Why is it called morbid obesity?Being overweight is associated with real physical problems which are now well recognized. The most obvious is an increased mortality rate directly related to weight increase. It was found that the mortality rates for men who are 50% above average weight increased approximately two times. For those suffering additionally from digestive tract diseases, it was four times higher, and for male diabetics it was five times higher. In women who are 50% above average weight, mortality rate was twice that for normal weights, three times higher for who had associated digestive tract diseases, and eight times higher for female diabetics. Overweight people of both sexes, especially the young, tend to die sooner than their lean contemporaries.
While obesity itself is a risk factor, most of the associated mortality and morbidity is associated with the co–morbid conditions. These conditions include hypertension, hypertrophy cardiomyopathy, hyperlipidemia, diabetes, cholelithiasis, obstructive sleep apnea, hypoventilation, degenerative arthritis and psycho–social impairment.
This morbidity and mortality in severely obese people cannot be overstated. The Guinness Book of Records has recorded that none of the world’s heaviest individuals lived beyond the age of forty.
The treatment goals for morbid obesity are: an improvement in health achieved by a durable weight loss that reduces life threatening risk factors and improves performance of activities of daily life.
What are the treatment options?There are only two ways of losing weight. First, by consuming fewer calories than you need (that is virtually starving) and thus burning up fat; or, secondly, by burning up fat by vigorous physical exercise. Which means, one must do a large amount of exercise very consistently for a long time to lose any reasonable amount of weight; and, of course, the fatter you are the harder it is to exercise. To lose weight successfully and over a reasonable time, you must have your intake cut down to about 400 – 500 Calories per day. The big problem with a diet like this of course will be hunger.
It is mandatory for the surgeon to consider medical as well as so–called non–operative treatments before surgical options. Published scientific reports document that non–operative methods alone have not been effective in achieving a medically significant long–term weight loss in morbidly obese adults. Weight reduction trials conducted under medical supervision over a period of 10 to 12 weeks shows average weight loss of 2.5 kg. These trials consist of dieting and regular exercises. The problem with this therapy is that weight loss is not significant and not sustained, since after a few weeks of trials patient compliance is reduced and they regain weight – sometimes more than what they started out with.
The use of anorectic medications has recently been advocated as a long–term therapeutic modality in management of what is clearly a chronic disease. In a study conducted over a nearly four–year period, utilizing a two–drug regimen of Phenteramine and Fenfluramine or Dexfenfluramine, the initially optimistic results were not sustained – there was drop out rate of one–third and a final average weight loss of only 1.5 to 2.0 kg. These drug combinations cause serious side–effects including cardiac valvular diseases and psychological disturbances. Fenfluramine Dex–fluramine are no longer marketed in India on orders from the drug regulatory authorities.
Bulking agents which give a feeling of fullness also have been tried. These drugs, when taken with water before meals, swell in the stomach. Though they don't have side effects like the previously discussed CNS drugs, their prolonged use leads to developing tolerance.
The fact is, there is an extremely high incidence of failure to sustain even a 10% long–term weight loss in morbidly obese patients with any form of non–operative treatment.
Jaw–wiring and intra–gastric balloons have been tried in the past but have not successful.