Bariatrics

The branch of medicine that deals with the causes, prevention, and treatment of obesity. This includes the discipline of bariatric surgery, which is commonly called weight loss surgery.

Arthritis

Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Most patients with morbid obesity have degenerative arthritis, which is the erosion of the joint lining from excess pressure caused by weight. The damage from degenerative arthritis cannot be reversed, but if excess weight is removed then further damage can be prevented.

Congestive Heart Failure (CHF)

A condition where there is ineffective pumping of the heart, leading to an accumulation of fluid in the lungs. Typical symptoms include shortness of breath with exertion, difficulty breathing when lying flat and leg or ankle swelling. Causes include chronic hypertension, cardiomyopathy and myocardial infarction. Most patients with morbid obesity actually have normal heart function, but the load caused by the excess weight is too much for the heart to keep up with so they become easily short of breath.

Diabetes

Tendency for blood sugar levels to be elevated, sometimes to a dangerous degree. Steady elevation of the blood sugar above normal causes ongoing damage to the nerves and blood vessels, and a higher chance of infection from any minor injury. A common result of advanced diabetes is foot infection that requires leg amputation. Other common complications of diabetes are loss of eyesight or loss of kidney function. Most people who have diabetes with obesity have plenty of insulin (the hormone that controls blood sugar) but the fat tissues do not react normally to the insulin – this is called Type 2 Diabetes. Weight loss surgery puts diabetes into permanent remission most of the time.

Dysmenorrhea (menstrual irregularity, infertility)

Any abnormality of a woman’s menstrual cycle, such as absence of menses, heavy bleeding, or irregular menses. All of these are frequently associated with the inability of a couple to achieve a pregnancy or to carry a pregnancy to term after one year of unprotected intercourse, which is the medical definition of infertility. In women with morbid obesity, it turns out that the fat cells (which secrete a tiny amount of hormone from each

cell) put out enough hormones to throw the entire system out of balance. Many of our weight loss surgery patients who were infertile prior to surgery can safely carry a child after surgery (once weight is stabilized — it is VERY IMPORTANT to avoid pregnancy while the patient is still losing weight.)

Edema

Retaining excess fluid in the tissues. Patients with morbid obesity often have edema of the legs, which they experience as leg swelling. This is usually caused by abdominal pressure that impairs blood flow out of the legs, though in advanced (severe) cases the swelling might also be caused by heart failure.

GE reflux disease (GERD)

The stomach contents regurgitate and back up (reflux) into the esophagus. The food in the stomach is partially digested by stomach acid and enzymes. Normally, the partially digested acid content in the stomach is delivered by the stomach muscle down into the small intestine for further digestion. With esophageal reflux, stomach acid content refluxes back up into the esophagus, occasionally reaching the breathing passages, causing inflammation and damage to the esophagus, as well as to the lung and larynx (the voice box). Morbidly obese patients experience much more reflux and heartburn than the normal weight population, because the increased abdominal pressure associated with obesity literally pushes fluids back up the esophagus. Almost all GERD improves significantly with weight loss. If a patient has really severe GERD, or damage of the esophagus so that it does not “pump” properly, then a gastric bypass is probably preferred over an adjustable Gastric Band or Gastric Sleeve.

Hernia

An abdominal incisional hernia is a weak area in the strong muscle layer that is supposed to contain the soft internal organs such as the intestine. Hernias are quite common in morbidly obese people, mostly arising from some prior surgical incision. The increased abdominal pressure associated with obesity interferes with the healing and “knitting” process that is needed for long term strength of the muscle layer after it has been cut for

surgery. This gap in the muscle layer allows a bulge of the soft tissues, which shows up as pain and a focal swelling. If the hernia is not treated (surgical repair) then the soft internal tissues such as intestine can become trapped in the hernia.

High blood pressure or hypertension

Arterial disease in which chronic high blood pressure is the primary symptom. Abnormally elevated blood pressure is very common in morbid obesity which leads to higher stress on the heart, with higher chance of heart attack and stroke. High blood pressure almost always improves and frequently resolves after weight loss.

Hypercholesterolemia, Hypertriglyceridemia

Condition of elevated cholesterol or triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinaemia IIb and hyperlipoproteinaemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. Elevated cholesterol and lipids are more common and more severe in morbidly obese patients. This condition almost always improves with weight loss, but about half of patients who are on lipid meds prior to weight loss surgery will still need the meds in the long run.

Metabolic Syndrome (previously called “Syndrome X”)

A group of metabolic abnormalities that all result from the primary disorder of insulin resistance (insulin resistance is the cause of Type 2 diabetes in morbidly obese patients).

All the metabolic abnormalities associated with Metabolic Syndrome can lead to cardiovascular disorders — when present as a group, the risk for cardiovascular disease and premature death are very high.

The characteristic disorders present in metabolic Syndrome include:

  • Insulin resistance
  • Hypertension (high blood pressure)
  • Abnormalities of blood clotting
  • Low HDL and high LDL cholesterol levels>
  • High triglyceride levels
  • Most patients with Metabolic Syndrome are morbidly obese. In most cases the features of Metabolic Syndrome will resolve after weight loss surgery.

Obstructive Sleep Apnea (OSA)

People with sleep apnea literally stop breathing repeatedly during their sleep, often for a minute or longer and as many as hundreds of times during a single night. Sleep apnea can be caused by either complete obstruction of the airway (obstructive apnea) or partial obstruction (obstructive hypopnea — hypopnea is slow, shallow breathing), both of which cause oxygen levels to drop below normal and cause loss of restful sleep. Patients feel chronically tired, have daytime drowsiness, and don’t feel rested when the alarm clock goes off. Someone in the family is usually complaining about snoring. This is a very underdiagnosed disorder — it is present in about 85% of morbidly obese patients. This almost always improves with substantial weight loss.

PCOS (Polycystic Ovarian Syndrome)

An endocrine (hormonal) disorder. Most often, symptoms first appear in adolescence, around the start of menstruation. However, some women do not develop symptoms until their early to mid-20’s. It affects women of all races and nationalities. No two women have exactly the same symptoms. The following characteristics are very often associated with PCOS, but not all are seen in every woman:

  • Hirsutism (excessive hair growth on the face, chest, abdomen, etc.)
  • Hair loss (androgenic alopecia, in a classic “male baldness” pattern)
  • Acne
  • Polycystic ovaries
  • Obesity
  • Infertility or reduced fertility

In addition, women with PCOS appear to be at increased risk of developing the following health problems during their lives:

  • Insulin resistance
  • Diabetes
  • Lipid abnormalities
  • Cardiovascular disease
  • Endometrial carcinoma (cancer)

Morbid obesity is a frequent underlying cause for PCOS, though not in all cases. In situations where morbid obesity and PCOS go together, significant weight reduction will often result in resolution of the PCOS as well.

Urinary incontinence

The involuntary release of urine. It often occurs during coughing or other forceful stresses. In many cases the leaking of urine is caused or worsened by the continuous pressure that obesity places on the bladder. In these cases we would expect weight loss to allow better bladder control.