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Risks of Remaining Obese - Risks of NOT Having Weight Loss Surgery
Every year, literally thousands of Americans DIE of obesity related diseases. More specifically, severely overweight people progressively develop diseases directly related to obesity that can lead to their death. These diseases and other problems related to obesity can cause a lot of expense and misery. What is amazing is that most of these diseases and problems resolve or nearly completely resolve with significant durable weight loss.
In the most recent data, 15% to 19% of Wyoming residents are considered obese (BMI ≥ 30, or 30 lbs overweight for a 5’ 4” woman). At least five percent of the people in Wyoming are morbidly obese, meaning that a conservative estimate would be that 20,000 plus people in Wyoming qualify for (are at risk and in need of) weight loss surgery.
What does it mean to be Morbidly Obese?
In short it means that your weight causes life threatening health problems (makes you sick) and/or causes problems in your life (physical, emotional, etc.). Medically, the word "morbid" means causing disease or injury. Morbid Obesity is a serious disease process, in which the accumulation of fatty tissue on the body becomes excessive, and interferes with, or injures the other bodily organs, causing serious and life-threatening health problems, which are called co-morbidities.
There are also specific weight criteria that have been assigned because at specific levels of obesity, there is a high likelihood of health problems. (Please see our web page to calculate whether you are morbidly obese.) This is where you can learn what a body mass index (BMI) is and calculate your BMI. It is concerning that too many morbidly obese people.
- Do not know that they are morbidly obese.
- May already have diseases that are related to their weight, do not realize the connection, and do not realize that without weight loss, these diseases are progressive.
- Are at risk for developing life threatening diseases over time.
Obesity related diseases (co-morbidities) include but are not limited to diabetes, obstructive sleep apnea, heart failure, coronary artery and vascular diseases, high blood pressure, high blood lipids and cholesterol, gastro-esophageal reflux (which can cause reactive airway disease), liver disease, and fatal blood clots. As a function of their obesity people can also suffer from degenerating joints, urinary incontinence, infertility and menstrual problems, vein diseases and leg ulcers that do not heal. They are at increased risk for certain types of cancer. Please read more about these obesity related diseases in our section on Obesity Related Diseases (Cormorbidities).
In addition to the health problems, many morbidly obese patients are subjected to many social and relationship problems. Properly fitting clothes are difficult to find, restaurant, theater and airplane seats are small and uncomfortable, health insurance is more difficult and more expensive to obtain, and job opportunities may not be made available.
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What is the cause of Morbid Obesity?
The causes for obesity are multiple and complex. It is not simply a result of overeating and too little activity, despite how many times you have heard it simply explained that way – even by your health care providers. Unfortunately, medical science has not yet explained the causes of obesity- yet. The ultimate biologic basis of severe obesity is unknown according to the National Institutes of Health.
 A weight gain cycle seems to develop in people who become morbidly obese. Due to modern American poor eating habits, social encouragement and temptation, and sedentary lifestyles the cycle starts to play upon genetics. But for those who are vulnerable it doesn’t stop with just the gaining of a few pounds. It appears that the excess fat becomes a detrimental metabolic machine that only worsens obesity. This is incompletely understood; however there are some known contributing mechanisms, including hormonal changes that occur as more and more fat is accumulated on the body. Treatment diseases related to obesity such as diabetes and arthritis with medication can contribute to the worsening of obesity. As an obese person begins to have problems with reduced ability to stay active, often due to arthritis of weight bearing joints, their energy expenditure goes down. Coupled with the psychic stress, poor self-image, and depression related to progressing obesity, each component of the weight gain cycle keeps it turning and worsening obesity. There are also factors that contribute that have to due with why diets do not work – the yo-yo dieting effect. Read more about this influence of yo-yo dieting on weight gain on our web page dealing with alternatives to weight loss surgery.
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Contributing Factors to the Weight Gain Cycle
Genetic Factors
According to medical research, a significant underlying cause of morbid obesity is genetic. It is not known if this genetic problem could be an inborn error of metabolism, an impaired ability to be satisfied with normal amounts of food, abnormal fat metabolism, or abnormal conversion of ingested calories to fat, but the research goes on. It seems obvious to some of us that obesity runs in families. Obesity is not completely explained by the eating and activity habits that these families have in common. Numerous scientific studies have established that genes play an important role in the tendency to gain excess weight.
- The body weight of adopted children shows no correlation with the body weight of their adoptive parents, who feed them and teach them how to eat. Their weight does have an 80 percent correlation with their genetic parents, whom they have never met.
- Identical twins, with the same genes, show a much higher similarity of body weights than do fraternal twins, who have different genes.
- Mice can be bred, which are very obese. This is the result of a defect in a single gene, called the ob gene, which is associated with the ability to make a hormone, called leptin. The problem in humans is much more complicated genetically, with over 100 genes involved in some aspect of obesity.
- Another hormone has recently been discovered, called ghrelin, which stimulates appetite in normal persons. Persons who lose weight by dieting have persistently elevated ghrelin levels, urging them to eat more. Persons who undergo a gastric bypass have a decrease in ghrelin levels by about 77%, indicating one mechanism of how the operation reduces appetite.
- Certain groups of people, such as the Pima Indian tribe in Arizona, have a very high incidence of severe obesity. They also have significantly higher rates of diabetes and heart disease than other ethnic groups.
The Pima Paradox
The Pima Indians are known in scientific circles as one of the heaviest groups of people in the world. In fact, National Institutes of Health researchers have been studying them for more than 35 years. Some adults weigh more than 500 pounds, and many obese teenagers are suffering from diabetes, the disease most frequently associated with obesity.
But here's a really interesting fact - a group of Pima Indians living in Sierra Madre, Mexico, does not have a problem with obesity and its related diseases. Why not?
The leading theory states that after many generations of living in the desert, often confronting famine, the most successful Pima were those with genes that helped them store as much fat as possible during times when food was available. Now those fat-storing genes work against them.
Though both populations consume a similar number of calories each day, the Mexican Pima still live much like their ancestors did. They put in 23 hours of physical labor each week and eat a traditional diet that's very low in fat. The Arizona Pima live like most other modern Americans, eating a diet consisting of around 40 percent fat and engaging in physical activity for only two hours a week.
The Pima apparently have a genetic predisposition to gain weight. And the environment in which they live - the environment in which most of us live - makes it nearly impossible for the Arizona Pima to maintain a normal, healthy body weight. |
Environmental Factors
Environmental and genetic factors are obviously closely intertwined. If you have a genetic predisposition toward obesity, then the modern American lifestyle and environment may make controlling weight more difficult.
Fast food and the modern American sedentary life often includes long days sitting at a desk, the computer, and in front of the TV. The American lifestyle magnifies hereditary factors such as metabolism and efficient fat storage.
Metabolism
We used to think of weight gain or loss as only a function of calories ingested and then burned. Take in more calories than you burn, gain weight; burn more calories than you ingest, lose weight. But now we know the equation isn't that simple.
Obesity researchers now talk about a theory called the "set point," a sort of thermostat in the brain that makes people resistant to either weight gain or loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you lost.
Medical Conditions
There are medical conditions, such as hypothyroidism, that can also cause weight gain. That's why it's important that you work with your doctor to make sure you do not have a condition that should be treated with medication and counseling. Once Diabetes occurs, it becomes even much harder to lose weight, because of hormone changes which cause the body to store fat even more than before. It is known that the medications to treat diabetes contribute to weight gain. Oral medication and insulin itself leads to progressive weight gain. Steroids that are used to treat arthritis and often worsen obesity, only to load more weight onto weight bearing joints. The progressive immobility of arthritis of weight bearing joints worsens the problem.
In summary
Medical science will continue to search for better answers. But until the disease is better understood, the control of excess weight is something patients must work at for their entire lives. It is a lifelong disease that needs a lifelong solution. That is why it is very important to understand that all current medical interventions, including weight loss surgery, should not be considered medical cures. Rather they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease. Surgical weight loss is a tool, not a cure.
Find our more about qualifying for surgery from the standpoint of your insurance company's criteria on our Financial and Insurance Info page.
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