Process
What is morbid obesity?
A clear definition of morbid obesity is very important because this definition is used to guide physicians in the selection of treatment options for people who are overweight. Clinically severe obesity is a chronic condition that is very difficult to treat. Surgery to promote weight loss by restricting food intake or interrupting digestive processes is an option. Individuals are usually considered morbidly obese if their weight is more than 100 pounds above their ideal body weight. However, a more widely accepted and more exact way to define morbid obesity is with the body mass index (BMI).
The BMI is calculated as follows:
BMI = weight (kg)/height (m2)
A BMI above 40 indicates that a person is morbidly obese and therefore a candidate for bariatric surgery. Bariatric surgery may also be an option for people with a BMI between 35 and 40 who suffer from life-threatening cardiopulmonary problems, diabetes or other medical problems listed below. However, as in other treatments for obesity, successful results depend on motivation and behavior.
People who are obese have higher rates of medical problems. The chance of problems such as heart disease, high blood pressure, diabetes and premature death increases dramatically as weight increases. Morbidly obese men between the ages of 25 and 35 have a 12-fold greater risk of dying prematurely compared to people of the same age who are of normal weight. Medical conditions that are commonly caused or exacerbated by obesity are outlined by organ systems:
- Pulmonary (related to lungs) – obstructive sleep apnea, obesity hypoventilation syndrome, asthma/reactive airway disease
- Cardiac (related to heart) – high blood pressure, heart failure caused by pulmonary hypertension, higher risk of coronary artery disease (atherosclerosis)
- Gastrointestinal, Abdominal – gallbladder disease, GERD (recurrent heartburn), recurrent ventral hernias, fatty liver
- Endocrine – diabetes, hirsutism, hyperlipidemia, hypercholesterolemia
- Genito-urinary, Reproductive – frequent urinary tract infections (UTIs), stress urinary incontinence, menstrual irregularity or infertility
- Musculoskeletal – degeneration of knees and hips, disc herniation, chronic non-surgical low back pain
- Skin – multiple disorders, most related to diabetes and yeast infections between skin folds
- Cancer risk – breast, uterine, prostate, renal, colon, pancreatic, gastric, gallbladder and endometrium
- Decreased life expectancy – morbidly obese patients live 10-15 years less than normal weight people
For nearly all people with clinically severe obesity, bariatric surgery is the standard of care. Bariatric surgery (weight loss surgery) is a surgical procedure that decreases the size of the stomach, allowing patients to eat smaller portions of food and still feel full, resulting in weight loss.
Patients can expect to lose an average of 30-60 percent of their excess weight with lap-band and 50-75 percent of excess weight with gastric bypass surgery. After weight loss surgery, patients will only require small portions of food to feel full and satisfied. Weight loss surgery will help eliminate cravings for large quantities of food at meal time. With time patients will be able to tolerate most foods.
Setting Realistic Expectations
The goal of surgery is to help lose over half of your excess weight. This can reduce or prevent health problems. It is not cosmetic surgery. Keep in mind that:
- Other medically managed weight loss methods must be tried first and documented. Surgery is only an option if other methods have not been successful.
- Surgery is meant to be permanent. You will need to make lifelong lifestyle changes.
- You must commit to making good food choices and being more active after surgery. Otherwise, you will not maximize your weight loss.
- You will not reach a healthy weight immediately. Most of the weight is lost over a period of 12 to 18 months after surgery.
- The surgery is a tool, which will help you lose weight. However, by exercising, attending support groups and workshops your chances of losing more weight will dramatically increase.
When other medically supervised methods have failed, bariatric surgery offers the best option of long-term weight control for those with clinically severe obesity.
The Normal Digestive Process
Normally, as food moves along the digestive tract, appropriate digestive juices and enzymes arrive at the right place and time to help digest and absorb calories and nutrients. After chewing and swallowing food moves down the esophagus and into the stomach where the acid in your stomach continues the digestive process. The stomach can hold about three pints of food at one time. When the stomach contents move through the pylorus to the duodenum, the first segment of the small intestine, bile and pancreatic juices help speed up digestion. Most of the calcium and iron in the foods we eat are absorbed in this area. The jejunum and ileum, the remaining two segments of the nearly 20 feet of small intestine, complete the absorption of almost all calories and nutrients.
The food particles that cannot be digested in the small intestine are stored in the large intestine until eliminated.
