Obesity Related Heath Conditions and the Benefits of Surgical Weight Loss
Anyone who has lived with obesity for any length of time will be well aware that the negative effects of carrying excessive weight are not limited to physical appearance. Overweight and obesity can impact upon every system in the body, leading to a host of health problems that limit quality of life and life expectancy. The social stigma carried by obesity can have a significant detrimental effect upon self-esteem and psychological wellbeing, whilst the physiological changes associated with the condition can lead to multiple life-threatening co-morbidities, including cancer, stroke and heart disease.
Many of the poor health outcomes associated with obesity can be avoided by weight reduction, either through dietary and lifestyle changes alone, or in conjunction with bariatric surgery. Multiple studies have found that severely obese patients who undergo bariatric procedures frequently display rapid, sustained improvements in many co-morbid conditions, leading to improved quality of life, increased life-expectancy and greatly reduced healthcare costs, when compared to severely obese individuals who do not undergo surgery. As many serious obesity-related health issues take time to develop, seeking help promptly is important in securing optimal outcomes, but even those who have been obese for many years can obtain significant physiological and psychosocial benefits from bariatric surgery.
Diabetes and Pre-Diabetes are Associated with Obesity
Type 2 diabetes is very strongly associated with obesity. Without intervention, weight gain can lead to diabetes relatively quickly, but weight loss and other lifestyle changes can help keep the condition under control, avoiding or minimizing the need for medication. If left untreated, diabetes can lead to serious complications such as stroke, blindness and kidney failure.
A diagnosis of diabetes is made when blood sugar levels are found to be consistently elevated. This indicates that the body is having problems producing or processing insulin, a hormone responsible for regulating levels of the sugar glucose within the blood. When blood sugar levels are higher than normal but not sufficiently elevated to be classed as diabetes, a diagnosis of pre-diabetes may be reached. Whilst symptoms of diabetes can include fatigue, thirst, frequent urination, and blurred vision, pre-diabetes is frequently symptomless, but can be assessed by a blood test in at-risk individuals. Pre-diabetes does not inevitably lead to type 2 diabetes; by losing weight, improving diet and increasing levels of exercise, the condition can be avoided altogether.
Bariatric surgery has been proven to be effective in treating diabetes in obese individuals, particularly those who have been diabetic for less than five years. Weight loss surgery is increasingly referred to as metabolic surgery because of the very high cure rate of type 2 diabetes. Currently bariatric surgery is offered to those with type 2 diabetes who have a BMI greater than 35 and are unable to lose weight through dietary and lifestyle changes.
Heart Disease and How Obesity Affects the Cardiovascular System
Heart disease encompasses a range of conditions affecting the cardiovascular system, including stroke, angina, coronary heart disease and cardiomyopathy. There is a direct relationship between obesity and heart disease, and a high body mass index (BMI) can aggravate other conditions linked to increased risk of heart disease, such as diabetes, hypertension, and unhealthy cholesterol levels. Furthermore, lack of physical activity can often be a contributory factor.
Bariatric procedures are known to have a positive impact upon cardiovascular risk; a recent study found significant reduction in the number and severity of cardiovascular events experienced by obese individuals who underwent bariatric surgery when compared to obese individuals who did not undergo surgery.
Cholesterol and Obesity Related Hypercholesterolemia
Cholesterol is a form of fat essential to wellbeing, but when present at inappropriate levels is linked to increased risk of heart disease. Alongside lifestyle factors such as lack of exercise and a diet high in saturated fat, the metabolic impact of obesity has a directly deleterious effect on cholesterol levels within the blood. This can cause fatty deposits to build up within the lining of artery walls, making them narrower and thus reducing the flow of blood through the artery over time. This process, known as atherosclerosis or hardening of the arteries, can ultimately lead to cardiovascular problems such as angina, heart attack, stroke and peripheral vascular disease. Reducing the amount of stored fat within the body by losing weight can improve metabolic function, helping to keep cholesterol levels under control.
Decreased Sleep because of Obesity and Sleep Apnea
Obstructive sleep apnea (OSA) is a respiratory condition in which airflow is restricted or breathing stops altogether for a period of time during sleep. These breathing disturbances, which can last anywhere from a few seconds to several minutes, frequently result in arousal from sleep, leading to increased sleepiness or fatigue during the daytime, which can have a significant impact upon quality of life. During an episode of OSA, lack of oxygen causes blood vessels to constrict and places strain upon the heart as it pumps harder to maintain oxygen supply to the vital organs. This is known to create increased risk of heart disease and hypertension, and can also be an exacerbating factor if those conditions are already present. OSA is particularly common in obese individuals, and weight loss is frequently an effective treatment in such cases.
Acid Reflux when specifically related to Obesity
Acid reflux occurs when the ring of muscle that acts as a valve between the stomach and the esophagus opens inappropriately or fails to close, allowing stomach acid to rise up into the esophagus. The most common symptom of reflux is a burning sensation in the back of the throat or center of the chest known as heartburn, but other symptoms, such as difficulty swallowing, a dry cough or breathing difficulties can also occur.
Whilst occasional episodes of acid reflux are common, and generally no cause for concern, frequent episodes, classed as gastroesophageal reflux disease (GERD), can cause serious complications including scarring and ulceration of the esophagus, which may ultimately lead to esophageal cancer.
Overweight and obesity are linked to increased risk of GERD, and weight loss can lead to a reduction in symptoms and improvements in esophageal valve function. Bariatric surgery can be extremely effective in controlling GERD, with some procedures now being considered as treatment options for non-obese individuals.
Increased Cancer Risk when Obese
Obesity is strongly associated with an increased risk of developing certain forms of cancer, including colon, kidney and esophageal cancer, as well as endometrial and breast cancer in women. Furthermore, the prognosis for those who do develop cancer is worse for the morbidly obese.
Whilst unexplained weight loss can be an early indicator of some types of cancer and always warrants careful investigation, intentional weight loss can have a significant positive impact, reducing cancer risk and improving life expectancy in those who do develop the disease.
Depression and its Complex Relationship with Obesity
A complex interdependent relationship exists between obesity and depression. Obese individuals can be subject to particular stresses and social pressures as a result of their condition, which can have a significant effect upon psychological wellbeing. Depression can also lead certain people to develop or maintain a dysfunctional relationship with food. Furthermore, feelings of low self-esteem, hopelessness and lack of energy associated with depression can make it extremely difficult for an obese individual who is depressed to maintain the dietary and lifestyle changes needed to sustain weight loss. Bariatric surgery can be of particular benefit in such cases, offering significant improvement rates in both conditions.
Extra weight and Obesity Related Co-morbidites Contribute to Osteoarthritis
Carrying extra body weight places increased mechanical stress on the musculoskeletal system. Over time this can cause permanent damage to the joints and nearby muscles and ligaments. Osteoarthritis of the hips and knees is particularly common in obese individuals. The condition can cause pain, swelling and stiffness of the joint, impacting upon mobility. Overweight and obesity are also linked to low back pain, and medical imaging studies have demonstrated that individuals with an elevated BMI show a significant increase in lumbar spine disc degeneration.
Weight loss can have a dual impact on obesity-related orthopedic conditions: mechanical stress on load-bearing joints is reduced, and capacity for exercise is increased. Regular exercise can help strengthen surrounding muscles, providing support and stability to the affected joint.
In addition to limiting mobility and placing mechanical strain on joints and muscles, carrying excessive weight can place an added burden on the heart and lungs, particularly during exercise. This frequently manifests as a condition known as exertional dyspnea, in which the body’s increased demand for oxygen during physical exertion cannot be met, resulting in breathlessness or labored breathing. Exertional dyspnea, alongside other factors such as skin chafing and osteoarthritis, can make physical activity particularly challenging for obese individuals, yet exercise is required for sustained weight loss. Bariatric surgery can help to break this cycle, with the rapid weight loss that typically follows a bariatric procedure enabling a healthy exercise regimen to be established.
The Various Forms of Incontinence
Incontinence is defined as the inability to exercise control over bowel movement or passage of urine. Overweight and obesity are well documented risk factors for both forms of incontinence, and research indicates that the risks are directly proportional to weight gain. Additionally, frequent episodes of fecal or urinary incontinence can trigger or exacerbate skin problems such as intertrigo, which are also common in obese individuals. Studies have shown that bariatric surgery frequently leads to significant improvement in symptoms of all forms of incontinence and associated conditions.
How Obesity Impacts Female Health, PCOS and Fertility
Polycystic ovarian syndrome (PCOS) is thought to be one of the most common causes of reduced fertility and menstrual dysfunction in women of reproductive age. Whilst there is compelling evidence to support a genetic pathway for the disease, severity of symptoms is strongly influenced by body weight, with obesity being a known risk factor for PCOS-related menstrual irregularities and infertility, as well as symptoms such as excess body hair and acne, which are linked to elevated androgen levels.
Weight loss can help control androgen levels and restore regular menstruation, reducing the risk of developing endometrial cancer and other associated conditions. For those who struggle to achieve or maintain the significant weight loss required, bariatric surgery is a viable treatment option.
Truncal Obesity and Syndrome X
Whilst overweight and obesity are known risk factors for many health problems, it is now understood that the pattern of weight distribution within the body can also be significant in determining individual susceptibility to certain conditions. A truncal or central pattern of weight distribution, where fat is stored predominantly in the abdominal area, is a strong indicator of risk for hypertension, heart disease and diabetes. This increased susceptibility is independent of BMI; indeed it is possible for an individual with a BMI within the normal range to carry risk-inducing quantities of fat in their abdominal region.
When truncal obesity occurs in conjunction with hypertension, high blood sugar and unhealthy cholesterol levels, this is known as syndrome X or metabolic syndrome. This collection of risk factors is strongly associated with increased susceptibility to conditions including diabetes, heart disease and stroke. Weight loss is critical for controlling all these factors, and studies indicate that complete resolution of syndrome X is possible following bariatric surgery.