Diet and medications may have little beneficial results in those with morbid obesity. Weight loss surgery may be a viable alternative for long-term weight reduction and improved health. Bariatric surgery is increasingly becoming popular especially gastric by-pass which is mostly suitable for those with a Body Mass Index of 40 and above or Morbid Obesity. It is important to note that this procedure is not for everyone and it is not an end itself. Consistent lifestyle modifications with lifelong adjustments are required even after gastric bypass surgery.
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Bariatric surgery have been considered as an alternative therapy for more than 50 million Americans when dieting, exercise and other means of treatment have failed or not promising. Obesity rise correlates with increase in cases of Heart disease, stroke, type 2 diabetes, hyperlipidaemia, cancers, depression, hypertension and other degenerative illnesses. Hence, those with a BMI greater than 35 with coexisting debilitative health conditions like Obstructive sleep apnea, arthropathies, diabetes etc may benefit from weight loss surgery.
Globally, these comorbid illnesses account for more than 2. 1 million deaths. There is a 22% reduction in life expectancy and qualitative life in a 25-year old morbidly obese man which approximates to almost 12 years of loss of life worsened by the fact that effective long-lasting dieting and exercise therapy for Morbid obesity is lacking.
Indications for Weight Loss Surgery
A Body Mass Index exceeding 40 or 35 in the presence of other comorbid or Obesity related conditions like: severe arthritis, obstructive sleep apnea especially when other common methods like dieting and exercise have failed. Though Gastric bypass surgery accounts for almost 61% of weight loss, it should be opted for as a last resort.
Co-morbidity: 177 morbidly obese patients with type 2 diabetes who underwent gastric bypass surgery between 1993 and 2003 were examined by researchers at Virginia Commonwealth University. Almost 90 percent of the patients saw their blood sugar levels returned to normal while about 60 percent were still diabetes-free five to fifteen years after the weight reduction procedure. Those with fluctuating sugar levels were the patients who were insulin-dependent before the surgery. Concomitant usage of oral medications for diabetes control in 75 percent of these patients rendered them diabetes free compared to 30 percent who were insulin-dependent prior to surgery.
Age
The acceptable age range is 18-65 years. Patients less than 18 years must require urgent weight reduction because co-morbid life-threatening maladies related to morbid obesity. Most patients above 65 years have co-morbid health conditions related to morbid with the likelihood of negative impact on the quality of life and life expectancy. The benefit or expectation of improved quality of life or life expectancy should outweigh the risk of surgery.
Family History
Weight loss surgery is indicated for those patients who are at risk "high risk for obesity-associated morbidity or mortality" according to the NIH report.
Bariatric operation will prevent the progression or generation of these comorbid conditions eventually sparing these patients the comorbidity and mortality.
Comorbid Health conditions related to Obesity
Hypertension Obstructive sleep apnea Type 2 Diabetes Hypercholesterolaemia Hypertriglyceridaemia Metabolic syndrome Coronary artery disease Gall stones Urinary stress incontinence Heart failure Stroke Depression Infertility Dysmenorrhea Osteoarthritis Deep veinous thrombosis Gastro-esophageal reflux disease Breast cancer Colon cancer Gall bladder cancer
In summary, the guidelines for weight loss surgery are confined within:
Age Body mass index Inability of conventional weight loss programs to achieve sustainable weight loss Occurence of co-morbid health maladies to morbid obesity Presence of family history of co-morbidities connected to morbid obesity.
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