What is obesity and how big of a problem is it?

Obesity is when a person has a body mass index (BMI) greater than or equal to 30. Morbid obesity is when the BMI is above 40. In the United States, 43% of adults are suffering from obesity and it is getting worse. The prediction for 2030 is that 50% of the adult population will be considered obese. The WHO recognizes obesity as an epidemic and now considers it a chronic and progressive disease resulting from multiple environmental and genetic factors. It is no longer thought to be a cosmetic issue caused simply by overeating and lack of self-control. Unfortunately, the disease of obesity can spurn many other health problems such as type 2 diabetes, hypertension, sleep apnea, fatty liver disease, and heart disease. This epidemic has a significant impact on the healthcare system and is the largest preventable cause of death resulting in deaths six to seven times higher than those caused by tobacco. Fortunately, there are numerous treatment options currently available, both surgical and non-surgical.

What are the various options for assisted weight loss?

Surgical weight loss options include gastric bypass, sleeve gastrectomy, and lap band; however, the latter has recently fallen out of favor. Non-surgical options are more appropriate for patients that have less weight to lose. Medication assisted weight loss and medically supervised weight loss programs top the list. Medication assisted programs are comprehensive combinations of lifestyle changes with the added assistance of medication to aid weight loss. Supervised weight loss programs do not use medication but could consist of weekly weigh-ins, nutritional counseling and meal replacement.

What is the difference between gastric bypass and sleeve gastrectomy?

Both gastric bypass and sleeve gastrectomy are forms of bariatric surgery. Gastric bypass involves reducing the size of the stomach and altering its connection to the intestines. Its advantages include faster weight loss, a high cure rate for type 2 diabetes, and it involves no foreign objects or implants. It’s disadvantages include the fact that, though it is very safe, it is major surgery that involves intestinal rerouting, it is difficult to reverse, and can result in nutritional deficiencies. Sleeve gastrectomy is a restrictive procedure, which involves removing two-thirds of the stomach. In comparison with gastric bypass, it is a relatively simple surgery that requires no intestinal rerouting and does not risk the malabsorption of nutrients. Another advantage to sleeve gastrectomy is favorable gut hormonal changes that suppress hunger and improve satiety. Some disadvantages are that we see only intermediate weight loss and some cure of type 2 diabetes. Also, it is irreversible. Both surgeries, as with any procedure, come with a risk of complications. However, bariatric surgery has been shown to be safer than many common procedures and it greatly offsets the risk of staying morbidly obese.

Why consider weight loss surgery?

Bariatric surgery is the most effective means of long-term weight loss for severe obesity. In fact, if a person’s BMI is over 40, non-surgical methods have a very low success rate. Additionally, surgery can improve, or even cure many major health problems. Studies have shown up to an 80% cure rate for type 2 diabetes, an 80% reduction in cardiovascular risk and substantial reduction in mortality from heart disease, a similarly substantial risk reduction for stroke, up to a 75% cure rate for obstructive sleep apnea, and a vast improvement in fatty liver disease. A 90% reduction in five-year mortality in severe obesity has also been reported.

What kinds of medicines are used in medication assisted weight loss?

There are numerous medications that can be used as tools to assist weight loss in a medical setting. Some good examples of the types used are Qysmia, which works in the brain to help suppress appetite and make you feel full sooner, Orlistat, which works in the gut to block the absorption of fat, and Phentermine, which is only for short-term use. Patients in this type of program usually see a 10 to 12% weight loss. It is important to remember however, that the medication is a great tool, but a person will not lose weight without also making changes to what they eat and how they move their body. There can also be side effects so it is extremely important to be under medical care while using such medications.

Various members of the Weight Loss Institute of New Hampshire (WINH) at Concord Hospital presented on obesity and weight loss options at the March Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The presenting members were Dr. Raza Shariff, MD; Kathleen Hayward, RDN, LD; Tricia Keville, APRN; and Elizabeth White, RDN, LD. The monthly series,supported by the Walker Lecture Fund, features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch the WINH presentation on Concord Hospital’s YouTube channel at: youtube.com/concordhospital.]]>