For those considering the surgery . . .

This information is from Dr. Fobi. Every year his office puts out a calendar with successful patients as the models. The information below is taken from the calendar.

1. Obesity is a hereditary disease:

The exact method of genetic transmission is not known. The expression of obesity varies with social, environment, cultural, economic and psychological influences.

Obesity may be caused by a glandular or hormonal imbalance, but that is rarely the case.

Obesity may be due to an eating disorder but rarely is severe obesity due to an eating disorder. It is highly probable that the obese person with eating disorders have the disorder as a result of the frustration or associated problems of their obesity.

Obesity is definitely not caused by lack of will power.

Obesity is not a psychological nor psychiatric disorder. On the contrary, obesity may predispose to psychological or psychiatric disorders.

2. Severity of obesity:

Mild obesity: > 120% of ideal weight but < 140% or BMI > 25 but < 30 or > 20 lbs but < 75 lbs above ideal weight.

Moderate obesity: > 140% of idea weight but < 160% or BMI > but < 35 or > 50 lbs but < 75 lbs above ideal weight.

Morbid or Severe obesity: > 160% of ideal weight or BMI > 5 but < 35 or > 75 lbs above ideal weight.

Super obesity or Malignant obesity: > 225% of ideal weight or BMI > 50.

3. Complications of obesity:

The multitude and severity of complications are all directly proportional to the severity and duration of obesity and vary with the distribution of the body fat.

Medical Complications:
Diabetes
Hypertension
Gallbladder Disease
Gastrointestinal Disorders
Menstrual Irregularities
Degenerative Arthritis
Venous Stasis Ulcers
Pulmonary Hypoventilation Syndrome, Sleep Apnea, Snoring
Coronary Artery Disease & Arterial Sclerotic Disease
Increase Incidence of Malignancies ovaries, cervix, uterus, breasts, prostate, and gallbladder.
Increased Risks with Surgeries
Accident Proneness
Pseudotumor Cerebri
Difficulties with physical examinations and other types of radiological evaluations because of the size.

Social Complications:
Clothing Limitation
Limitation in Performing Daily Acts of Living, Poor Hygiene and Sanitation
Limited Access to Chairs, Seats & Passage Ways
Limitation in Walking, Climbing Stairs
Sexual Limitations
Economic Complications
Cost of Futile Weight Loss Modalities ($13 billion/yr)
Cost of Treating Various Medical Conditions Due to Obesity Estimated at $39 billion per year.
Lack of Insurance Coverage or Increased Premiums
Cost of Special Clothing and Devices to Perform Daily Acts of Living
High Rate of School Drop Out
Difficulty Obtaining Good Jobs
Cost of Extra Food Consumed

Psychiatric Complications:
Depression
Social Withdrawal
Neurotic Disorders
Guilt, Self Hate
Suicide

4. Treatment and Management:

Nonsurgical treatment results in 98% recidivism rate.
Diets (Weight Watches, Jenny Craig, Nutrisystem)
Supervised Modified Low Calorie Diets (Optifast, Medifast)
Behavior Modification (Tops)
Pills and Pharmaceuticals
Exercise Programs
Combination of Two or More of the Above
Other Dieting Treatments (Overeaters Anonymous)
Surgical – Only treatment that provides effective long-term control.

1. Gastric Bypass: Golden standard for obesity surgical treatment > 80% success with > 50% excess weight loss maintained for more than five years. Mortality of < 1% and morbidity of < 20%. Long-term complications include deficiency of Iron, Calcium, Fat soluble Vitamins A, D, and E and Vitamin B12, Folic Acid, Thiamine & Pyridoxine. Anemia is seen in menstruating individuals. There are various modifications of the gastric bypass operation. The Fobi-Pouch, one of the modifications, has excellent weight loss, few complications, a low revision rate and well tolerated by the patients.

2. Gastroplasty: This is another common operation for control of obesity. About 60% success rate with > 50% excess weight loss maintained for more than five years. Mortality rate of < 1% with morbidity of < 10%. High revision rate due to staple line breakdown which approaches 28% over a five year period. No long-term complications characteristic of this operation. Vertical banded gastroplasty (VBG) and silastic ring vertical gastroplasty (SRVG) re the two common gastroplasty operations performed.

3. Other Operations:
Biliopancreatic Diversion (BPD)
Gastric Banding (GB)
Intestinal bypass (JIB) (abandoned)
Biliopancreatic Diversion with the Duodenal Switch

Conclusion

There is need for more research in the field of obesity. Until a time when a less invasive, effective, nonsurgical treatment is available, surgery offers the only long-term control of obesity. Surgery should not be considered as the last resort because at this time it is the only effective resort in treating severe obesity (> 75 lbs. Above ideal weight).