The term ‘morbid obesity’ is used for very overweight people (where the word morbid refers to disease). Very obese people have a strikingly shorter life expectancy (reduced by 5 to as much as 20 years).
Insulin resistance and type 2 diabetes (abnormal glucose metabolism), dyslipidemia (abnormal blood fats) and hypertension are all common consequences of severe obesity.
Each of these is a significant illness and is considered a ‘silent killer’ as they accelerate the process of atherosclerosis (hardening of arteries) which in turn causes heart attacks and strokes.
Having all 3 conditions exponentially increases the risk of vascular disease developing.Currently, bariatric surgery provides by far the best chance at reversing the disease process and complications of obesity. Following surgery, medications used to treat type 2 diabetes, dyslipidemia and hypertension can usually be decreased or stopped.
Other debilitating consequences of obesity include osteoarthritis, fibromyalgia (muscular pain and stiffness), gastro-oesophageal reflux disease, urinary incontinence, and depression. Indeed, the list of serious medical conditions associated with obesity is very long.
Due to profound changes in the weight-regulation centre of the brain (in the hypothalamus) weight control mechanisms malfunction and it becomes impossible to rectify the problem with attempts at exercise and dieting. This may further lead to feelings of hopelessness and failure.
Obesity surgery corrects this weight-regulation centre malfunction enabling weight loss. GERD, urinary incontinence and fibromyalgia gets much better once weight comes down, and depression & arthritis may also improve.
Obstructive sleep apnoea is almost always present to a greater or lesser degree in very obese patients. Due to fat tissue creating an obstruction in the airways and made worse by abdominal and chest wall fat impeding lung expansion, people literally stop breathing for short periods during the night. This leads to poor quality sleep and feeling tired all the time. Worse still, severe lung disease (pulmonary hypertension) and heart failure often develop.
Successful weight loss results in obstructive sleep apnoea disappearing.
Cancers (like cancer of the colon, breast, ovary or pancreas) are far more common in obese people. This is due to dysfunctional growth hormones, including insulin.
Currently, bariatric surgery provides by far the best chance at reversing the disease process and complications of obesity. The risks for cancer and heart disease as well as life expectancy significantly improve.
Finally, bariatric surgery aims to fundamentally improve the long-term health trajectory for each patient and should be viewed as a very important step in life’s journey with the chronic disease entity of obesity.
It should not be viewed as a destination or an endpoint. Appropriate follow-up after surgery is crucial. Weight regain needs to be avoided and co-morbid conditions need to continue to be managed. Experts recommend lifelong monitoring of organ function and screening for macro- and micronutrient deficiencies and this requires visits to healthcare professionals, blood tests and, at times, other investigations.
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