Australia is facing an epidemic of obesity and obesity related diseases. Year on year, the proportion of the population that is either obese or overweight is increasing. Australia now has the highest proportion of overweight children and teenagers in the world. The overweight and obesity rates for 15 to 18 year olds have doubled between 1986 and 2000.
When discussing obesity, doctors tend to talk about your Body Mass Index or BMI. The BMI is the ratio between a patient’s weight in kilograms divided by their height squared. If your BMI is greater than 25, you are overweight; greater than 30, you are obese; greater than 35, severe obesity; greater than 40, morbidly obese.
In terms of health, if your BMI is greater than 35, you are one and a half times more likely to die than someone with a normal BMI and when your BMI reaches 40, you are two and a half times more likely to die. To put it another way, having a BMI of greater than 30 is the equivalent of smoking 10 cigarettes per day.
Morbid obesity is associated with a number of conditions such as diabetes, high blood pressure, high cholesterol and sleep apnoea. For example your risk of dying from cardiovascular disease such as heart attacks or strokes is five times higher than normal if you are morbidly obese. The risk of stroke is four times higher in middle aged women who are overweight.
In addition, certain cancers are much more common in obese patients such as oesophageal cancer, breast cancer, ovarian cancer and prostate cancer. Often these cancers are detected at a later stage in obese patients and therefore they have poorer outcomes.
For women, menstrual irregularities, infertility and polycystic ovarian syndrome are much more common in those who are overweight. 50% of obese women have irregular periods and are three times more likely not to ovulate. Being overweight and pregnant increases your risk of pregnancy induced hypertension, pregnancy induced diabetes, pre-eclampsia and post-partum haemorrhage.
Being heavily overweight increases your musculoskeletal problems such as osteoarthritis and lower back pain. This in turn can lead to a vicious circle where back and joint problems decrease mobility, reducing a person’s ability to exercise, and therefore compounding their weight gain.
Psychological difficulties are also common in patients who are overweight. Low self-esteem is frequently seen, as is depression. In addition, discrimination in employment is frequently reported. People can experience difficulty in gaining a job or when they have a job, being promoted within that job, simply because of their obesity. These issues in term feed back into low self-esteem, leading to poor quality of life and frustration.
The vast majority of morbidly obese patients have tried various dieting regimes and often initially have had good success but over time have regained the weight that they have lost and often gone on to become heavier than they were when they first started. The use of very low calorie diets and even pharmaceutical medication unfortunately does not produce significant, sustained, long-term weight loss in the morbidly obese patient. Currently obesity surgery is the only treatment that has been shown to produce significant and sustained long-term weight loss for the morbidly obese.
For patients who undergo obesity surgery, the health issues associated with being overweight such as hypertension, high cholesterol and sleep apnoea resolve or are improved well before the patient reaches their long-term goal weight. For women, improvements in menstrual cycle and fertility can be seen after as little as 5% of excess weight loss.
One of the most exciting areas in weight loss surgery is in the area of treatment of Type 2 or non-insulin dependent diabetes (NIDDM).
Diabetes is the sixth leading cause of death in the United States and as your BMI increases, so does the incidence of diabetes. 60% to 70% of people with Type 2 diabetes are obese. Type 2 diabetes is usually treated initially with diet and this is then followed by medical treatment in the form of tablets. If this is not sufficient to produce good control of blood sugars, the next step would be the introduction of insulin injections.
More and more studies are now showing that Type 2 diabetic patients can obtain potentially life-transforming benefits from weight loss surgery. Recent studies have shown that up to 77% of patients can have their diabetes completely resolved following weight loss surgery. If you look for improvement in diabetic control or reduction in the amount of medication needed, then this success rate increases to 86%. These improvements in diabetic control translate to a 92% reduction in deaths from diabetes-related causes.
There are different types of weight-loss surgery. They have all been shown to produce significant benefits to diabetics. However, laparoscopic gastric bypass has particular benefits for diabetic patients as this operation produces improvement in diabetic sugar control before patients have significant weight loss. This is due to the diversion of the food stream from the first part of the small bowel, the duodenum and jejunum. The reason why this diversion improves diabetic control is currently unclear. Studies have shown that gastric bypass surgery resolves diabetes in 84% of patients, whereas the laparoscopic gastric band resolves diabetes in 73% of cases and best medical treatment in 13% of cases. Furthermore, other studies have shown that the results of weight loss surgery in diabetic patients are better if the patients have their surgery within a few years of their diagnosis of diabetes.