Morbid Obesity

Morbid Obesity

Obesity is a true epidemic in the western and westernized world. In Greece, 35% of adolescent females and 31% of adolescent males are overweight. In the USA, 23% of adults are obese. Obesity is measured by the Body Mass Index, or BMI, which takes into consideration both the weight and the height of an individual. Someone with BMI higher than 35 is consider to have “morbid obesity”.

Management of morbid obesity should first be a combination of supervised diet and exercise programs, and the aim is the definitive relief from morbid obesity, that is the permanent return of BMI back to normal. However, most often patients can more easily lose weight, than keep their new lower weight; usually they tend to regain their initially lost weight. Thus, they keep following round after round of weight loss and regaining.

Is obesity a disease?

Obesity is not only a condition that makes people “uncomfortable”, or one with only psychological and social repercussions. It is a true disease. Patients with morbid obesity have a life expectancy of 20 years less than the rest of the population, and are faced with an average of 6 operations only to fix complications exclusively related to their state of obesity. In addition, the risk of complications after an operation not related to their obesity (i.e.: appendectomy, hernia repair, etc) is 100% higher compared to the non-obese. Patients with BMI higher than 30 have:

1. 35% risk for hypertension

2. 60% risk for Diabetes

3. 25% risk for coronary artery disease

4. sevenfold increased risk for gallstones

5. much higher risk for osteoarthritis, congestive heart failure, stroke, and sleep apnea

6. double risk for breast and colon cancer

7. three times higher risk for cancer of the uterus

8. higher chance to develop polycystic ovaries and infertility.

From all the above, it becomes obvious that morbid obesity should be considered as a severe disease and treated as such. Patients who fail to permanently lose weight and keep their new weight, despite three conscientious, supervised attempts consisting of diet and exercise should consider surgical treatment. There are several options for a surgical solution to morbid obesity, each with its advantages and disadvantages. Generally, a very detailed history should be taken, diet habits should be scrutinized, thorough blood analyses should be performed and then a long discussion should take place between the patient and the treating surgeon. According to the specifics of this analysis, the appropriate operation should be suggested to each individual patient.