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What is morbid obesity? Obesity is the result of an incorrect food intake, being a true social problem in highly developed countries. In Spain it affects 30% of the whole population, 10% of which show a morbid obesity. By excluding endocrine or metabolic disorders, obesity arises from an abnormal food intake, both in amounts and quality of foods. As a result, the patient intakes a caloric amount strongly superior to the one he is able to consume, and the excess calories store up in the body fat. Ideal body weight (IBW) varies along with the height and sex. As a rule, it should approximate the last two digits of the height expressed in centimeters. In example, a person 165 cm tall will have an approximate ideal body weight of 65 Kg, 2 to 3 Kg more in women and 1 to 2 in men. Moreover, after 30 years of age it should be considered normal to have 8 to 10 Kg more than ideal body weight. In order to establish a fixed parameter for obesity and to establish its grade, the physician divides the weight (in Kg) by the square of the height (in m2), obtaining a number known as body mass index (BMI).  A subject is deemed to be normal having a BMI lower than 25. He is overweight with a BMI ranging from 25 to 30, pathologically obese between 30 and 40 and morbidly obese over than 40. Generally, all patients consulting a physician for a problem of obesity already have experienced at least one or more hypocaloric dietetic programs to reduce the obesity. BMI ranging from 25 to 30 an hypocaloric program followed by an endocrinologist can often be a sufficient treatment. From 30 to 35 drugs can be added to control the overweight, but when BMI overtakes 35 surgical treatment should be seeked. When BMI overtakes 40,the medical risks connected with morbid obesity are exceedingly higher than those related to surgery, and therefore surgery should be always indicated. Problems related to morbid obesity
A BMI exceeding 40 is what the American Society for Bariatric (Obesity)
Surgery considers to be a state of morbid obesity. In such states the risk of respiratory, cardiocirculatory, endocrine,
cancer disorders is superior to that related to an open surgical procedure (life expectancy is
reduced of one year less each 10 Kg of excess weight). With a BMI ranging from 30 to 40 metabolic (diabetes), hepatic,
cardiocirculatory (acute myocardial infarction, hypertension) and joint disorders have a definite
higher incidence than in the non obese population. All these reasons strongly suggest the
importance of overweight reduction, and surgery can be one of the therapeutic options. With a BMI lower than 30 diet and endocrine counseling are the first choice for treatment. U.S. insurance companies consider a subject as morbidly obese when he
shows an excess body weight over 45 Kg. They offer a complete reimbursement of medical expenses
related to surgery for obesity also when BMI is under 40 or excess body weight is under 45 Kg
but a serious medical condition due to obesity is present. There is also a group of subjects that show a strong tendency to fall
asleep during daytime and repeated episodes of apnea during sleeptime. They are easily
recognizable, as they show loud snoring and involuntary movements during the sleep. When apnea (a
period of 10 or more seconds without breathing) exceeds 20 episodes per night, daytime sleepiness
(falling asleep in inappropriate situations such as in meetings, while driving, etc.) or
psychocognitive impairment and altered emotional status are present, then surgery is
strongly indicated, as it offers very good results. At the same way, arthritis of the extremities and of lumbar spine is
frequently associated to obesity. Diabetes, arterial hypertension, gastroesophageal reflux
disease, hyperuricemia, urinary incontinence and amenorrhea are all strongly related
to obesity, and they disappear as soon as the patient returns towards its ideal body weight
after surgery. Last, but not least, it is important not to forget all the psychological
consequences of obesity, such as depressed mood, low self-esteem, insecurity, etc. Possible treatments The first choice in the treatment of morbid obesity is represented by
diet and endocrine counseling, thereby reducing food intake and general
behaviour. When this treatment is not followed by a significant reduction of body
weight, surgery is a good option. It should be remembered that surgery is not indicated before the end of
the growing process (around age 18 years) and that it should be reserved to
patients younger than 55, even though less aggressive techniques such as laparoscopy can be used
up to 65 years of age. Before surgery, the obese patient needs to be investigated in search of
medical conditions that can be at the origin of their obesity (especially hypothyroidism) and
of psychological conditions that can alter the postoperative period. For these reasons, medical teams dealing with morbid obesity need the
presence of dietologists, endocrinologists, psychiatrists and surgeons. The final result
of treatment should be the correction of all behavioral, social and psychological
problems related to morbid obesity. Contact Dr. Carlos Ballesta |