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Co-morbidities of Obesity
Diabetes Mellitus
Type 2 Diabetes represents over 85% of diabetes (Type 1 representing about 15%). Obese people are 40 times as likely to develop Type II Adult-Onset Diabetes. Up to 80% to 90% of diabetes type 2 is related to obesity. Sixteen million people have Diabetes type 2 and unfortunately about one third do not know they are diabetic. Because of these facts, if you are not known to be diabetic, we will screen you to make sure.
Obese individuals develop a resistance to insulin, which regulates blood sugar levels. Over time, the resulting high blood sugar can cause serious damage to the body. Diabetes is the #4 cause of death in the United States. Elevation of the blood sugar, the essential feature of Diabetes, leads to damage to tissues throughout the body: Diabetes is the leading cause of adult-onset blindness, a major cause of kidney failure, and the cause of over one half of all amputations. Diabetes contributes significantly and is a major risk factor to coronary artery disease and peripheral vascular disease. We know that the longer you have Diabetes the worse it is.
Significant and durable weight loss like the kind achieved by weight loss surgery is the only known “cure” for type 2 diabetes. The effect of weight loss surgery on diabetes type 2 is one of the most amazing effects of this surgery. A recent article in the Journal of the American Medical Association shows that weight loss surgery completely resolves diabetes in 76.8% and significantly improves diabetes in 86% of patients. Weight loss surgery has been shown to dramatically impact the mortality of diabetic patients. Obese diabetics who did not have weight loss surgery in this study had 5 times the risk of dying compared to those who had weight loss surgery.
Sleep Apnea Syndrome
Sleep apnea, the cessation of breathing during sleep, is often caused in the obese person by soft tissue collapse and compression of the neck, the palate and the tongue. This can cause intermittent obstruction of the air passage, closing the airway to the lungs especially when lying down. It leads to loud snoring, and periods of complete obstruction, during which no air gets in at all.
The sleeping person sounds to an observer like they are holding their breath, but the sleeper is usually unaware that the problem is occurring at all. The oxygen levels in the system decrease, the carbon dioxide builds up and the patient wakes up repeatedly during the night (up to over a hundred times), although they may be unaware of doing so. The patient sometimes is only aware that they sleep poorly. Affected persons awaken exhausted and often fall asleep during the day, sometimes even at the wheel of their car, are irritable and complain of being tired all the time. The health effects of this condition may be severe, high blood pressure, right heart failure, cardiac rhythm disturbances, and sudden death. This condition really has a high mortality rate, and is a life-threatening problem.
Obesity Hypoventilation Syndrome
With significant obesity, the weight of the soft tissues literally limits how big a breath a person may take. This condition is clinically important in the very severely obese – usually over 350 lbs. It is characterized by episodes of drowsiness, or narcosis (sleepiness from carbon dioxide build up and lack of oxygen), occurring during awake hours. Accumulation of toxic levels of carbon dioxide occurs in the blood. It is often associated with sleep apnea, and may be hard to distinguish from it.
 Difficulty Breathing (Dyspnea) with Minimal Exertion
Obese persons find that exercise causes them to be out of breath very quickly, during ordinary activities. The lungs are decreased in size, and the chest wall is very heavy and difficult to lift. At the same time, the demand for oxygen is greater in an obese person with any physical activity. It is literally like carrying a 100-pound plus pack on your back. This condition prevents normal physical activities and exercise, often interferes with usual daily activities, such as shopping, yard-work or stair climbing, making even ordinary living difficult or miserable, and it can become completely disabling.
Heartburn/Reflux Disease, Nocturnal Aspiration Syndrome, Asthma, and Bronchitis
Gastro Esophageal Reflux Disease (GERD) is common, but much more common and more severe in the obese. The pressure in the abdominal cavity is substantially elevated in the obese. This fact in the obese interacts with some more common physiologic causes of GERD. The burning pain in the mid chest (heartburn) can be severe and often necessitates regular stomach acid blocking medications. However, sometimes GERD can be hidden. The stomach acid may burn the esophagus and cause esophagitis (mild to severe inflammation). The esophagus may become strictured, or scarred and constricted, causing trouble with swallowing.
Whether the reflux is symptomatic or not, approximately 10 - 15% of patients with even mild symptoms of heartburn will develop a condition called Barrett's esophagus, which is a pre-cancerous change in the lining of the esophagus, a cause of esophageal cancer. Sometimes regurgitation type symptoms are prominent. Some patients with GERD will bring up acid into the throat, where it can go down the lungs where it doesn’t belong. This can burn the vocal cords and cause laryngitis. When the stomach contents are inhaled, it can cause choking and coughing especially at night. It can cause bronchitis, pneumonia, and/ or lung injury. This is called nocturnal aspiration syndrome.
Obesity is associated with a higher rate of asthma (reactive airway disease) overall, about 3 times normal. It is said that up to half of adult onset asthma is caused by GERD. Reactive airways are often caused by acid reflux (described above), which can irritate a sensitive airway and provoke an asthmatic attack. The improvement of asthma after surgery is often very dramatic, even before much weight loss has occurred.
Weight loss surgery is curative of GERD and is the procedure of choice for morbidly obese patients for GERD treatment. Previous conventional laparoscopic reflux surgery (which we perform on non-obese patients) actually is a relative contraindication for weight loss surgery because it scars the stomach and esophagus. It will make subsequent weight loss surgery dangerous.
Heart Disease
Severely obese persons are approximately 6 times as likely to develop heart disease as those who are normal-weighted. Heart disease is the leading cause of death in the United States today, and obese persons tend to develop it earlier in life. Coronary artery disease causes heart attacks and congestive heart failure, and sudden death in obese people. Severely obese persons are 40 times as likely to suffer sudden death, in many cases due to cardiac rhythm disturbances.
Coronary artery disease (CAD) has a number of risk factors. Risk factors that are unrelated to obesity include male, age, family history, and smoking. However, every other known risk factor is directly related to obesity, specifically: diabetes, lipid problems (high cholesterol and triglycerides), high blood pressure, and lack of physical activity. In addition, OBESITY by itself is an independent risk factor for CAD. Increased load on the heart and destruction of heart muscle from heart attacks all too often leads to early development of congestive heart failure. Significant weight loss will decrease if not alleviate most or all of the obesity related risk factors. Significant weight loss will decrease the risk of death from CAD by more than 40%.
High Blood Pressure (Hypertension)
Excess body weight strains the heart. Obesity explains more than 30% of hypertension and morbid obesity doubles the high blood pressure risk. Hypertension, leads to development of coronary artery disease, and damage to the blood vessels throughout the body, causing susceptibility to strokes, kidney damage, and hardening of the arteries. If your doctor finds you have high blood pressure, the first thing he or she will recommend to you is weight loss.
High Blood Cholesterol
Cholesterol levels are commonly elevated in the severely obese -- another factor predisposing to development of heart and blood vessel disease. This abnormality is not just related to diet, but is an effect of the massive imbalance in body chemistry and metbolism which obesity causes.
Stress Urinary Incontinence
Most morbidly obese women have stress urinary incontinence to the point that they have to wear pads. A large heavy abdomen and the pressure inside the obese abdomen , along with relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened. This leads to leakage of urine with coughing, sneezing, or laughing. . The discomfort, inconvenience and embarrassment are often overwhelming. This condition is strongly associated with being overweight, and is usually relieved by weight loss.
Menstrual Irregularities and Infertility.
Morbidly obese women often experience disruptions of the menstrual cycle, including interruption of the menstrual cycle, abnormal menstrual flow and increased pain associated with the menstrual cycle. This is a problem of itself, but obesity can cause the inability or diminished ability to produce offspring. This is probably because of an estrogen-like compound produced by the fat that “confuses” the reproductive system. This “un-opposed estrogen” is probably the cause of several of the obesity associated conditions. Women can see other effects of the abnormal hormone environment that occur with obesity, such as hirsutism (excess hair growth). Weight loss surgery will help normalize the body’s hormonal environment.
We strongly caution women to use effective birth control methods during their precipitous weight loss after weight loss surgery (about a year and a half). Women who are convinced they are infertile can become fertile at any time during the weight loss process. It possible to have healthy pregnancies after weight loss surgery, however women should not get pregnant in the first year and a half after surgery.
Arthritis of Weight Bearing Joints (Degenerative Joint Disease)
The spine, hips, knees, ankles and feet have to bear most of the weight of the body. These joints tend to wear out more quickly, or to develop degenerative arthritis much earlier and more frequently, than in the normal-weighted person. Eventually, joint replacement or other surgery may be needed, to relieve the severe pain. Unfortunately, joint replacement has much poorer results in the obese.
The entire weight of the upper body falls on the base of the spine and over time, causes it to wear out and cause pain. The consequence may be accelerated arthritis of the spine, or "slipped disk", when the cartilage between the vertebrae squeezes out. Either of these conditions can cause irritation or compression of the nerve roots, and lead to sciatica -- a dull, intense pain down the outside of the leg. Many orthopedic surgeons refuse to perform the surgery in severely overweight patients. Orthopedic surgery is dangerous in the morbidly obese.
Over 80% of morbidly obese people have been show to be on regular Non Steroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen. Some of the best drugs for symptomatic relief called Cox-2 inhibitors like Vioxx, Celebrex, Bextra, etc have been suspected of increasing cardiovascular disease. Steroids whether injected or taken systemically make obesity worse. The worse the arthritis and pain gets, the less mobile the obese person is.
Venous Stasis Disease and Pulmonary Embolism
The veins of the lower legs carry blood back to the heart, and within them is a delicate system of one-way valves, to allow them to carry blood "uphill" against gravity. The pressure of a large abdomen increases the load on these valves, eventually causing damage or destruction. Blood clots also can form in the legs, further damaging the veins. The blood pressure in the lower legs then increases, causing swelling and damaging pressure to the skin. This condition is called chronic venous stasis. This condition can cause or lead to terrible skin problems on the lower legs with hardening and discoloration of the skin, and ulceration.
Clots that form in these deep veins of the legs can also break free and float into the lungs -- called a Pulmonary Embolism -- a serious or even fatal event. Obesity is a known risk factor for blood clots of the leg veins (deep venous thrombosis) and blood clots that may travel to the lungs.
Increased Risk of Cancer
A New England Journal of Medicine article has recently confirmed the suspicions of a lot of physicians specifically about Morbidly Obese people (BMI > 40). Morbid Obesity increases ones chances of suffering from some cancers like breast, uterine, colon, and prostate cancers. In fact, current patterns of obesity in the US suggest: that 14 % all deaths from cancer in men and 20 % all deaths from cancer in women can be attributed to Morbid obesity.
Emotional/Psychological Illness and Depression
Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, stares and remarks from strangers. There can be serious self-esteem issues. Though there is not a higher rate or incidence of “mental illness” in the morbidly obese population, the incidence of depression is high. There is no wonder, that anxiety and depression are common in the morbidly obese.
Social Effects
Seriously obese persons suffer inability to qualify for many types of employment, and discrimination in employment opportunities, as well. They tend to have higher rates of unemployment, and a lower socioeconomic status. Ignorant persons often make rude and disparaging comments, and there is a general societal belief that obesity is a consequence of a lack of self-discipline, or moral weakness. Many severely obese persons find it preferable to avoid social interactions or public places, choosing to limit their own freedom, rather than suffer embarassment.
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 Health Threat of Morbid Obesity: Obesity is deadly.
In summary, all the comorbidities listed on this page in combination make Morbid Obesity a fatal condition. Morbid obesity clearly means a shorter life expectancy (literally on average 10 to 15 years less) in comparison of normal weighted individuals. For individuals whose weight exceeds twice their ideal body weight (that's about 2-6% of the U.S. population), the risk of an early death is doubled compared to non-obese individuals. An article in the Journal of the American Medical Association in 2003 outlined the years of lost life for individuals that suffer from Morbid Obesity at various age ranges. Their studies show that some groups can have up to a 20% shorter life due to their over weight. What are you willing to do to live up to ten to fifteen years longer, and do it with a markedly better quality of life?
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This program is designed and was conceived to benefit the people of Wyoming, with our unique circumstances: large traveling distances, small populations, weather