Severe Obesity and Surgery as a Recommended Treatment Procedure

Body mass index is a measurement that is used to determine whether one’s weight falls within the ideal range in relation to one’s height. Consequently, deriving a value that falls above this range indicates obesity.

Severe obesity is a chronic and life-threatening condition characterized by having a BMI equal to or more than 40 which can be translated to gaining 100% or more of one’s ideal body weight for men and 80% for women or being overweight by more than 100 pounds (45.5 kilos) (cdc.gov, SAGES.org).

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Aside from massive weight gain, a symptom of severe obesity is the development of large quantities of fatty tissue resulting from the accumulation of excessive amounts of energy in the body (my.clevelandclinic.org).

Women having a 35-inch or more waist circumference and men having 40 or more inches are considered obese. Severe obesity also predisposes a person to other serious illnesses such as diabetes, cardiovascular disease, hypertension and respiratory conditions.

Etiology

A host of factors such as biochemistry, physiology and genetics impact on a person’s ability to maintain weight. A low metabolic rate compounded with expending low amounts of energy as in a sedentary lifestyle, an excess in calorie intake or a combination of both lead to abnormal weight gain (SAGES.org). Influences from the environment, culture, socio-economic situation and psychology are also potential contributory factors.

In a study involving adults who were adopted when they were still children, their adult weights were closer to the weights of their biological parents than the weights of their adoptive parents leading researchers to conclude that genetics plays a role in the development of obesity (my.clevelandclinic.org).

Although genetic factors are beyond control, environmental influences on lifestyle such as eating habits and level of physical activity are modifiable factors that may lead to severe obesity.

Serious binge eating disorder, a psychological condition wherein a person has an uncontrollable compulsion to take in large quantities of food, also leads to severe obesity and is associated with around 30% of cases.

Other factors responsible for a mere 1% of severe weight problems are certain disorders which include hypothyroidism, Cushing’s syndrome, depression and a number of neurological problems while the use of steroids and some antidepressants also cause significant weight gain (my.clevelandclinic.org).

Prognosis

Severe obesity requires a difficult treatment process that is long-term and depends on the patient’s motivation. Immediate treatment is necessary because of the complications involved which manifest after 10-30 years and may be irreversible.

Cardiovascular problems and heart disease are caused by the constantly high cholesterol levels in the blood while the heart is required to work harder because of the larger body mass (Wallace, Schulte, Nakeeb and Andris). The risk of stroke is high.

Type II or adult-onset diabetes, brought about by the continually elevated glucose levels in the blood, is also a complication and further causes tissue damage and the necessity for amputation, kidney failure and blindness (Wallace, Schulte, Nakeeb and Andris).

Pulmonary problems also develop as a consequence of the lungs decreasing in size and the difficulty of lifting the massive chest wall during inspiration.

Hypoventilation and sleep apnea may occur – the first leading to respiratory acidosis from increased carbon dioxide concentration in the blood and the second to hypertension, arrhythmia and sudden death (Wallace, Schulte, Nakeeb and Andris).

The following illnesses are also connected with severe obesity: gallbladder disease and gallstones from high cholesterol levels, osteoarthritis or the deterioration of joints from excess weight, gout which also affects the joints, aggravated asthma and bronchitis, higher incidence of colon, rectal and prostate cancer in males and higher incidence of gallbladder, breast, uterine, cervical and ovarian cancer in females (my.clevelandclinic.org).

Laparoscopic Obesity Surgery as a Treatment Procedure

Laparoscopic gastric banding is a stomach reduction or gastric restriction technique that entails the placement of a half inch band around the upper region of the stomach which forms a small pouch and a narrow outlet into the lower region (SAGES.org).

Substantial and rapid weight loss – from 40-50% in 24 months following the operation is the expected outcome and along with this are significant improvements in blood pressure, cholesterol and blood sugar levels as well as breathing (SAGES.org).

This procedure is recommended only for patients who have severe obesity and who 1. are within the 16-65 age range, 2. have no endocrine or metabolic disorder associated with their condition, 3. have no history of prior abdominal surgery causing dense scar tissue, 4. are experiencing complications related with their weight disorder, and 5. were unsuccessful in utilizing non-surgical treatments in reducing weight (SAGES.org).

With regards to complications, death occurring immediately after the operation is considered to be low at less than 2% of all reported cases while wound infections, wound breakdown, abscess, leaks from staple-line breakdown, perforation of the bowel, bowel obstruction, marginal ulcers, breathing problems and blood clots in the legs can reach a high of 10% or more (SAGES.org).