A healthy weight is what your body naturally weighs when you consistently eat a nutritious diet and balance the calories you eat with physical activity you do. Weight, however, is only one measure of your health. People who are thin, but don’t exercise or eat nutritiously aren’t necessarily healthy. Likewise, a person who is overweight may be healthy if he or she eats healthfully and exercises regularly.
Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. According to the National Institutes of Health (NIH), 97 million Americans (more than one-third of the adult population) are overweight or obese today. An estimated 5 to 10 million of those are considered morbidly obese.
Morbid obesity is a chronic disease, meaning that its symptoms build slowly over an extended period of time. It is typically defined as being 100 lbs. or more over ideal body weight or having a Body Mass Index (BMI) of 40 or higher. According to the NIH Consensus Report, morbid obesity is a serious disease and must be treated as such.
Obesity becomes "morbid" when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases (also known as co-morbidities) that can result either in significant physical disability or even death. An estimated 5-10 million Americans are considered morbidly obese.
Causes of Morbid Obesity
The reasons for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Studies have demonstrated that dieting and exercise programs have a limited ability to provide effective long-term relief for morbid obesity. Research has shown that in many cases, there is a significant, underlying cause of morbid obesity, including, but not limited to:
Science continues to search for answers, but until the disease is better understood, controlling excess weight is something people must work at their entire lives. As such, it’s important to understand that all current medical interventions – including weight loss surgery – should not be considered medical cures.
Obesity-Related Health Conditions (Co-morbidities) Whether alone or in combination, these health conditions are commonly associated with morbid obesity. Your doctor can provide you with a more detailed list:
Weight Loss Surgery As the advantages of weight-loss surgery become more apparent, it is being prescribed by more physicians than ever as a viable treatment for patients with morbid obesity. And while there are risks associated with any major surgery, including weight-loss surgery, in many cases, the risks from not having the surgery may be greater. In most cases, weight loss (bariatric) surgery is recommended by your physician when:
Sarasota Memorial performs two bariatric surgery procedures that are recognized and approved by the American Society for Bariatric Surgery and the National Institutes of Health.
Each procedure is highly specialized and has its own physiological method of achieving weight loss in the body. As with all medical procedures, each has its own advantages and risks. For detailed information about Sarasota Memorial’s gastric bypass and adjustable band surgeries, click on the procedure you want to know more about.
Roux-en-Y Gastric Bypass In the health care industry today, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States.
In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.
Patrick Fitzgerald, MD and John Nora, MD perform the Roux-en-Y procedure at Sarasota Memorial Hospital.
All of the following deficiencies can be managed through proper diet and vitamin supplements. Poor absorption of iron and calcium can result in a predisposition to iron deficiency anemia and osteoporosis. Women already at risk for osteoporosis after menopause should be aware of the potential for heightened bone calcium loss. Some patients can experience metabolic bone disease resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones.
Other negative side effects of gastric bypass surgery can include chronic anemia due to Vitamin B12 deficiency (manageable with Vitamin B12 pills or injections). A condition known as "dumping syndrome " can occur as the result of rapid emptying of stomach contents into the small intestine (sometimes triggered when too much sugar or fat are consumed). Not generally considered a serious risk, it can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
Adjustable Gastric Banding
At Sarasota Memorial, the gastric band procedure is available to patients using either the LAP BAND® by Allergan, Inc., or the REALIZE® Personal Banding System from Ethicon Endo-Surgery, Inc.
Both gastric bands serve to reduce stomach capacity and restrict the amount of food that can be consumed at one time. In both cases, this minimally invasive procedure does not require stomach cutting and stapling or gastrointestinal re-routing to bypass normal digestion.
In gastric banding surgery, an implanted medical device, a silicone ring, is placed around the upper part of the stomach and filled with saline on its inner surface. This creates a new, smaller stomach pouch that can hold only a small amount of food, so the food storage area in the stomach is reduced. The band also controls the stoma (stomach outlet) between the new upper pouch and the lower part of the stomach. When the stomach is smaller, you feel full faster, while the food moves more slowly between your upper and lower stomach as it is digested. As a result, you eat less and lose weight.
During this procedure, surgeons usually use laparoscopic techniques to wrap the band around the patient’s stomach. A narrow camera is passed through a port so the surgeon can view the operative site on a nearby video monitor. Like a wristwatch, the band is fastened around the upper stomach to create the new stomach pouch that limits and controls the amount of food you eat. The band is then locked securely in a ring around the stomach.
Risks specific to this surgery include infection, spleen bleeding or injury, gastric perforation (a tear in the stomach wall), and access port leakage. Beyond surgical risks, most patients experienced at least one side effect during recovery. Common side effects include nausea and vomiting, heartburn, abdominal pain, and slippage of the band.
Scott Stevens, MD performs the Adjustable Gastric banding procedure at Sarasota Memorial Hospital.