SEVERE OBESITY
What is Severe Obesity?
Severe Obesity is a chronic, life threatening, multifactorial disease of excess fat storage that contributes to multiple health problems known as co-morbidities. Obesity becomes “severe” or “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. Severe 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 Severely 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!
Severely obese patients generally 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)
Causes of Morbid Obesity
The reasons for obesity are multiple and complex. Despite conventional wisdom, 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.
The underlying causes of severe obesity are not known. There are many factors that contribute to the development of obesity including genetic, hereditary, environmental, metabolic and eating disorders. There are also certain medical conditions that may result in obesity such as intake of steroids and hypothyroidism.
Genetic Factors
Numerous scientific studies have established that your genes play an important role in your tendency to gain excess weight.
- The body weight of adopted children shows no correlation with the body weight of their adoptive parents, who feed them and teach them how to eat. Their weight does have an 80 percent correlation with their genetic parents, whom they have never met.
- Identical twins, with the same genes, show a much higher similarity of body weights than do fraternal twins, who have different genes.
- Certain groups of people, such as the Pima Indian tribe in Arizona, have a very high incidence of severe obesity. They also have significantly higher rates of diabetes and heart disease than other ethnic groups.
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.
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.
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.
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:
- More than 100 lbs. over your ideal body weight, or
- Have a Body Mass Index (BMI) of over 40, or
- Have a BMI of over 35 and are experiencing severe negative health effects, such as high blood pressure or diabetes, related to being severely overweight
- Unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting
If you would like to calculate your BMI, just go to our BMI Calculator Page.
