If you are currently considering any Type of weight loss surgery, it is likely that you have been thinking about your decision for some time. Certainly, it is a decision that warrants much thoughtful consideration. Hopefully this post will help you with various aspects of your decision-making process.
Perhaps you began to think about weight loss surgery after a conversation with your primary care physician, who was concerned about specific obesity-related health problems, such as heart disease, hypertension, high cholesterol, diabetes, or sleep apnea. Perhaps as weight loss surgeries of various types got more media coverage, you learned more about one or more of the weight loss procedures and thought that some form of weight loss surgery might be right for you. Possibly, a friend or relative has already undergone weight loss surgery. Or maybe you just began to research it on your own after years of struggling with more traditional methods of weight loss, typically involving dieting and exercise. In any case, you’ve obviously begun to think seriously about having surgery to correct your weight problem once and for all or you wouldn’t be reading this.
The decision to pursue weight loss surgery should not be taken lightly. There are many factors to consider. This post contains all the need-to-know information about weight loss surgery and how to decide whether or not it is right for you.
The following issues should be taken into account as you consider whether or not weight loss surgery is right for you.
Determining Your BMI
You are most likely considering weight loss surgery because you are obese. But there may be medical concerns and similar factors that will sway your decision one way or the other. You will want to consider all these factors as you think about weight loss surgery.
First, do you qualify for the diagnosis of severe obesity? This is one of the first considerations when deciding if surgery is an appropriate weight loss tool for you. Doctors use the body mass index (BMI) to categorize degrees of overweight in patients. Consult Figure 2.1 to determine your BMI, or you can calculate your BMI as follows:
BMI = weight in kilos / (height in meters) 2
A BMI of 20–25 is considered normal, 25–30 overweight, and over 30 obese. However, surgery is not recommended as a weight management tool unless your BMI is over 40, or is over 35 and you have other significant health problems. If your BMI is under 35, that is wonderful news! This means that you are at significantly less risk from being overweight and no longer need to consider surgery, as other weight loss methods may well succeed and will carry less risk.
If your BMI is over 40, you are severely, or morbidly, obese, and surgery may be an option worth considering.
Hyperlipidemia is a common complication of obesity. Studies have shown coronary artery disease, evidenced by plaques in the blood vessels extending from the heart, occurring as early as late adolescence. They have also shown that high LDL (“bad”) cholesterol, low HDL (“good”) cholesterol, and high triglycerides are common factors accompanying the development of coronary artery disease. As a result, all obese adults should be screened for lipid or cholesterol abnormalities. Lifestyle changes are often the first line of therapy against abnormal lipids in the blood.
Hypertension is also increasingly recognized as a common side effect of obesity. Weight loss can produce dramatic improvements in blood pressure.
If you have been diagnosed with obesity, hypertension, and hyperlipidemia, you may also have the metabolic syndrome.” This is a newly described clustering of metabolic risk factors, known to have a significant negative effect on heart health. The factors include abdominal obesity, low HDL, high triglycerides, insulin resistance or diabetes, and high blood pressure. All these factors are thought to be caused by insulin resistance, a condition in which the body becomes increasingly resistant to the actions of insulin, a hormone secreted by the pancreas.
If you have had chest pain or shortness of breath your doctor may have tested you for the possible presence of arteriosclerosis, or coronary artery disease. If you have noticed any of these symptoms and have not told your doctor, you should call him or her immediately, as they can be signs of serious illness. If you have had a heart attack, stroke, or congestive heart failure, you have certainly been told that your weight may be contributing to your poor heart health and weight loss surgery may be an option worth considering.
Type 2 Diabetes/Glucose Intolerance
The incidence of type 2 diabetes in the United States is rising dramatically, paralleling the rise in obesity. Obesity is a known contributor to the development of type 2 diabetes.
Other risk factors include a positive family history of NIDDM (noninsulin-dependent diabetes), increased body fat and abdominal fat, insulin resistance, and ethnicity (with greater risk in African American, Hispanic, and Native American adults). Heart disease, vision problems, kidney failure, high blood pressure, and stroke can complicate NIDDM. Because NIDDM can lead to premature death and disability, addressing excess weight in people with type 2 diabetes is critical.
Polycystic Ovary Syndrome and Menstrual Irregularities
First of all, ovarian cysts are normal variants for many women. Having cysts on your ovaries does not mean you have polycystic ovary syndrome (PCOS). Many women suffer from PCOS, which is characterized by menstrual changes, acne, or excessive hair growth (on the face, abdomen, chest, and back)—signs of hyperandrogenism, or excessive male hormones. About 50–75% of women with PCOS are obese, and obesity may be a factor in the development of PCOS in some susceptible women. If you have been diagnosed with PCOS and are obese, you have an elevated risk of developing hyperlipidemia, hypertension, diabetes, and the metabolic syndrome. It may also be especially hard for you to lose weight because many women with this syndrome have abnormalities in insulin metabolism. To complete this negative health cycle, obesity seems to contribute to the insulin resistance and risk for diabetes that many women with PCOS experience.
Pulmonary Risk and Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is common among the extremely obese. This condition has a known link to future cardiovascular disease and can be fatal. Current recommendations state that all overweight adults should be screened for snoring, and those who snore should have a sleep study including a polysomnogram to determine if they have OSA.
Many overweight individuals are diagnosed with asthma. Obesity is certainly one of many factors that can worsen symptoms of asthma. However, sometimes shortness of breath indicates that there is either undiagnosed heart disease or that extra weight is making it harder for the lungs to do their job every day. This is not asthma but restrictive lung disease. It is helped not by inhalers but by weight loss. So if you have shortness of breath and you haven’t talked to your doctor, make sure to do so to clarify the specific cause is, whether or not you already know you have asthma.
In severe cases, the restriction that excess weight puts on the lungs can lead to something called obesity hypoventilation syndrome, a condition in which blood oxygen decreases and carbon dioxide increases, all because the lungs are unable to function optimally. This condition can lead to daytime sleepiness and over the long term can cause congestive heart failure.
Many kinds of gastrointestinal problems can occur in significantly overweight people. Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of abnormal liver tests in the United States. It is commonly seen in association with obesity, diabetes, hypertension, and hypertriglyceridemia. Most patients have no symptoms and present only with mildly abnormal laboratory results. It is not clear how NAFLD develops, but it can progress to hepatitis, cirrhosis, and end-stage liver disease. In one study examining the liver biopsies of morbidly obese adults preparing to undergo gastric bypass surgery, 65% of the patients had moderate to severe liver changes, 12% had advanced fibrosis, or scarring of the liver, and 33% had nonalcoholic hepatitis. The presence of type 2 diabetes was strongly correlated with advanced liver disease, more so than was BMI.
Gastrointestinal reflux, or heartburn, is a common but bothersome condition that is often exacerbated by weight. Reflux can cause chest pain, an acid taste in the mouth, and a cough, among other symptoms. Fatty foods, cigarettes, alcohol, caffeine, and certain medications can worsen it. While reflux can often be managed medically, it can sometimes lead to changes in the esophagus that can predispose one to cancer.
Finally, nearly 50% of cases of gallstones, small stones that can obstruct the normal flow of bile from and within the gall bladder, are associated with obesity. Gallstones can impede efforts at weight loss. Also, gallstones can sometimes be a complication of weight loss surgery as well. Be on the lookout for this condition, which often causes periodic abdominal pain, particularly if you have a family history of gall bladder disease, in order to get diagnosed and treated early.
Overweight adults are at increased risk for a number of weightrelated orthopedic complications. Chronic excess weight can lead to a bowing of the lower legs called Blount’s disease. Significant hip, knee, and back pain, and even osteoarthritis can result from the excess pressure on joints that increased body mass imposes. Many overweight patients require hip and knee replacements that, while effective, are costly and time-consuming interventions to manage pain and improve range of motion. Significant weight loss is known to help with such orthopedic disease.
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a condition seen much more commonly in obese individuals. As its name implies, IIH is associated with increased in tracranial pressure in the absence of tumors or other brain disease. It often causes severe headaches and can sometimes lead to blindness. To diagnose IIH, your doctor will need to do a careful eye exam and perhaps even use magnetic resonance imaging (MRI) and a spinal tap, or lumbar puncture, to check the pressure of your spinal fluid. Once diagnosed, IIH that requires that you promptly lose weight.
Many overweight women experience stress incontinence, a condition that can cause mild to severe leakage of urine from the bladder when they sneeze, laugh, cough, or even go for a walk. The condition develops when the abdomen increasingly exerts pressure on the bladder. Although surgery and medications can help control the problem, they often fail to. Weight loss can often significantly relieve symptoms.
Gout is caused by a buildup of uric acid that exceeds what the kidneys can filter. The acid builds up in the joints and can cause swelling, inflammation, and pain, most commonly in the big toe or ankle joints. Obesity increases the risk of developing gout, as does alcohol consumption, a diet high in uric acid (red meat, red wine, cream sauces), and kidney failure. Recent studies describe links between gout and high blood pressure as well. While gout is best managed with dietary changes and medication, weight loss will help prevent its recurrence.
Skin and Blood Vessels
Often, overweight patients notice that areas of hanging skin folds, particularly around the breasts, abdomen, and inner thighs, can be come chafed, irritated, and difficult to clean. Superficial fungal or bacterial infections of the skin can result and can lead to deep tissue infections, although this is rare. Patients who are extremely obese, especially those with diabetes, tend to have decreased circulation to their hands and feet, delaying the healing of such infections.
Obese individuals often develop venous stasis, wherein slowed blood flow to the legs’ veins leads to damage to the valves in the leg veins. Obesity can worsen this condition by making it hard to maintain regular mobility: a sedentary lifestyle further inhibits blood flow. Especially in those with a family history of venous stasis, this can lead to superficial varicose veins, a benign but unattractive condition. A separate, more serious complication of venous stasis is deep venous thrombosis (DVT), a blood clot in a deep leg vein. These clots need to be promptly managed, as they can lead to life-threatening complications such as pulmonary embolism. Leg swelling and pain can indicate DVT.
Cancer risk increases with obesity. It is unclear whether weight loss can decrease the risk. Cancers associated with weight gain are those of the prostate, colon, breast, uterus, and gall bladder.