loss which we hear from our patients following weight loss surgery include
- My self confidence has improved and I have got my life back
- I am back to work for the first time in 16years!
- We can go on a family holiday abroad now that I can fit in an aeroplane seat
- I managed to get out of the house to our village centre for the first time in ten years
- I can now go up the stairs without getting out of breath
- The number of medications I have had to take has drastically gone down since my weight loss surgery
- I am full of energy and can join in family fun
Managing Obesity:
Managing obesity should be a two pronged approach of early prevention and also offering the necessary help and support to millions of individuals in our society who are already struggling with the effects of obesity on their daily lives. Once obesity is established, its management involves a multi-disciplinary team approach involving clinicians, dieticians, nurse specialists, clinical psychologists who are dedicated to managing obesity. Behavioural changes in the form of reduced calorie intake, increased physical activity have so far been associated with disappointing long-term results in most cases.
Medications such as the appetite suppressant sibutramine and the anti-fat absorbent orlistat, provides only modest weight loss and tend to be associated with significant side effects. Moreover they are only licensed for use for a short period and once stopped the modest weight loss is regained.
Many people can achieve satisfactory weight loss by healthier diet choices, increased physical activities and behavioural changes. However, some people would require extra help in their efforts to lose and maintain a healthier weight in the longer term. Weight loss surgery or bariatric surgery remains the most reliable means of achieving long term weight loss in morbidly obese individuals. It is not a cosmetic procedure and should only be considered as a last resort when all other methods of non-surgical weight loss have failed.