Morbid Obesity

By Meg Marinis, Director of Research May 06, 2010
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Morbid Obesity

In Episode 621, How Insensitive, Bobby Corso arrives at Seattle Grace-Mercy West Hospital in a... rental box truck. It takes several paramedics and firefighters to help him down onto a gurney because unfortunately, he has not walked in over a year. At nearly 700 lb, Bobby falls into the category of a rapidly rising health problem in the country today—morbid obesity.

Morbid obesity is a serious health condition in which excess body fat has accumulated to the extent that it interferes with basic physical functions such as breathing or walking. A person is diagnosed as morbidly obese when he or she has reached at least 100 lb over the ideal body weight or if they have a BMI of forty or higher (BMI stands for Body Mass Index, a measurement defined by the ratio of an individual's height to his or her weight; normal BMI ranges from twenty to twenty-five). These patients stand at greater risk for serious illnesses that may reduce life expectancy such as diabetes, high blood pressure, sleep apnea, gastroesophageal reflux disease (GERD), gallstones, osteoarthritis, heart disease, cancer, and the list only continues.

What are some of the effects of these conditions?

- Obese people are resistant to insulin, which regulates blood sugar. This problem can induce illness such as Type 2 Diabetes.

- When the body carries around excess weight, the heart will not work correctly. The patient will develop hypertension (High blood pressure) which may lead to strokes, as well as damage the heart and kidneys.

- When additional weight is placed on joints such as the knees and hips, wear and tear ensues causing decreased mobility, back pain, and osteoarthritis of weight-bearing joints. However, in Bobby's case of morbid obesity of approximately 700 lb, his ankle simply could not withstand the amount of weight, thus fracturing when he tried to walk.

- Fat deposits in the tongue and neck can block air passages, especially in patients who sleep on their backs, causing sleep apnea and respiratory problems. As a result, patients will lose sleep and suffer from daytime drowsiness and headaches.

- Excess weight will weaken and overload the valve at the top of the stomach, which then allows stomach acid to escape into the esophagus, causing GERD; this escape of acid has also been linked to esophageal cancer.

- Obesity can also lead to constant depression and emotional changes from failed diets, disapproval from family and friends, and remarks from strangers. Obese people also often struggle with fitting comfortably in public places, fearing discrimination from others.

- Obesity may wreak havoc on male and female hormone cycles, even causing infertility in some patients.

- A large, heavy abdomen relaxes pelvic muscles, weakening the valve on the urinary bladder. During a fit of coughing, sneezing, or laughing, an obese person may experience leakage and urinary stress incontinence.

- Menstrual irregularities often appear in women, presenting as irregular or absent periods with increased pain.

What can one do to pursue treatment for morbid obesity?

If a person struggles with morbid obesity, diet and exercise is the way to go, but an alternative solution would be to consult with a bariatric surgeon to determine whether or not the person may be a candidate for surgical treatment. They can perform a thorough work-up as well as help the patient submit a bariatric surgery insurance claim and provide weight loss financing options. Weight loss surgery addresses the issue at the source—it reduces the patient's ability to overeat.

Gastric bypass surgery includes dividing the stomach into a large and smaller portion, thus creating a small-sized pouch or stomach (that can only hold about a cup of food). Next, the newer small pouch will be disconnected from the first part of the small intestine (the duodenum), reconnecting the stomach to a portion of intestine further down (the jejunum). Then, food will pass directly from the stomach into the jejunum, "bypassing" the duodenum, which leads to reduced absorption of calories. As a result, one experiences satiety much quicker, thereby helping to induce weight loss.

Now gastric banding surgery can be described as a restrictive procedure in which the surgeon uses one of a variety of techniques to actually reduce the size of the stomach. Therefore, when eating, a person will feel full faster, eat less, and lose weight.

Along with bariatric surgery, many obese patients choose to have their panniculus removed; the panniculus is the excess skin and fat in the lower stomach area that hangs below the belt line (often described as the "abdominal apron"). The extra fold or folds of skin and fat can affect hygiene, strain the back, and make physical activity quite difficult. Health conditions can ensue such as rashes, skin ulcers, and odor (such as the infection that Bobby developed).

People should strongly pursue treatment for morbid obesity, not only for the many physical health conditions one could easily develop, but also for the psychological and social effects as well. Some of obesity's worst effects are emotional pain and suffering. Additionally, a common misconception of obesity is that these people are simply lazy and do not even try to lose weight; this perspective remains extremely damaging, leading to prejudice and discrimination in the job market, at schools, and in social situations.

For more information on obesity, please visit: http://www.cdc.gov/obesity/index.html