What Is Morbid Obesity?
Morbid Obesity is a chronic, life threatening, multifactorial
disease of excess fat storage that contributes to multiple
health problems known as co-morbidities. Obesity
becomes “morbid” when it reaches the point
of significantly increasing the risk of one or more obesity-related
co-morbidities that result either in significant physical
disability or even premature death. As you read about
morbid obesity you may also see the term “clinically
severe obesity” used. Both are descriptions
of the same condition and can be used interchangeably. Morbid
obesity is typically defined as being 100 lbs. or more
over ideal body weight or having a Body Mass Index of 40
or higher. A person can also be considered Morbidly
Obese with a BMI of 35-40 with certain serious co-morbidities. According
to the National Institutes of Health Consensus Report,
morbid ovesity is a serious disease and must be treated
as such. It is a chronic disease, meaning that its
symptoms build slowly over an extended period of time. Being
a chronic disease, it also means it takes Chronic Treatment!
Patients suffer with:
- Impaired satiety (unable to feel satisfied from the
food they eat)
- Calories that are stored (as fat) not burned
- Inadequate basal metabolic rate (possibly due to years
of yo-yo dieting)
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Causes of Morbid Obesity
The reasons for obesity are multiple and complex. Despite
conventional wisdom (or ignorance), 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.
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. That is why it is very important to understand that all current
medical interventions, including weight loss surgery, should not be considered
medical cures. Rather, they are attempts to reduce the effects of excessive
weight and alleviate the serious physical, emotional and social consequences
of the disease.
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We probably have a number of genes directly related to
weight. Just as some genes determine eye color or height,
others affect our appetite, our ability to feel full or
satisfied, our metabolism, our fat-storing ability, and
even our natural activity levels.
The Pima Paradox
The Pima Indians are known in scientific circles as one
of the heaviest groups of people in the world. In fact,
National Institutes of Health researchers have been studying
them for more than 35 years. Some adults weigh more than
500 pounds, and many obese teenagers are suffering from
diabetes, the disease most frequently associated with obesity.
But here's a really interesting fact - a group of Pima
Indians living in Sierra Madre, Mexico, does not have a
problem with obesity and its related diseases. Why not?
The leading theory states that after many generations
of living in the desert, often confronting famine, the
most successful Pima were those with genes that helped
them store as much fat as possible during times when food
was available. Now those fat-storing genes work against
them.
Though both populations consume a similar number of calories
each day, the Mexican Pima still live much like their ancestors
did. They put in 23 hours of physical labor each week and
eat a traditional diet that's very low in fat. The Arizona
Pima live like most other modern Americans, eating a diet
consisting of around 40 percent fat and engaging in physical
activity for only two hours a week.
The Pima apparently have a genetic predisposition to
gain weight. And the environment in which they live - the
environment in which most of us live - makes it nearly
impossible for the Arizona Pima to maintain a normal, healthy
body weight.
Environmental Factors
Environmental and genetic factors are obviously
closely intertwined. If you have a genetic predisposition
toward obesity, then the modern American lifestyle and
environment may make controlling weight more difficult.
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.
For those suffering from morbid obesity, anything less
than a total change in environment usually results in failure
to reach and maintain a healthy body weight.
Metabolism
We used to think of weight gain or loss as only a function
of calories ingested and then burned. Take in more calories
than you burn, gain weight; burn more calories than you
ingest, lose weight. But now we know the equation isn't
that simple.
Obesity researchers now talk about a theory called the "set point," a
sort of thermostat in the brain that makes people resistant to either weight
gain or loss. If you try to override the set point by drastically cutting your
calorie intake, your brain responds by lowering metabolism and slowing activity.
You then gain back any weight you lost.
Eating Disorders &
Medical Conditions
Weight loss surgery is not a cure for eating disorders.
And there are medical conditions, such as hypothyroidism,
that can also cause weight gain. That's why it's important
that you work with your doctor to make sure you do not
have a condition that should be treated with medication
and counseling.
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Health Threat of Morbid Obesity
Morbid obesity brings with it an increased risk for a shorter
life expectancy. For individuals whose weight exceeds twice
their ideal body weight (that's about 2-6% of the U.S.
population), the risk of an early death is doubled compared
to non-obese individuals. An article in JAMA (Journal of
the American Medical Association) in 2003 outlined the
years of lost life for individuals that suffer from Morbid
Obesity at various age ranges. Their studies show that
some groups can have up to a 20% shorter life due to their
over weight. The risk of death from diabetes or heart attack
is five to seven times greater. Even beyond the issue of
obesity-related health conditions, weight gain alone can
lead to a condition known as "end-stage" obesity
where, for the most part, no treatment options are available.
Yet an early death is not the only potential consequence.
Social, psychological and economic effects of morbid obesity,
however unfair, are real and can be especially devastating.
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Obesity-Related Health Conditions
Obesity-related health conditions are health conditions
that, whether alone or in combination, can significantly
reduce your life expectancy. These are termed “co-morbidities”.
A list of some of the more common co-morbidities follows.
These co-morbid conditions are what make morbid obesity
a DISEASE in and of itself.
Type 2 Diabetes. Obese individuals
develop a resistance to insulin, which regulates
blood sugar levels. Over time, the resulting high
blood sugar can cause serious damage to the body.
Type 2 Diabetes represents over 85% of the diabetes
(Type 1 representing about 15%) and most Type 2 Diabetics
are obese to Morbidly Obese. Whereas this disease
was unheard of in children 25 years ago, it is one
of the biggest epidemics in adolescent medicine at
the present time.
High blood pressure/Heart disease. Excess
body weight strains the ability of the heart to function
properly. The resulting hypertension (high blood
pressure) can result in strokes, as well as inflict
significant heart and kidney damage.
Osteoarthritis of weight-bearing joints. The
additional weight placed on joints, particularly
knees and hips, results in rapid wear and tear, along
with pain caused by inflammation. Similarly, bones
and muscles of the back are constantly strained,
resulting in disk problems, pain and decreased mobility.
Sleep apnea/Respiratory problems. Fat
deposits in the tongue and neck can cause intermittent
obstruction of the air passage. Because the obstruction
is increased when sleeping on your back, you may
find yourself waking frequently to reposition yourself.
The resulting loss of sleep often results in daytime
drowsiness and headaches. A resent study shows significant
life lost to traffic accidents due to sleep apnea
and at a price tag of over one billion dollar.
Gastroesophageal reflux/Heartburn. Acid
belongs in the stomach and seldom causes any problem
when it stays there. When acid escapes into the esophagus
through a weak or overloaded valve at the top of
the stomach, the result is called gastroesophageal
reflux, and "heartburn" and acid indigestion
are common symptoms. Approximately 10-15% of patients
with even mild sporadic symptoms of heartburn will
develop a condition called Barrett's esophagus, which
is a pre-malignant change in the lining membrane
of the esophagus, a cause of esophageal cancer.
Depression. Though
there is not a higher rate or incidence of “mental illness” in the
morbidly obese population, the incidence of depression
is high. Seriously overweight persons face constant
challenges to their emotions: repeated failure with
dieting, disapproval from family and friends, sneers
and remarks from strangers. They often experience
discrimination at work, cannot fit comfortably in
theatre seats, or ride in a bus or plane.
Infertility. The
inability or diminished ability to produce offspring.
This is probably because of an estrogen-like compound
produced by the fat that “confuses” the
reproductive system. This “un-opposed estrogen” is
probably the cause of several of the associated conditions.
Urinary stress incontinence. A large, heavy
abdomen and relaxation of the pelvic muscles, especially
associated with the effects of childbirth, may cause
the valve on the urinary bladder to be weakened, leading
to leakage of urine with coughing, sneezing, or laughing.
Though this is not life threatening it does change
people’s lives. Often our female patients who
suffer most from this condition become reclusive and
homebound. The discomfort, inconvenience and embarrassment
is often overwhelming.
Menstrual irregularities. Morbidly
obese individuals often experience disruptions of the
menstrual cycle, including interruption of the menstrual
cycle, abnormal menstrual flow and increased pain associated
with the menstrual cycle.
Cholesterol and Triglyceride abnormalities. These
are the fat levels in the serum of the blood that increase
the risk of heart disease.
Some cancers. Morbid Obesity increases ones chances
of suffering from some cancers like breast, and uterine
cancers. |
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Am I Morbidly Obese?
Answering this question may give you the courage you need
to take the first step. Below are tools you can use to
determine if you are morbidly obese and potentially a candidate
for weight loss surgery.
There are several medically accepted criteria for defining
morbid obesity. You are likely morbidly obese if you are:
