Stroke

Coronary artery disease* Diabetes* Dyslipidemia* Hypertension

Cancer

Phlebitis

Pulmonary disease* abnormal function* Obstructive sleep apnea* hypoventilation syndrome

Nonalcoholic fatty livercirrhosis

Gynecologic abnormalities* abnormal menses* infertility* polycystic ovarian syndrome

Gastroesophageal refluxdisease

Hypertension

• Most common complication of obesity

• Blood pressure is determined by a complex system of circulating hormones, many are made in fat tissue and the kidneys. These hormones control the diameter of the arteries and thereby control the pressure in the arteries.

• A 10% reduction of body weight has been associated with a decrease in blood pressure

• Chronic obesity also can reduce the efficacy of anti- hypertensive medications

Diabetes• Obesity is the leading cause of diabetes

• The risk of diabetes increase 53x’s with severe obesity

• Type 2 diabetes is almost always associated with obesity and appears to be related to hormonal substances (cytokines) produced by adipose (fat) tissue and to the increase amount of blood fats that occurs in diabetes.

• The majority of obese individuals with diabetes can eliminate the need for medications or insulin by reducing their weight by 10%

Heart Disease and Stroke• Increase in heart disease is associated with obesity independent and additive of the increased risk factors of HTN, diabetes, and elevated cholesterol

• There is a 3x risk of heart disease with obesity

• As a general rule, for every pound over your ideal body weight, subtract one month from your life expectancy

• For each point increase in BMI there is a 6% increase in the risk of an ischemic stroke

• For each point increase in BMI there is a 4% increase in the risk of developing atrial fibrillation this is related to left atrial enlargement and congestive heart failure

Respiratory Disease

• Over 75% of patients with obstructive sleep apnea are >120% of their ideal body weight

• A neck circumference of >17 inches is also related to sleep apnea

• Upper body fat deposits may increase airway collapsibility and interfere with inspiratory and expiratory muscles. This airway collapsibility will decrease with weight loss

•Obesity also appears to be a risk factor for airway hyper- responsiveness ( asthma)

Gastrointestinal Problems

• Obese patients are 2.5 x more likely to have reflux symptoms or esophageal ulcer than patient with a BMI <25

• There is also a link between GERD and esophageal adenocarcinoma

• Fatty liver disease: NASH (Non-alcoholic Steato-hepatitis) is caused by excessive fat deposition in the liver. This leads to silent inflammation, usually detected by adnormal liver function and can lead to cirrhosis or liver failure.

• Obesity is associated with cholelithiasis. There is also an increased risk for cholelithiasis in patients who lose weight rapidly and can affect about 38% of patients after having bariatric surgery

Degenerative Osteoarthritis•There is a marked in osteoarthritis is the obese. It is most common in the knees and ankles as a consequence of wear and tear

• Adipose (fat) tissue produces cytokines that “destroy” the normal cartilage in joints

• If a patient loses weight, destruction of joints does not disappear: yet joint pain will generally diminish due to less stress on the joint

Gynecological and Obstetrical Complications

• Obesity during pregnancy is associated with: * Gestational diabetes * Preeclampsia * Delivery Complications:

• Macrosomia (big baby)• Shoulder dystocia• C sections• infections

• Obesity is responsible for 6% of primary infertility; Impotence Polycystic ovary syndrome

• Polycystic Ovary syndrome is the most common endocrine disorder in women of age. It is characterized by: chronic anovulation, polycystic ovary morphology, and hyperandrogenism

Cancer• The World health Organization has estimated that being

overweight and inactive accounts for 1/4 to 1/3 of all cancers of the breast, colon, endometrium, kidney, and esophagus

• Obesity can unfavorably influence the diagnosis of cancer and the response to therapy thereby there is an increase in the likelihood of dying from cancer • Overall Overweight and obesity could account for 14% of all cancer deaths in men 20% of all cancer deaths in women

Psychosocial function• There is a stigma associated with obesity in areas such as education, employment, and healthcare

• For adolescents with a BMI above the 95% for age and sex: * Completed fewer years of school * 20% less likely to be married * lower household incomes * higher rates of household poverty

• Depression has been associated with obesity causing profound sadness, crying, and loss of energy

Why is this important?

• Bariatric surgery patients will be at risk for surgical complications but we must keep in mind what medical complications of obesity they might already have

• If they have diabetes, peri-operative blood sugars will need to be watched closely as their diet will change dramatically

• Patients with ostearthritis, might need aids to support mobilization post-operatively

• Patients with obstructive sleep apnea may need the support of CPAP peri-operatively

Bariatric Medicine Test

1. All of the following are medical complications of obesity EXCEPT: a. Diabetes b. Alzheimers c. Sleep apnea d. Polycystic ovarian syndrome

2. Weight reduction can help all of the following complications EXCEPT

a. Diabetes b. Hypertension c. Cancer d. Osteoarthritis

3. What substance does fat tissue produce that destroys normal cartilage in joints?

a. Cytokines b. lymphokines c. Cartilagikines d. Insulin

4. A neck circumference of what is related to sleep apnea

a. > 15 inches b. > 16 inches c. > 17 inches

5.

5. What amount of weight loss can effect a lowering of blood pressure

a. 20 lbs b. 5% c. 30 lbs d. 10%