What is “Obesity” and what is “Morbid Obesity?”
Obesity results from the excessive accumulation of fat that exceeds the body’s skeletal and physical standards. Morbid Obesity is a serious disease process in which the accumulation of fatty tissue on the body becomes excessive and interferes with or injures the other bodily organs. This can cause serious and life-threatening health problems, which are known as co-morbidities.
What causes obesity?
The reasons for obesity are multiple and complex. It is not simply a result of overeating. Research has shown that in many cases a significant, underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief. Environmental factors, such as fast food, long days sitting at a desk, and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage. Science continues to search for answers. But until the disease is better understood, the control of excess weight is something patients must work at for their entire lives.
What health conditions does morbid obesity contribute to?
Morbid obesity increases the risk of developing heart disease, high blood pressure (also known as hypertension), high blood cholesterol, sleep apnea, respiratory insufficiency, obesity hypoventilation syndrome, asthma and bronchitis, degenerative disease of the Lumbo-Sacral spine, degenerative arthritis of weight-bearing joints, heartburn or reflux disease, diabetes mellitus, gallbladder disease, stress urinary incontinence, venous stasis disease, and emotional or psychological diseases, such as depression – to name a few.
What is BMI?
BMI means Body Mass Index. *BMI is: (weight in kilograms) divided by (height in meters)
What factors determine whether or not an individual is morbidly obese?
Three criteria are used to determine whether a patient is morbidly obese. These criteria are:
- If you are more than 100 lb over your ideal body weight
- If you have a Body Mass Index (BMI)* of greater than 40
- If your BMI is more than 35, and is accompanied by serious co-morbidity.
I am morbidly obese. What are my best treatment options?
The primary goal in managing and treating obesity is to decrease a patient’s medical risk and improve quality of life. An appropriate weight management program combines physical activity, diet, behavioral modification, psychological counseling and sometimes drug therapy to help patients achieve weight loss or prevent further weight gain. Surgery is reserved for patients who have repeatedly failed to lose weight by all other means (diet, exercise, behavioral and drug therapy) and this is the last resort. Surgical treatment is medically necessary because it is the only proven method of achieving long term weight control for the morbidly obese.
I’m considering weight loss surgery. Is there anything I should know first and foremost before finalizing my decision?
- Weight loss surgery is major surgery. Although most patients enjoy an improvement in obesity-related health conditions (such as mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer. You should make the decision to have weight loss surgery only after careful consideration and consultation with an experienced bariatric surgeon or a knowledgeable family physician. A qualified surgeon should answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required. They may, as part of routine evaluation for weight loss surgery, require that you consult with a dietitian/nutritionist and a psychiatrist/therapist. This is to help establish a clear understanding of the post-operative changes in behavior that are essential for long-term success.
- It is important to remember that there are no ironclad guarantees in any kind of medicine or surgery. Weight loss surgery will only succeed when the patient makes a lifelong commitment. Surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.
What is the difference between a “restrictive” surgical procedure for weight loss and a “malabsorptive” surgical procedure? Is there a procedure that combines both methods?
- Restrictive procedures only restrict the amount of food that can be eaten at one time. This restriction takes place through either the placement of an adjustable gastric band or by the creation of a small stomach pouch as with the Sleeve gastrectomy and Gastric Bypass.
- Malabsorptive procedures involve the rearrangement of the intestinal tract so that the digestive enzymes are diverted away from the food stream until very late in its passage through the intestine. The effect is to selectively reduce the absorption of fats and starches, while allowing almost-normal absorption of protein and sugars. Although such procedures are quite powerful, patients are subjected to the increased risk of nutrient deficiency in protein, vitamins, and minerals. Vitamin supplements must be taken, intake of fat must be extremely limited, and dietary intake of protein must be maintained.
- Roux-en-Y gastric bypass, still considered the “gold standard” of modern obesity surgery, combines both restrictive and malabsorptive components. In this procedure a small stomach pouch is created at the top of the stomach to restrict food intake. Then, a section of the small intestine is attached directly to the pouch. This allows food to bypass the lower stomach and a portion of the small intestine.
How does the insurance process work?
- Insurance coverage varies for weight loss surgery procedures. It is crucial that you call your insurance provider to determine if your policy covers surgical weight loss. As an integral part of our team, the insurance coordinator can answer questions and give you guidance when working with your insurance company to acquire approval. It is a team effort between you and our insurance coordinator to ensure everything is done to gain approval to undergo one of the surgical weight loss procedures.
- Insurance companies often require medically supervised diets that span 3 months or greater. If this is the case with your insurance and you do not have prior documentation, you will be required to obtain this information before your paperwork is sent for approval.
How long does the insurance approval process take?
Some insurance companies will make the decision about your weight loss surgery within a few weeks. Some insurance carriers take several weeks or months to return a decision. We will contact you when we have heard from your insurance company. You may contact your insurance company to check on the status of your insurance approval.
What if my insurance carrier denies the request for coverage of a weight loss surgery?
We understand the importance of surgical weight loss procedures and will work with you every step of the way. If your insurance company denies the request for coverage of your weight loss surgery procedure, our insurance coordinator will discuss appeals and self-pay options with you.
What are some of the risks involved in weight loss surgery?
There are risks involved with any surgical procedure. A patient’s weight, age and medical history play a significant role in determining specific risks. Your surgeon will inform you about your specific risks for bariatric surgery. Risks associated with any abdominal surgery include:
- Complications due to anesthesia
- Wound infections
- Deep Venous Thrombosis (DVT) – clots in the lower extremities
- Pulmonary Embolism (PE) – clots that travel to the lungs
- Pneumonia – infection of the lung
- Atelectasis – collapse of part of the lung and decreased lung volume. Most often due to the patient taking incomplete breaths. It is prevented by encouraging deep breathing and early ambulation
- Stroke or heart attack
- Intra-abdominal infections
- Injury to intra-abdominal organs or structures
Some risks are specific to the type of weight loss procedure performed. Please refer to the explanation of each of these procedures to review the risks associated with them.
Is there anything I can do before surgery to reduce the risks of complications?
To try to reduce some risk, you can do the following before surgery:
- Stop smoking
- Stop drinking alcohol
- Increase physical activity
- Lose 10% of body weight
Doing these can not only help to reduce your risk but will also help to optimize your recovery.
Do I need to make an appointment with any other physicians before surgery?
Yes, you will need to make an appointment to see your primary care physician prior to surgery. Your primary doctor will need to evaluate you and provide a medical clearance to be able to undergo surgery. Additionally, you may be required to see other medical specialists such as an endocrinologist, cardiologist, pulmonologist, etc., depending on your medical health and conditions.
How long is the recovery?
As most of these procedures are performed laparoscopically (using minimally invasive techniques) patients are ambulating the day of surgery. Generally by 2-3 weeks post surgery patients are usually ready to resume normal activities.
How soon after surgery may I return to work?
How quickly you return to work will vary according to your physical condition, the nature of the work you do (i.e. desk job vs. construction work), and the type of weight loss surgery you had. Most patients are able to resume their jobs within two to four weeks of their procedure.
Do patients need additional surgeries after weight loss surgery?
Additional procedure may be necessary if patients have complications such as leaks, fistulas, obstructions, migration or erosion of the gastric band. Revisional operations may be required due to weight regain. These revision procedures are associated with increased complications after surgery. You should discuss this with you surgeon.
Will having weight loss surgery mean I can eat anything and not exercise?
It is important to remember that there are no ironclad guarantees in any kind of medicine or surgery. Weight loss surgery will only succeed when the patient makes a lifelong commitment. Surgery is only a tool and the beginning of a multidisciplinary process to transform you life. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes. Weight loss surgery is the beginning of a new life.
How much weight can I expect to lose?
Weight loss will vary depending upon your weight prior to surgery and the type of procedure you get. After your surgery, your choice of foods and level of activity will change and contribute to further weight loss.
I have heard that hair loss is common after weight loss surgery. Is this true?
Any time patients experience rapid weight loss, they can expect some hair loss. This is a temporary problem and can be limited with adequate vitamin and mineral supplementation.
Can one get pregnant and have children after weight loss surgery?
Yes, barring other outstanding fertility problems. It is recommended, however, that patients wait at least one to two years after weight loss surgery to get pregnant. This gives the patients time to adapt to their new lifestyle, and allows the body time to build up and stabilize its nutritional status.
Is there anything I can do to prevent hanging skin after weight loss?
Exercise can help, but if you lose an excessive amount of weight, more than likely you will have hanging skin. Often the skin returns, much as after pregnancy. Exercise is recommended to help tone the muscles, and the skin. Some patients will want plastic surgery to help the problem areas. It is recommended that patients wait for two years after weight loss surgery prior to undergoing plastic surgery to allow for maximum weight loss.
Will I ever regain the weight I lose?
Weight loss surgery, as stated previously, is only a tool that must be used to help control your weight. If you do not use the tool properly, you will regain some of the weight you lose. Weight loss surgery provides you with an opportunity to change your lifestyle and eating habits, thus making weight control easier in the long run.
Should I join a support group for weight loss surgery patients before or after surgery?
Support groups have multiple valuable benefits. Patients who attend support groups have been shown to lose more weight than those who don’t. “Implementing regular Support Group Meetings as part of the post-operative follow-up care may offer patients with the best chance of achieving maximal weight loss.” Zirui Song, B.A. (Surgery for Obesity and Related Diseases, 2008. Mar-April 4(2):100-3.) In addition they provided many weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most patients learn in support groups, for instance, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being.