Weight Related Health Problems

Diabetes type 2

Adult onset diabetes type II is increased blood sugar due to impaired insulin function. It results in numerous health problems such as heart disease, strokes, kidney dysfunction, blindness, peripheral vascular disease and gangrene etc. Tight control of blood sugar is the main aim of treatment because this results in decreased adverse consequences of the diabetes. Controlling the blood sugar requires a combination of treatments. Weight loss surgery effectively decreases the requirements for insulin and other medication in the vast majority of patients.

Surgery within 2 years of your diagnosis gives best chance of your diabetes rersolving.


For example, 98% of patients who have medication controlled diabetes will find their dosing lower or stop taking medication altogether. The impact of surgery on diabetes is especially impressive if surgery is performed within 2 years of the diagnosis of diabetes or commencing the medication.

High Blood Pressure

Heart Disease

High blood pressure or hypertension is very common among the overweight and obese. It contributes to the increasd risk of heart disease and stroke etc and good control will improve your chances of a healthy life. Weight loss surgery decreases the need for medication to control blood pressure. Most people require fewer medication and can often stop medication all together.

Lipid disorders

Linked to cardiovascular disease, lipid disorders are hypercholesterolaemia and hyperlipidaemia. Or high cholesterol and blood fats. The have a variable response to surgery. Some people no longer have probelems with their lipids while others see no change. Surgery does not worsen the probem.

There are numerous medical conditions associated with obesity. Weight loss surgery improves most of them.

Heart disease

Narrowing of the arteries in the heart is a leading cause of heart attacks and heart disease. Obesity is associated with an increased risk of this and weight loss is known to halt the progression of the disease. Weight loss surgery is beneficial in preventing heart disase from worsening.

Asthma

Asthma is a chronic lung disease where the ariways become narrowed. Obesity is asssociated with asthma and impaired lung function. Losing weight decreases the severity of asthma. Wweight loss surgery dramatically decreases the chances of an asthma attack being so severe that the patient needs to go to hospital and dramatic decrease in the use of medication.

Sleep apnoea

This is snoring at its loudest and worst. Not only is sleep apneoa snoring and resulting in a poor sleep for everybody concerned, but the person is actually choking and waking up every few minutes because they can’t get any air in. Over 80% of patients undergoing weight loss surgery with a BMI over 40 have sleep apneoa. Sleep apneoa leaves you feeling tired and exhausted when you first get up in the morning, you have a headache, and then you just have to soldier on because every day is like this and you don’t know any better. You are tired and a=overweight and you want to do something about your weight but you are too tired to be bothered.

Sleep apneoa is choking all night, then waking up wondering why you don't feel refreshed.


Sleep apneoa is a cruel curse of obesity. The usual management is to have a sleep study to confirm the diagnosis and apply a mask to the face to help with breathing at night. Fortunately weight loss surgery is very effective in over 90% of people in resolving sleep apnoea.

Depression

Obesity is highly associated with depression. And weight loss surgery returns your risk of depression back down to the rest of the population.

Reflux

Weight loss surgery is very effective at treating gastrooesophageal reflux disease. Reflux, or heartburn is very common in obesity.

The first step in treating reflux is to loose weight.

When this fails, then medicaaion and other measures are required. It is due to acid escaping forom the stomach up in to the oesophagus where it gives a burning sensation. This can be stopped by anti-reflux surgery, which is extrmeely effective. But antireflux surgery is less eeffective in obesity. The most effective operations for reflux in the obese aer all weight loss operations. These operations achieve this by decreasing weight , but also making the barrier between the acid and the oesophagus better. (The band is a ring above the prt of the stomach that maks the acid and is like a onbe way valve in some ways, the sleeve decrease the amount of acid the stomach makes, and the bypass separates the oesophagus from the part of the stomach that makes acid, and a hiatus hernia if present is repaired.)

Over 95% of people who have weight loss surgery have improved reflux control or no symptoms at all.

Various Cancers

There are a number of cancers associated with obesity including uterine (endometrial), bowel (colorectal) and stomach cancers. The impact of weight loss surgery is difficult for researchers to quantify. It is logical that weight loss surgery would decrease your risk, but as yet I am unaware of any evidence that proves this.

Gallstones

Frequently people with gallstones are overweight, but this is not always the case. Not all gallstones caue symptoms and therefore not all gallbladders and their stones need removing.However, if you already have symptoms from your gallbladder stones you might consider having your gallbladder out as part of you weight loss operation. This is because weight loss surgery and the subsequent weight loss further increases your chances of the gallbladder causing pain.

Arthritis

Osteo-arthritis and obesity are so linked together that sometimes symtpom control of joints like the hips and knees and ankles is very difficult without weight loss. Weight loss surgery significantly decreases pain from osteoarthritis in these joints in particular and so treaments are more effective, less required, and this translates into a decreased the chance of needing a joint replaced.

DVTs (Deep Vein Thrombosis)

Clots that form in the deep veins of the legs happen from time to time in perfectly healthy people and paeople with clotting abnormalities. Obesity increases the risk of DVT further. Obesity is alos associated with elevated Homocysteine levels which further increases the risk of clot. People having weight loss surgery are given every precaution to prevent clots occuring around the time of surgery, but they can still occur. Clots in the legs which dislodge and go to the lungs are potentially lethal.

Lower Back Pain

Not unique to obesity, of coure, but certainly more common, more difficult to manage and more likely to interfere with day to day life. Weight loss and therefore weight loss surgery is central to management of the obese person with back pain. Many other joints, especially weight bearing joints, such as the hips, knees and ankles, are really troublesome for obese people, and are more easily managed and less painful with weight loss surgery.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a common complaint where there is compression of a nerve (the Median nerve) in the wrist. This is due to the pressure inside the tunnel (made by bones and ligaments in the wrist) increasing and causing the nerve to misfire. This in turn cuases pins and needles, tingling, numbness and even pain and loss of movement in the fingers, and can spread up the forearm. tightly The pressure increases with obesity and the nerve misfires. More severe cases require surgery on the wrist. Weight loss and therefore weight loss surgery decreases Carpal Tunnel Syndrome in those for whom this is a causative factor.

Pregnancy Complications

Pregnancy and obesity are not well matched. For obese women, it is more difficult to conceive a baby, carry the pregnancy to full term, is more dangerous for the mother and the baby, and is associted with health problems for the baby. This is such an important feature of pregnancy that it determines where a doctor will be happy and fully able to care for a pregnancy. Many smaller hospitals do not allow women who are above a certain BMI to even book their delivery with them. Weight loss surgery has been extensively studied with regards to safety and efficacy in pregnancy.

The Gastric band and Sleeve in particular have excellent results in achieving good weight loss and compatability with healthy pregnancy.

Bypass and larger weight loss oeprations are associated with malnutrition and there are very small numbers of women who have not been able to have a healthy pregnancy after this surgery. This is in some part due to the fact that they have lost so much weight and this skews the results of some studies. The Gastric band has the advantage that if during the pregnancy there is excessive weight loss or inadequate weight gain then the band can be easily loosened to allow good weight gain. Pregnancy can be very nauseating and morning sickness and vomiting a major problem. This has not been worsened by women who have had weight loss surgery.

Infertility

Infertility has numerous causes. Obesity is so linked to infertility that before commencing assisted fertilisation infertile couples are recommended weight loss. Weight loss surgery effectively acheives the amount of weight loss required to increase fertility in affected people, with as much as a 30% increase in fertility in some studies. But, if the infertility is not weight related, and it often is not, then weight loss will be of no benefit. So weight loss in this context should be undertaken when the person wants to lose weight for reasons in addition to their fertility. (In other words, don’t have weight loss surgery just because you are infertile, as this has a low overall likelihood of you achieving your goal.)

Skin Infections

Skin infections are especially troubelsome in sweaty areas, folds of skin and traumatised skin, but also in gravity dependent areas and swollen areas like very large legs and tummies. Weight loss surgery can achieve the amount of weight loss required to imrove the management of these problems and even see them resolve completely. Obviously, weight loss also causs exces skin, but this type of skin is not as likely to get infeted as skin with large amounts of fat under it.

Incontinence

Urinary and faecal incontinence both have numerous causes. Urinnary incontinence in particular is resposive to weight loss surgery. The overall results are not very impressive as one or other of the numerous other casuses of the incontinence do not not necessarily resolve with weight loss.

Fatty liver

The fancy term for this is NonAlcoholicSteatoHe[atitis or NASH for short. It is a good indicator that the body is struggling to cope with the amount of fat it has. Fat is making the liver malfunction. There is too much fat in the liver and it is swelling up and getting bigger. This makes the liver faulter at it many important tasks and this has widespread effects on the body. Weight loss of as little as 10kg can improve this.

Please Contact Melbourne Bariatrics on  03  9770  7189  for more information or to make an appointment
Royal Australasian College of SurgeonsAMA - Australian Medical AssociationFRACS - Fellow of the Royal Australasian College of Surgeonsmattu - Minimal Access Therapy Training Unit GuildfordIFSO - International Federation for the Surgery of Obesity and Metabolic DisordersMonash University
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