A lot of things. Obesity is not simply a result of overeating. Research has shown that, in many cases:
- A significant underlying cause of morbid obesity is genetic
- Once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief
Environmental factors such as 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. 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.
Morbid obesity increases the risk of developing heart disease, high blood pressure (also known as hypertension), high blood cholesterol, sleep apnea, respiratory insufficiency, obesity hypoventilation syndrome, asthma and bronchitis, degenerative disease of the Lumbo-Sacral spine, degenerative arthritis of weight- bearing joints, heartburn or reflux disease, diabetes mellitus, gallbladder disease, stress urinary incontinence, venous stasis disease and emotional or psychological diseases such as depression.
Three criteria are used to determine whether a patient is morbidly obese. They are:
- If you are more than 100 lbs. over your ideal body weight
- If you have a body mass index (BMI) of greater than 40
- If your BMI is more than 35 and is accompanied by serious obesity related conditions
The primary goal in managing and treating obesity is to decrease a patient's medical risk and improve quality of life. An appropriate weight management program combines physical activity, diet, behavioral modification, psychological counseling and sometimes drug therapy to help patients achieve weight loss or prevent further weight gain. Surgery is reserved for patients who have repeatedly failed to lose weight by all other means (diet, exercise, behavioral and drug therapy), and this is the last resort. Surgical treatment is medically necessary because it is the only proven method of achieving long-term weight control for the morbidly obese.
Weight loss surgery is major surgery. Although most patients enjoy an improvement in obesity-related issues such as mobility and self-esteem after weight loss surgery, this should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer. You should make the decision to have weight loss surgery only after careful consideration and consultation with an experienced bariatric surgeon or a knowledgeable family physician.
A qualified surgeon should answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required. They may, as part of routine evaluation for weight loss surgery, require that you consult with a dietitian/nutritionist and a psychiatrist/therapist. This is to help establish a clear understanding of the post- operative changes in behavior that are essential for long-term success.
It is important to remember that there are no guarantees in any kind of medicine or surgery. Weight loss surgery will succeed only when the patient makes a lifelong commitment. Surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.
As with any surgery, weight loss surgery has its risks. That's why North Shore-LIJ’s highly skilled surgeons carefully assess which patients are candidates for bariatric surgery. They also use state-of-the-art equipment and procedures for the best possible results. The possible risks include:
- Anastomotic leak - leaking from the staple line around new connections
- Dehiscence - an opening or splitting of the surgical suture line
- Gastric fistula - may occur when there is abnormal connection with the stomach, usually to other organs in the body
- Pulmonary embolism - a blockage of an artery in the lungs that usually forms in the legs. Anti-clotting medications are given to patients to avoid this.
- Wound infection at the site of surgical incision
- Wound seroma - a mass at the site of surgical incision caused by fluid within the tissue
Bariatric surgery is typically extremely successful. However, there are rare instances (about 3 percent of cases) where a patient will experience problems like too much or too little weight loss. Follow-up bariatric surgery, known as revision surgery, may be performed to correct such issues.
To try to reduce some risk, you can do the following at least two months before surgery: increase physical activity, lose 10 percent of your body weight, quit smoking and stop drinking alcohol. Doing these things will also help your recovery.
Recovery includes six weeks with no strenuous activities. Most office and routine work can be resumed within three weeks. The Lap-Band recovery is typically a week. Most patients completely recover in six weeks to three months. How quickly you return to work will vary according to your physical condition and the nature of the work you do, as well as the type of weight loss surgery you had. Most patients are able to resume their jobs within six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure (e.g., laparoscopic sleeve DS, Lap-Band surgery) may be able to return to work in as soon as one to three weeks.
Weight loss will vary depending upon your weight prior to surgery. After your surgery, your choice of foods and level of activity will change. The majority of patients lose one-third of their original body weight within two years of surgery.
Any time you experience rapid weight loss, you can expect some hair loss. This is a temporary problem. It usually occurs during the third through eleventh months after surgery, the period than before.
Yes, as long as you have no other outstanding fertility problems. It is recommended, however, that patients who undergo the gastric bypass procedure wait at least two years after surgery to get pregnant.
Exercise is recommended to help tone the muscles and the skin. Some patients will want plastic surgery to help the problem areas, although we suggest patients wait for two years after weight loss surgery, because there will be less skin to remove and plastic surgery may not be necessary.
Weight loss surgery is only a tool that must be used to help control your weight. If you do not use the tool properly, you will regain some of the weight you lose. Weight loss surgery provides you with an opportunity to change your lifestyle and eating habits, thus making weight control easier in the long run.
Joining a support group is not required, although support groups have provided many weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most patients learn in support groups, for instance, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well being. Most bariatric surgeons will tell you that ongoing post- surgical support helps produce the greatest level of success for their patients.