What is Severe Obesity?
Severe obesity, otherwise known as “morbid obesity”, is defined using various methods. One of these methods uses Ideal Body Weight and is defined as being approximately 100 pounds (45.5 kg) or 100% above ideal body weight. This is determined according to the Metropolitan Life Insurance Company height and weight tables. Body Mass Index or BMI is calculated based upon a person’s height and weight, and is generally more accurate than ideal body weight calculations.
According to the Center for Disease Control (CDC), the rates of obesity have been increasing steadily with a prevalence of approximately 25 -30% in most US states. Morbid obesity is associated with the development of life-threatening complications such as hypertension, diabetes, sleep apnea, and coronary artery disease, to name a few.
Numerous therapeutic approaches to this problem have been advocated, including low calorie diets, medication, behavioral modification and exercise therapy. However, the only treatment proven to be effective in long-term management of morbid obesity is surgical intervention.
What Causes Severe Obesity?
The cause of severe obesity is poorly understood. Severe obesity is most likely a result of a combination of genetic, psychosocial, environmental, social and cultural influences that interact resulting in the complex disorder of both appetite regulation and energy metabolism. Severe obesity does not appear to be a simple lack of self-control by the patient.
What are the Treatment Options?
In 1991, the National Institutes of Health Conference concluded that non-surgical methods of weight loss for patients with severe obesity, except in rare instances, are not effective over long periods of time. It was shown that nearly all participants in any non-surgical weight-loss program for severe obesity regained their lost weight within 5 years. Although prescriptions and nonprescription medications are available to induce weight loss, there does not appear to be a role for long-term medical therapy in the management of morbid obesity. Weight gain is rapid once medication is withdrawn. Various professional weight loss programs use behavior modification techniques in conjunction with low calorie diets and increased physical activity. Weight loss of one to two pounds per week has been reported, but nearly all the weight loss is regained after 5 years.
A number of weight loss operations have been devised over the last 40-50 years. The most commonly performed operations include: Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding.
The gastric bypass procedure involves dividing the stomach into two compartments, forming a small gastric pouch. The new gastric pouch is connected to varying lengths of your own small intestine constructed into a Y-shaped limb (Roux-en-Y gastric bypass). The combination of reduction in the size of the stomach and the malabsorbtion with bypassing a portion of the intestine leads to significant weight loss.
The sleeve gastrectomy involves removal of 75 – 80% of the stomach. The reduced volume capacity of the stomach combined with the alteration in hunger/satiety hormones leads to significant weight loss.
The laparoscopic gastric band involves placing a 1/2 inch belt or collar around the top portion of the stomach. This creates a small pouch and a fixed outlet into the lower stomach. The gastric band has not been found to be very effective long-term and is not recommended by the surgeons at Lowell Surgical Associates.
At Lowell Surgical Associates, we also offer revisional bariatric surgical procedures. Most commonly this would involve removal of an adjustable gastric band, with conversion to a gastric bypass or sleeve gastrectomy. In very selected cases, patients with other failed bariatric surgical procedures or weight regain after a prior successful procedure may be candidates for revisional surgery.
Frequently Asked Questions
Bariatric surgery includes a variety of surgical procedures designed to induce significant weight loss. The two most common procedures done in the country and at Lowell General Hospital are the gastric bypass and the sleeve gastrectomy.
The gastric bypass operation involves stapling the stomach into a small pouch and rerouting a portion of the intestine. By having food bypass the remainder of the stomach and a portion of the intestine, smaller amounts of food are eaten and less of that food is absorbed by the body. The
sleeve gastrectomy involves removing about 80% of the stomach, restricting the amount of food that can be eaten.
With significant weight loss, we also expect to see improvements in several obesity-related medical problems, such as diabetes, hypertension, high cholesterol, and sleep apnea.
Patients are considered for bariatric surgery when they are roughly one hundred pounds over their ideal body weight. More accurately, we use the body mass index (BMI), a formula which includes weight and height.
In addition to highly experienced surgeons, we have a comprehensive program with a dedicated support team. We believe that a successful surgery must be accompanied by diet and lifestyle change, as well as long term follow up in order to ensure success and maintenance of weight loss.
In fact, the Center for Weight Management and Bariatric Surgery has one of the largest bariatric surgery programs in Massachusetts and is nationally accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®).
Bariatric surgery is widely covered by almost all insurances and we have staff that help patients navigate through any insurance requirements.
As seen in Merrimack Valley Magazine