How important is weight control anyway?
By: Jon Pirrello, MD, Presbyterian Bariatric and General Surgery Matthews

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The problem
Obesity is growing at epidemic rates not only in the United States, but throughout the world. Until recently, obesity was neither recognized nor defined as a disease by the Centers for Disease Control. However, we have long known there is a relationship between obesity and high blood pressure, high cholesterol, sleep apnea and type 2 diabetes mellitus. Each of these diseases is a risk factor for coronary artery disease. However, when a patient has more than one of these diseases, which is frequently the case in patients with morbid obesity, they place an enormous strain on their heart, which often results in a dramatic reduction in life expectancy and quality of life.

Defining obesity
More than two-thirds of U.S. adults and almost one-third of children and adolescents are overweight or obese. Since 1980, obesity rates have doubled for adults and tripled for children. People are overweight when they have increased body weight in relation to their height that may or may not be due to increases in body fat. People who are obese have an excessively high body weight in relation to their height. Body mass index (BMI) is used to express the relationship of weight-to-height.

While patients who fall into the class I obesity range have a higher likelihood of developing weight-related comorbidities, people with class II obesity and one or more of the weight-associated medical problems, as well as anybody classified as class III or higher, will dramatically increase their likelihood of developing life-threatening weight-related illnesses. Obesity has been clearly linked to a shorter life expectancy and, if not adequately treated, is likely to result in death more than 10 years sooner than people with “normal” BMI when matched for age and gender.

Classifying body mass Underweight < 18.5 “Normal” BMI 18.5 – 25.0 Overweight 25.1 – 29.9 Class I Obesity 30.0 – 34.9 Class II Obesity 35.0 – 39.9 Class III Obesity 40.0 – 49.9 Class IV Obesity 50.0 – 59.9 Class V Obesity > 60.0

What factors determine if someone will become obese?
Your metabolism involves a complex network of hormones and enzymes that not only convert food into fuel but also affect how efficiently you burn that fuel. These chemical reactions require energy to occur, and that energy comes largely from our nutritional intake. Therefore, the process of metabolism establishes the rate at which we burn our calories and, ultimately, how quickly we gain weight or how easily we lose it.

Metabolism is affected by age, sex, genetics, eating behaviors and, to some extent, our environment. As we age, our metabolism will generally slow and we will burn fewer calories at rest. Skipping meals or prolonged fasting causes our bodies to conserve calories in response to a perceived period of starvation. To avoid this problem, plan your diet around small meals on a schedule that promotes relatively consistent calorie intake throughout the day.

Increasing physical activity can cause the body to expend more energy, and this will generally lead to burning more calories. Exercise also improves conditioning, which will make your heart and muscle function more efficiently, and can lead to burning more calories even when at rest.

What are your options for weight reduction? Surgical vs. non-surgical methods
Surgical options are associated with bariatric, metabolic or weight-reduction surgery but can often include a larger non-surgical program. Non-surgical methods generally involve one or more of the following:

1. Diet
2. Exercise
3. Behavioral therapy
4. Medications

Patients usually begin non-surgical therapy managed by their primary care physicians or are referred for non-operative weight management therapy. Surgical therapy is an option when patients have attempted and failed more conservative therapy and continue to exhibit class II obesity with associated weight-related problems or class III or higher BMI with or without comorbidities.

How do surgical and non-surgical methods compare in terms of outcomes?
People with a BMI of 35 or more are considered candidates for weight-reduction surgery by most insurance providers. They generally will pursue non-surgical therapy and will be successful with their efforts between 10 to 15 percent of the time. Once somebody meets the criteria to qualify for surgical intervention, they are successful with conservative therapy less than 1 percent of the time.

For this reason, patients who meet the criteria to qualify for weight-loss surgery are referred for an evaluation with a bariatric surgeon.

What are the options for weight reduction surgery?
Four operations are commonly being performed today for management of morbid obesity and associated co morbidities. In order of less invasive to more invasive, these include:

1. Adjustable gastric banding (AGB)
2. Vertical sleeve gastrectomy (VSG)
3. Roux-en-Y gastric bypass (RNY)
4. Biliopancreatic diversion with duodenal switch (DS-BPD)

Key takeaways

• Obesity, and to a greater extent, morbid obesity are associated with several life-threatening diseases that ultimately lead to a shorter life expectancy.
• Patients with a BMI of less than 35 should be managed by their primary care provider or referred for conservative weight management by a medical bariatrician.
• Patients with a BMI of 35 or higher with one or more weight-related medical problems or a BMI of 40 or higher with or without medical problems meet the criteria for diagnosis of morbid obesity, and warrant consideration for weight reduction surgery.
• Once the criteria are met to diagnose morbid obesity, patients managed with non-surgical weight management methods alone are successful less than 1 percent of the time.
• Based on the overall poor results of non-surgical management in morbidly obese patients and the dire consequences of failing to resolve morbid obesity, the standard of care is for these patients to be referred for surgical evaluation.

To learn more about the Novant Health Bariatric Center, call 704-316-8000 or click here.

A cause for concern
Being overweight or obese increases the risk of premature death and many diseases and health conditions, including the following:

• Hypertensions (high blood pressure)
• Hyperlipidemia (high cholesterol)
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Depression
• Osteoarthritis
• Sleep apnea
• Some cancers

Obesity is also associated with:

• Pregnancy complications
• Menstrual irregularities
• Presence of excess body and facial hair
• Stress incontinence
• Irregular surgical risk
• Increased mortality
• Shorter life expectancy