Type 2 Diabetes Mellitus
Obese individuals develop insulin resistance, a substance that regulates blood sugar levels. Over time, the resulting high blood sugar content can cause serious damage to the arteries, leading to blockages in the vessels of the heart, kidneys, brain, and extremities.
Osteoarthritis
The additional weight applied to the joints, especially the knees, ankles, hips, and spine, causes rapid wear, accompanied by pain and inflammation, potentially leading to disc herniation problems and reduced joint mobility.
Obstructive Sleep Apnea and Respiratory Problems with Snoring
Fat deposits in the tongue and neck can cause intermittent obstruction of the airway. Since this obstruction increases when sleeping on your back, you may frequently wake up snoring to readjust in bed. The resulting sleep reduction often causes daytime drowsiness and headaches.
Dyslipidemias
These are a series of disorders in the fatty substances of the blood. A common form of dyslipidemia is often referred to as “high cholesterol.” However, dyslipidemia is a term that encompasses all related health problems resulting from having an excess of certain lipids or a deficiency of certain types of them. The danger arises when lipids begin to accumulate on the artery walls, along with platelets and other debris, causing thickening, obstruction, and hardening of the arteries. Some arteries become literally blocked; this condition is known as atherosclerosis. Depending on the site of obstruction, it can result in a heart attack of the organ that the artery supplied with oxygen.
Gastroesophageal Reflux and Gastritis
Acids perform their function in the stomach and rarely cause problems when they remain there. When there is acid reflux into the esophagus through a weakened or overloaded valve at the top of the stomach, it causes what is known as gastroesophageal reflux, with common symptoms being “heartburn” or pain either behind the chest or “in the pit of the stomach.” Approximately 10% to 15% of patients with sporadic, even benign, heartburn symptoms develop a condition known as Barrett’s esophagus, which is a premalignant change in the mucosa or lining of the esophagus and is a cause of esophageal cancer. On the other hand, this gastroesophageal reflux can come into contact with the airways (bronchi), causing asthma attacks or bronchospasm.
Gallbladder Diseases
These occur more frequently with obesity, partly due to repeated weight loss efforts (diets), which produce a change in metabolism, predisposing these patients to form gallstones. When these stones form in the gallbladder, they can cause severe abdominal pain, infection, and jaundice (yellowing resulting from the accumulation of bilirubin in the body), leading to the need for gallbladder removal.
Cancer
Obesity can increase the likelihood of developing certain types of cancer by 50%. In women, breast, uterine, endometrial, and ovarian cancer. In men, the likelihood of colon and prostate cancer increases.
Infertility due to Polycystic Ovary Syndrome and Menstrual Cycle Disorders
Women with morbid obesity often experience menstrual cycle disorders, including interruption, abnormal menstrual flow, and increased pain.
Stretch Marks
Skin hygiene can be a serious problem in obese individuals, as skin friction is very common, potentially causing small abrasions or lesions, leading to fungal or bacterial infections. Additionally, there can be darkening and thickening of the skin on the neck, friction sites, and folds (Acanthosis Nigricans), as well as the appearance of warts and skin tags.
Leg Swelling and Skin Ulcers
Leg swelling is common among obese individuals and can be caused by decreased venous return or the formation of blood clots in the leg veins. Without treatment, extremely difficult-to-treat leg ulcers can develop.
Stress Urinary Incontinence
A large, heavy abdomen, combined with the relaxation of pelvic muscles, especially associated with the effects of childbirth, can weaken the bladder sphincter or valve, causing urine leakage when coughing, sneezing, or laughing.
Pulmonary Embolism
Pulmonary emboli are nothing more than clots within the venous circulation of the lungs. Most of these clots form in the lower extremities due to a condition known as Deep Vein Thrombosis (DVT). Since overweight individuals are more susceptible to circulatory problems, their chances of experiencing pulmonary emboli and sudden death are higher.
Psychosocia
No less important are the psychological, social, and economic problems (work difficulties due to limitations, disability, discrimination at work, on planes, in theaters, etc.). These patients often have a negative self-image, with a tendency towards depression, social isolation, sexual problems, divorces, and can even lead to suicide. All this results in a poor quality of life and a high risk of severe complications that compromise their life expectancy. Additionally, these individuals with severe overweight conditions face constant emotional shocks, repeated failures in diets they undertake, desperation from family and friends, mocking smiles, and comments from strangers.
Approach to the Problem
The surgical treatment of obesity is major surgery, which is not a cosmetic treatment. It does not involve removing fat. Bariatric surgery involves reducing the size of the stomach, with or without a procedure that prevents the absorption of some nutrients via laparoscopy. Its practice is increasingly common to treat morbid obesity and is the result of three factors:
- The current understanding of the significant risks that morbid obesity poses to health.
- The relatively low degree of risks and complications of the procedures compared to not performing the surgery.
- The inefficiency of non-surgical methods currently used to achieve effective and sustained weight reduction.
Bariatric surgery is indicated for patients between 15 and 65 years of age. Patients with a Body Mass Index (BMI) over 40 are candidates for surgery to improve their quality of life, avoid complications, and prevent premature death. Surgery is also indicated for patients with a BMI between 35 and 40 with comorbidities. Repeated failure with medical treatments and diets is an obvious reason for surgery. Some candidates for surgery are so obese and in such poor health that they need to be hospitalized and treated beforehand to improve their surgical risk.
The option of surgery should be offered to well-informed, motivated patients who fervently desire a change in their weight and lifestyle and have an acceptable surgical risk. The patient must accept lifelong follow-up and monitoring after the operation.
In each case, the risks and benefits of surgery must be assessed. Above all, surgery should be considered a method intended to alleviate a debilitating disease. Although the cost of this surgery is not affordable for all patients, it is lower than the risks of obesity and less than treating secondary diseases and their complications in the medium and long term with a better quality of life.
Effectiveness of Obesity Surgery
The actual amount of weight a patient loses after the procedure depends on several factors, including age, weight before surgery, the patient’s general health condition, the surgical procedure performed, the patient’s ability to exercise, their commitment to follow and maintain dietary and other follow-up care instructions, the patient’s motivation, and the cooperation of their family, friends, and associates.
In general, success in bariatric surgery is defined as the control or cure of comorbidities, achieving a loss of at least 50% or more of excess weight, and maintaining this level for at least five years. The ideal operation is one where the excess weight loss is over 50%, maintained for more than 5 years, benefiting at least 75% of the operated patients, allowing a good quality of life and diet, with no long-term complications, and having a low risk of mortality (<1%) and complications (<10%). Clinical data vary according to each of the different procedures mentioned. Results can also vary depending on the surgeon.
Clinical studies reveal that after surgery, most patients lose weight quickly and continue to do so up to 18 to 24 months after the procedure. In the first six months, patients can lose between 30% and 50% of their excess weight, and even 70% to 80% of excess weight 12 months after surgery.
Patients with lower initial BMIs may lose a higher percentage of their excess weight and probably come closer to their ideal body weight. Patients with type 2 diabetes tend to show a lower overall reduction in excess weight than patients without this disease. Surgery has been found to be effective in improving and controlling many obesity-related diseases or health conditions.
A study conducted on 500 patients showed that 96% of certain associated diseases studied (back pain, sleep apnea, hypertension, diabetes, and depression) improved or were cured. For example, many patients with type 2 diabetes, although showing a lower overall reduction in excess weight, resolved their diabetic condition excellently, to the point that their need to continue medication was very mild or disappeared.
