Is Obesity The New Epidemic?
Obesity was not always a major health problem. Just since the 1980s, obesity worldwide has more than doubled1. In the 1960s approximately 15% of those in the United States were obese, forty years later, in 2000, 37%2 were considered obese. If the trend continues, 51% of the population will be obese by 2030. For most of the world’s history, famine and starvation have actually been the major threats to humanity and although it still is in certain portions of the world, the advances of technology and agricultural development have reduced the risk malnutrition significantly. Now, obesity is the fifth leading cause of death worldwide, accounting for 2.8 million adults who die each year from obesity related causes1. Unfortunately, children are fighting obesity and its health concerns as well. Nearly 17% of children and adolescents, approximately 12.4 million, are obese in the United States3.
Obesity is defined as having an excess amount of adipose tissue (a.k.a. fat) to the point that it begins to negatively affect one’s health and quality of life. Although it’s an imperfect measurement, the body mass index (BMI) is the most common way obesity is measured and decades worth of research has proven that the BMI provides a good estimate of how excessive fat correlates with serious medical conditions like diabetes, heart disease, cancer, joint deterioration, along with a decreased quality of life and increased risk of death. An individual’s BMI is calculated based on his/her height and weight (BMI = kg/m2).
The breakdown of BMI classifications is as follows:
BMI = 18.5-24.9 is considered a healthy weight
BMI = 25.0-29.9 is considered overweight
BMI = 30-39.9 is considered obese
BMI = 40 or greater is considered morbidly obese
Total muscle mass and waist circumference in addition to BMI, however, are important factors to take into account. Muscle contains powerful metabolism factories and actually weighs more than fat. Therefore, an extremely muscular individual may have an elevated BMI yet not be considered truly overweight or obese. More and more studies have also identified waist circumference as a more accurate indicator of increased health risks compared to overall BMI. Waist circumferences greater than 35 inches (88 cm) in women or 40 inches (102 cm) and greater in men, have a strong correlation with higher rates of obesity related conditions and death.
Although fat in and of itself, is not harmful and is actually necessary for life sustaining functions, excess fat can start to harm the body and its function in a variety of ways. One way fat can negatively affect the body, is that fat cells release substances that can cause a low level of inflammation. Too much inflammation will cause swelling and harm to numerous organs. Inflammation and swelling of blood vessels can lead to heart attacks and strokes. Swelling and inflammation in the liver and pancreas can interfere with their important functions in the body and ultimately accelerate liver failure. Too much fat has also been linked the development of numerous cancers ranging from brain to colorectal cancer with many more in between.
Quality of life is also significantly affected by obesity. Those who are overweight or obese are much more likely to experience arthritis, which is characterized by crippling pain and swelling of the joints. Arthritis is a leading cause of disability and can contribute to even more weight gain, depression and other medical conditions that can limit one’s enjoyment of life, especially if they are constantly in pain and can’t participate in activities that would have otherwise brought them joy.
A Solution: Weight Loss Surgery
Weight loss surgery (a.k.a. bariatric surgery) is currently the leading medical intervention that provides a significant, sustained weight loss for those who are morbidly obese. After weight loss surgery, not only is weight loss sustained, obesity related conditions such as diabetes, high blood pressure and heart disease are also dramatically decreased. A large, controlled Swedish study with four thousand four hundred and forty seven obese participants, half of which had some form of weight loss surgery, were followed for approximately fifteen years. Those who had weight loss surgery, had significantly less deaths related to cardiovascular disease, such as heart attacks and stroke4. They also had less cardiovascular events in general.
Low back pain is another common complaint among obese patients. A retrospective study of morbidly obese individuals who had undergone weight loss surgery discovered that compared to others, back and radicular pain was significantly lower and they also experienced a marked increase in the L45 intervertebral disc height thus reducing pressure on the discs and nerves of the low back5. Another study compared the average duration of remission in Type II diabetic who underwent bariatric surgery with those who only received conventional therapy with diet and exercise. Those who had a weight loss surgery, had an average of eleven years in remission over a lifetime compared with only two years in the conventional therapy group5.
The first effective weight loss surgery was done in the United States was in 1954. It was introduced by Kremen and Linner and called the jejunoileal bypass. Similar to what today is known as the duodenal switch, this weight loss procedure bypassed 90% of the small intestine by connecting the front part of the jejunum (the middle part of the small intestine) to the end of the ileum (right where the small intestine meets the large intestine). Weight loss was achieved by preventing a bulk of calories from being absorbed. However, nutrients were also being blocked and many people who underwent this bariatric surgery found themselves in a serious state of malnutrition. They also experienced an overgrowth of bacteria in the bypassed intestine which frequently led to toxic conditions such as liver failure, skin problems, digestive conditions and more. Understandably, the procedure was abandoned and the search for better a bariatric procedure began.
Later in 1963, Drs. J. Howard Payne, Lorent T. DeWind and Robert R. Commons developed the Jejuno-colic Shunt, which connected the upper small intestine (the duodenum) to the large intestine, bypassing two-thirds of the small intestine. The research that ultimately lead to what we now know as the gastric bypass, began in 1965 when Dr. Edward E. Mason and Dr. Chikashi Ito developed the original gastric bypass weight loss surgery at the University of Iowa. Their gastric bypass surgery led to far fewer complications than earlier intestinal bypass surgeries and became the foundation for the bariatric surgeries we know today. Dr. Edward E. Mason is considered the “father of bariatric surgery” due to his conception and pioneering of the gastric bypass surgery.
Concepts of Weight Loss Procedures
When it comes to weight loss surgery, three basic concepts exist. First, is gastric restriction which aims to restrict the amount of food the stomach can hold, thus decreasing the amount of food an individual can eat. Examples of weight loss surgeries that employ gastric restriction are intragastric balloons, adjustable gastric banding and sleeve gastrectomy. The second concept is similar, gastric restriction with mild malabsorption. The Roux en Y, also known as the gastric bypass surgery, is a popular bariatric surgery that restricts the amount of food one can eat at a time while also reducing the amount of food absorbed since part of the small intestine is bypassed. The third concept in weight loss surgery goes further with the malabsorption but not too far. Like the first weight loss surgery performed in 1954, the duodenal switch bariatric surgery combines gastric restriction with decreased absorption by bypassing a larger part of the small intestine while also surgically decreasing the size of the stomach.
Over the past few years numerous clinical research studies and overall experience has enriched and supported the field of bariatric surgery. Procedures are not only safer, they are more effective and bariatric surgeons often provide comprehensive support with dietary counseling and coaching to help their patients maintain their weight loss and healthy lifestyle. Most weight loss procedures are permanent but others like the intragastric weight loss balloons are temporary and designed only to “jump start” the weight loss process, teach healthier eating habits and set people on the right path for their long term weight loss goals.
Types of Weight Loss Devices
In addition to the surgical weight loss surgeries such as the Roux en Y gastric bypass and sleeve gastrectomy, currently, in the United States there are seven FDA approved obesity treatment devices on the market. Worldwide, there are several more. Of those approved in the U.S., there are four different categories: gastric banding, intragastric balloons, gastric emptying systems, and electrical stimulation systems.
Gastric banding is a restrictive but adjustable type of bariatric surgery that restricts the amount of food one can ingest at a time, thus aiding in weight loss and portion control. The band is made of medical grade silicone and through a laparoscopic surgery (surgery that uses only small incisions) it is placed around the upper part of the stomach. The band portion, also called the collar is attached to a port that is able to be accessed from outside the body in order to adjust the restrictiveness of the band. The two types of gastric weight loss banding available in the U.S. include the LAP-BAND® and the REALIZE ™ Adjustable Gastric Band.
Intragastric balloon procedures have been used worldwide for more that 20 years to help individuals “jumpstart” weight loss and healthier eating habits. But just recently was approved by the FDA within the last two years. By taking up space in the stomach, saline or air filled silicone balloons are placed in the stomach either endoscopically (an outpatient procedure that uses a flexible tube to place the balloon into the stomach by going in through the mouth and down the esophagus (our feeding tube) into the stomach). Or by swallowing a deflated balloon contained in a dissolvable capsule. Three gastric balloon procedures are approved for use in the U.S. and they are ReShape Integrated Dual Balloon System (Reshape Dual Balloon), ORBERA Intragastric Balloon System and Obalon Balloon System.
Another FDA approved weight loss system involves emptying the stomach after food is ingested and the only only FDA approved device in this category is the AspireAssist. The AspireAssist is a reversible weight loss device that utilizes a port to empty the contents of the stomach after a meal is ingested. A port valve that lies flush against the skin attaches to the tube and allows the stomach contents to be emptied after meals. Twenty to thirty minutes after consuming a meal, an individual attaches an external device that opens the port valve and drains the stomach’s contents into a toilet.
Electrical stimulation is the final category of FDA approved weight loss devices and involves placing an electrical stimulator under the skin of the abdomen to block nerve activity between the brain and stomach. The device approved of in the U.S. is The Maestro® System. A rechargeable neuroregulator is implanted into the fatty tissue under the skin and two electrodes are surgically placed on the nerve through laparoscopy by a bariatric surgeon. It delivers VBLOC® therapy which intermittently blocks nerve signals of hunger while the individual is awake. It can be removed or deactivated when necessary.
Many obese individuals frequently find themselves struggling with their weight and essentially feeling as if they’re trapped in a vicious weight loss/gain cycle. Most Americans in general, have attempted numerous diets and other weight loss methods, only to see their weight yo-yo back and forth, eventually giving up on long-term weight loss. When combined with a comprehensive treatment plan, weight loss surgery can serve as an effective tool to provide individuals with long term weight-loss and overall improved health and wellness. Bariatric surgery has proven over the years to help improve or resolve many obesity-related conditions, such as type 2 diabetes, high blood pressure, heart disease, and many more. Cancers as well are less frequent in those who are not obese. Individuals who improve their weight and live a healthier lifestyle, often find themselves taking less and less medications to treat their obesity-related conditions while also living a fuller more enjoyable life. Additional, significant weight loss through bariatric surgery can also pave the way for many other exciting opportunities for the individual, their family, and most importantly, their health.
- World Health Organisation Fact sheet N°311
- Centers for Disease Control and Prevention
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion
- Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012 Jan 4. 307(1):56-65. [Medline]
- Lidar Z, Behrbalk E, Regev GJ, Salame K, Keynan O, Schweiger C, et al. Intervertebral Disc Height Changes after Weight Reduction in Morbid Obese Patients, its Effect on Life Quality, Radicular and Low Back Pain. Spine (Phila Pa 1976). 2012 May 29. [Medline].