Obesity Care And Bariatric Surgery

Kenric M Murayama, Shanu Kothari

• Publisher: WSPC
• Year: 2016
• ISBN:
  9789814699327
• Topic: Medicina
• Subtopic: Nutrición, dietética y bariatría

The intent of the book is to provide readers with a summary of the obesity problem with specific focus on the metabolic health issues (ie, diabetes mellitus), obstructive sleep apnea, non-alcoholic fatty liver disease and the psychological effects of obesity. This will provide readers with an understanding of the commonly performed operations for obesity along with evidence-based outcomes, nutritional issues, and metabolic consequences.

The intent of the book is to provide readers with a summary of the obesity problem with specific focus on the metabolic health issues (ie, diabetes mellitus), obstructive sleep apnea, non-alcoholic fatty liver disease and the psychological effects of obesity. This will provide readers with an understanding of the commonly performed operations for obesity along with evidence-based outcomes, nutritional issues, and metabolic consequences.

Readership: Surgeons performing obesity surgery, dietitians, endocrinologists, diabetologists, nutritional scientists, and those dealing with eating disorders.
Key Features:

• Broad coverage of the topic from experts in the field
• Quick reference for those participating in the care of morbidly obese patients
• Comprehensive review of key co-morbid conditions associated with obesity

Chapter 1

Obesity-Related Health Issues

Rajasree Nambron* and Daniel K. Short^†,‡,§

*Department of Internal Medicine, Gundersen Health System,
1836 South Avenue, La Crosse, WI 54601, USA

^†Department of Endocrinology, Gundersen Health System,
1836 South Avenue, La Crosse, WI 54601, USA

^‡[email protected]

The prevalence of both overweight and obesity are increasing in the United States and worldwide. More than one third of adults in the US are currently obese.¹ The estimated financial impact of obesity in 2008 was over 140 billion dollars,² including both direct and indirect costs. The health impact of obesity, including morbidity and mortality, is devastating. Both years of life and quality of life are affected; obesity at age 40 decreases life expectancy by 7 years,³ and the quality-adjusted years of life lost in the USA due to obesity and obesity related diseases have doubled recently.⁴ It is estimated that obesity leads to between 111,000 and 365,000 excess deaths annually in the United States. WHO describes obesity as most visible but neglected health issue affecting both developed and developing countries.⁵

The accepted definition of overweight is a body mass index (BMI) of 25 kg/m² or above, and obesity is defined as a BMI of 30 kg/m² and above.

Table 1 Classification of overweight and obesity by BMI.

	Obesity Class	BMI (kg/m^2)
Underweight	—	<18.5
Normal	—	18.5–24.9
Overweight	—	25–29.9
Obesity	Class I	30–34.9
	Class II	35–39.9
Severe Obesity	Class III	>40

Economic impact: It has recently been estimated that the financial cost of obesity is approximately 190 billion dollars annually in the US.^4,6 A study from the Mayo Clinic reported that obese employees accumulate 1,850 dollars more in medical costs than their healthy counterparts each year. For an employee with BMI of 35–40, the cost was actually 3,000 dollars annually.⁶ It is estimated that it costs 5 billion dollars annually for the extra jet fuel needed to fly heavier Americans. The cost of excess absenteeism for male and female workers with BMI > 40 is estimated to be over 1,000 dollars per year.⁶

Health Risks

Obesity is strongly associated with the development of premature cardiovascular disease. There are several other major physical and mental conditions associated with obesity. These are briefly outlined in the following sections.

Hypertension:

Data from NHANES III show that as BMI increases, blood pressures increases proportionally.⁷ For example, a person with 10 kg higher body weight will have on average 2 mm Hg higher systolic and 2.3 mm Hg higher diastolic pressures, according to the results of a large international study (INTERSALT), involving over 10,000 men and women.⁸

Dyslipidemia:

The pattern of dyslipidemia seen with obesity includes high triglycerides, high total cholesterol and low high density lipoproteins (HDL) combined with normal or high low density lipoproteins (LDL). Several studies have shown that as BMI increases there is an increase in triglyceride levels.⁹ This is true in both men and women and at all ages. Weight gain, overweight and obesity have all been shown to increase cholesterol levels. People with a higher waist circumference have also been shown to have a higher total cholesterol.

Diabetes Mellitus:

Several studies including the Nurse’s Health Study have shown that there is an increased relative risk of developing diabetes with an increase in BMI over 25 kg/m².¹⁰ It has also been shown that abdominal obesity is an independent risk factor for developing diabetes.

Coronary artery disease:

Increases in weight lead to higher levels of total cholesterol, LDL cholesterol and triglycerides, as noted above. Also fibrinogen increases, insulin resistance may develop and blood pressure may rise as well. These changes in turn can lead to adverse coronary outcomes. CHD risk is lowest in men and women with BMI lower than 22 and then rises progressively with increases in BMI.¹¹ For example, a gain of 5–8 kg in weight leads to a 25% increase in myocardial infarction incidence and CHD related deaths. This has been shown in several populations around the world.¹¹ The co-morbid conditions associated with obesity, such as diabetes, hypertension and hyperlipidemia likely contribute to the increased vascular risk.

Atrial flutter/fibrillation:

In an analysis of over 5,000 patients in the Framingham study, patients with a BMI > 30 kg/m2 were prone to have atrial fibrillation.¹² Other studies have shown an increase in both atrial flutter and atrial fibrillation in obese patients without any underlying cardiac disease.¹³

Congestive heart failure (CHF):

CHF is a complication of obesity which has been identified in several studies, and is a major cause of death.¹⁴ With increasing weight gain, the heart muscle is affected, with a resulting increase in left ventricular mass. Obesity leads to an increased blood volume and high cardiac output which causes eccentric hypertrophy and diastolic dysfunction. This is worse in the setting of coexisting diabetes and hypertension. Excess wall stress can ultimately lead to systolic dysfunction as well. Obesity hypoventilation syndrome and hypoxemia and obstructive sleep apnea cause hypoxemia and can also lead to congestive heart failure.

Stroke:

An increased risk of ischemic stroke has been reported with increasing BMI. As an example, the Nurse’s Health Study reported an increased risk of ischemic stroke in women whose BMI was over 27 kg/m2.¹⁵ An increased risk of both hemorrhagic and ischemic stroke has been reported in men as well.^15,16 In a study with over 85,000 participants, an increased risk of stoke was seen with every standard deviation of increase in BMI, waist circumference and waist to hip ratio.¹⁷

Sleep apnea:

Sleep apnea is strongly associated with obesity and diabetes. Sleep apnea can lead to pulmonary hypertension and right heart strain. Due to increased abdominal pressure, obese patients exhibit increased residual volume, decreased lung compliance and reduced respiratory drive. Obstructive sleep apnea and obesity hypoventilation syndrome cause significant morbidity and also generate considerable costs to the medical system in terms of both medical care and hospitalizations.

GERD:

Obesity is a strong risk factor for gastroesophaegeal reflux disease and esophagitis, likely due...

Table of contents

• Cover
• Halftitle
• Title Page
• Copyright
• Contents
• Preface
• Chapter 1. Obesity-Related Health Issues
• Chapter 2. History of Bariatric Surgery
• Chapter 3. Roux-en-Y Gastric Bypass: Indications, Procedures and Outcomes
• Chapter 4. Biliopancreatic Diversion and Duodenal Switch: Indications, Procedure and Outcomes
• Chapter 5. Sleeve Gastrectomy: Indications, Procedure and Outcomes
• Chapter 6. Comparative Outcomes in Bariatric Surgery
• Chapter 7. Complications of Bariatric Surgery and Management
• Chapter 8. Innovations in Bariatric Surgery
• Chapter 9. Nutrition After Bariatric Surgery
• Chapter 10. Metabolic Impact of Bariatric Surgery
• Index