We Understand Obesity

Simple facts on the complex illness of obesity and weight loss

Obesity is now the leading cause of preventable death in Canada and the United States. Over 60% of Canadians are categorized as being overweight or obese. Obesity is a serious medical problem facing Canadians.

Individuals with a BMI greater than 30 are at higher risk of being afflicted by health problems such as diabetes, heart disease, liver disease, sleep apnea and cancer. Obesity can affect the way you feel about yourself, give you a poor self-image and cause you to become socially isolated. The traditional remedy for being overweight is to exercise more while you eat less and eat sensibly. However, studies show that diets and commercial weight loss programs rarely produce sustained weight loss. Most people regain the weight they lose on a diet and some end up weighing even more. This pattern of yo-yo dieting in obese patients leads to a feeling of frustration, depression and very often patients will give up attempting to lose weight.

Not everyone who has a weight problem should consider surgery. It depends on whether or not you are overweight, obese, or morbidly obese. One way to tell is by your Body Mass Index (BMI), which depends on your weight and your height. The ideal BMI is between 19 and 25. If your BMI is greater than 27 you may be a candidate for one of our weight loss procedures.

 

What's your BMI?

BMI measures your weight/height ratio. It is your weight in kilograms divided by the square of your height in meters. For instance, if your height is 1.82 meters, the divisor of the calculation will be (1.82 * 1.82) = 3.3124. If you weigh 70.5 kilograms, then your BMI is 21.3 (70.5 / 3.3124).

The BMI assessment tool is not intended to be used for those under 18 or those over 65 years of age, pregnant and lactating women, and highly muscular individuals. BMI is only one tool and it is not perfect for all.

If you are concerned about your BMI results and need some personal advice, contact a patient coordinator

Classification of Obesity
Classification	BMI (Kg/m2)	Associated Health Risks
Underweight	< 18.5	Low
Normal	18.5 – 25	Minimal
Overweight	25 – 30	Slight Increase
Obese	30 – 35	High
Severely Obese	35 – 40	Very High
Morbidly Obese	40 - 50	Extremely High
Super Obese	>50	Extremely High

Causes of Obesity

Obesity is a chronic complex medical illness that was classified as a disease by the World Health Organization in 1997. There are many factors leading to obesity. The five main causes are discussed below:

1. Poor eating habits

Most people are aware that poor eating habits can affect your weight. Overeating is the most common cause of obesity, but failure to eat a balanced diet and unhealthy snacks between meals can also lead to obesity. If you get more energy from your food than you need, the body stores the excess calories as fat. If your body does not use the extra calories, you will gain weight.

2. Lack of physical activity

Lack of physical activity is a contributing factor to obesity. Individuals who are overweight find it harder to be physically active, which can contribute to even more weight gain. Obesity leads to back, hip, knee, and foot pain, which in turn further inhibits an active lifestyle and leads to increased obesity.

3. Family history

If you have family members who are obese, then you have a higher risk of obesity. Many people report being obese since childhood. Scientists have found many genes that may contribute to obesity. Genetic research shows that a number of metabolic processes, such as how fat is burned as well as feelings of satiety or fullness are not as effective in obese people.

4. Psychological factors

Many individuals use food as a source of comfort for psychological stress. They may eat in times of grief or anxiety. After diets fail, some people feel a sense of disappointment and may gain more weight than they lost with the diet. This can result in a vicious cycle of eating and dieting that will only make the person gain more weight.

5. Metabolic disorders

Metabolism refers to how your body utilizes energy from food. Every person has a slightly different metabolism, meaning that they use calories in varying degrees of efficiency. Many factors affect metabolism. Metabolic disorders (such as thyroid disease) are rarely the major cause of obesity, but can adversely affect an individual who is otherwise susceptible.

Risks of obesity

If you are obese, there are increased risks to your physical and psychological health. Studies show that obesity is directly linked to a reduced quality of life and that sustained weight loss restores the quality of life indicators to normal levels.

1. Health risks

Obese people have a higher risk of developing many health problems. The most common and most serious are:

• Diabetes
• Arthritis and joint problems
• High blood pressure
• High cholesterol
• Sleep apnea
• Asthma
• Coronary artery disease
• Cancer
• Gallbladder problems

If you are obese and have any of these conditions, such as diabetes or heart disease, they are likely to get worse over time. The more weight you gain, the greater the risk. As a result, your life expectancy may be shortened. Studies have shown that a 45-year-old man with a BMI of 45 may, on average, have his life expectancy shortened by up to 15 years. With a BMI > 30 there is a 70% increase in coronary artery disease, a 75% increase in stroke and a 400% increase in diabetes.

In women obesity can also affect fertility, meaning that you are less likely to become pregnant. If you do become pregnant while obese, you have a higher risk of health problems during pregnancy and childbirth.

2. Psychological risks

People with a weight problem often report having a negative self-image and suffer from low self-esteem and social isolation. Depression is very common in patients who are morbidly obese. There is significant improvement in all of these issues in individuals who are successful at losing weight and maintaining the weight loss.

3. Social discrimination

Obese people can suffer from discrimination, which can affect their employment opportunities and earning potential as well as their personal relationships.

Non-surgical treatment options

The traditional approach for losing weight is to eat less and do more physical activity. Weight loss is a function of how many calories are consumed and how many are burned. If you are severely obese, this approach may not be enough to ensure significant and lasting success. The decision to abandon a diet and exercise program is commonly made during times of stress or anxiety. Many who lose weight gain it back quickly when the diet ends. The cycle of losing weight and gaining it back is called the “yo-yo effect”. While temporary weight loss can help, the yo-yo effect can make it harder to lose weight in the future. This repeated failure of sustained weight loss can lead to feelings of disappointment and depression.

Recent published scientific reports (Annals of Internal Medicine – Jan 2005) document that non-operative methods alone have not been effective in achieving a medically significant long-term weight loss in morbidly obese adults. The average weight reduction in a 10-12 week trial of non-surgical methods produced an average weight loss of 2.5 kg. The use of behaviour modification, diet and exercise show that the initial optimistic results are not sustained. Most commercial weight loss programs suffer from high dropout and failure rates. The cost of these programs contributes to frustration if a person fails to achieve their goals.

Dieting often causes depression, anxiety, irritability, weakness and preoccupation with food. The goal of any treatment plan for obesity should be an improvement in health, achieved by a sustainable weight loss that reduces life-threatening risk factors and improves the performance of the activities of daily living.

Comparison of surgical treatment options

When non-surgical methods of weight loss have not proved successful, there are other options. In addition to the Lap-Band Program that the Surgical Weight Loss Centre offers, there are other surgical weight loss options available, however, they are much more invasive and pose higher risks.

There are 3 categories of obesity surgical treatment:

• Restrictive – Weight loss is achieved solely by reducing intake of calories and enhancement of the early sensation of satiety
• Malabsorptive – shortens the digestive tract to limit the number of calories and nutrients than can be absorbed.
• Combination – restricts the amount of food the stomach can hold and reduces the number of calories absorbed by altering the digestive tract.

Laparoscopic Adjustable Gastric Banding
(LAGB or Lap-Band surgery)

The laparoscopic adjustable gastric banding (Lap-Band) surgery restricts the amount of food the stomach can hold by placing an inflatable silicone band around the upper part of the stomach. The new, small upper stomach pouch limits the amount of food that can be consumed at one time and a narrowed stomach outlet increases the time it takes for the stomach to empty. The subsequent reduction in food intake results in weight loss.

Advantages

• Lowest mortality rate
• Least invasive surgical approach
• No stomach stapling or cutting or intestinal re-routing
• Adjustable
• Reversible
• Lowest operative complication rate
• No malabsorption of nutrients

Disadvantages

• Slower initial weight loss than Gastric Bypass or BPD (which may be an advantage since it may mean less potential breakdown of muscle during weight loss)
• Regular follow-up critical for optimal results
• Requires an implanted medical device
• In less than 5% of cases, effectiveness can be reduced due to band slippage
• In less than 2% of cases, the access port may leak and require minor revisional surgery

This surgery is offered at the Surgical Weight Loss Centre. Click here for more information.

Biliopancreatic Diversion (BPD)

Biliopancreatic Diversion (BPD) is a malabsorptive procedure and is a more extreme alteration of the digestive process. Roughly three-fourths of the stomach is removed and the stomach pouch is connected to the final segment of the small intestine. By diverting food through this new "limb," the nutrients are separated from the bile and pancreatic enzymes that would break them down.

As a result, BPD greatly reduces nutrient absorption and caloric intake.

Advantages

• Greatest amount of initial weight loss due to the high levels of malabsorption
• Allows larger meals because of larger stomach pouch
• Higher total average weight loss reported than with Gastric Bypass or Lap-Band

Disadvantages

• Requires cutting and stapling of stomach and bowel
• More operative complications than with Lap-Band, VBG or Gastric Bypass
• Portion of digestive tract is bypassed, reducing absorption of essential nutrients
• Requires lifelong monitoring for protein malnutrition, anemia and bone disease
• Increased risk of intestinal irritation and ulcers
• Non-adjustable
• Extremely difficult to reverse
• "Dumping syndrome" can occur
• Highest mortality rate as compared to other procedures

This surgery is not offered at the Surgical Weight Loss Centre.

Gastric Bypass

Gastric Bypass (also known as the Roux-en-Y) is a combination procedure using both restrictive and malabsorptive elements. With this surgery, first the stomach is stapled to make a smaller pouch. Then most of the stomach and part of the intestines are bypassed by attaching (usually stapling) a part of the intestine to the small stomach pouch. The result is that you cannot eat as much and you absorb fewer nutrients and calories.

Advantages

• Rapid initial weight loss
• Minimally invasive approach is possible

Disadvantages

• Cutting and stapling of stomach and bowel are required
• More operative complications than with Lap-Band
• Portion of digestive tract is bypassed, reducing absorption of essential nutrients
• Medical complications can occur due to nutritional deficiencies
• "Dumping syndrome" can occur
• Non-adjustable
• Extremely difficult to reverse
• Higher mortality rate than Lap-Band procedures

This surgery is not offered at the Surgical Weight Loss Centre.

Gastric Sleeve

The gastric sleeve procedure involves dividing the stomach into a tube or sleeve and removing the rest of the stomach. It was originally designed as the first stage of the BPD procedure described above. It is purely restrictive and does not cause any malabsorption. There are no long term studies available to show whether the initial weight loss is sustained. Significant concern exists that the sleeve will dilate and the stomach will resume its previous capacity leading to weight regain.

Advantages

• Rapid initial weight loss
• Minimally invasive approach is possible

Disadvantages

• Cutting and stapling of stomach is required
• More operative complications than with Lap-Band
• Portion of the stomach is removed
• Non-adjustable
• Non-reversible
• Significant risk of weight regain in 2 – 3 years when the stomach sleeve dilates
• Higher mortality rate than Lap-Band

This surgery is not offered at the Surgical Weight Loss Centre