Today obesity is a medical and social problem, reaching epidemic proportions worldwide, with over 300 million obese people, medical costs accounting for 2-7% of total health expenditure in developed countries. The phenomenon is even more worrying to the United States where over 50% of the adult population is overweight or obese, showing 5% of morbidly obese population. In France, the prevalence of obesity in adults is 6-11%, and a rate of 0.2 – 0.3% for morbid obesity. Morbid obesity is defined when Body Mass Index (BMI) is greater than or equal to 40 kg/m2.
How to Calculate Obesity
If you feel that you are overweight, you may wonder just how much overweight you are. Some people can lose ten or twenty pounds and be within a healthy weight range. Others will have to lose 110 to 120 pounds to fall within a healthy weight range.
What is the Meaning of BMI?
Obesity is calculated using the BMI, or Body Mass Index. This is a rather complicated mathematical formula, but luckily, you can now find countless BMI calculators on the internet that are free to use. The formula uses your current height and current weight to find the BMI.
Once you use a calculator to measure your BMI, you should know that if your BMI is 18.5 or less, you are underweight. If it is 25 to 29.9 you are overweight, and if it is 30 or over, you are obese. A normal weight has a BMI between 18.5 and 24.9.
Using a BMI Calculator to Measure Obesity
Using a BMI calculator online is very easy. You simply enter your height, in feet and inches, and your current weight in pounds. Click a button and your BMI will be figured for you. Most BMI calculators these days can measure your BMI using feet, inches, and pounds, or in centimeters and kilograms.
Because scripts that are used on websites don’t always work correctly, it is always a good idea to try two or three different free BMI calculators to make sure that you are getting the same answer. You can also do the math yourself if you like. The formula for figuring your BMI is weight in pounds x 703, divided by height in inches squared. The metric formula is weight in kilograms divided by height in meters squared.
Can You Count on BMI Charts?
While the BMI chart is fairly standard, there are some factors that the BMI calculation does not take into consideration. One example of this is age. Your age actually changes what a healthy weight is for you. However, the jury is still out on what you should weigh, at a specific height, and at a specific age. The BMI also does not consider whether you are male or female, or whether you naturally have large bones or smaller bones.
In the end, you only have the BMI to count on, but you also have to pay close and honest attention to how you feel physically and mentally, and find the weight that makes you feel the best.
Over time, many strategies for obesity treatment have been proposed. The National Institute of Health in the United States issued recommendations and guidelines for treatment of obesity in the year 2000. They are now at the very foundations of the treatment of obesity. The treatment includes three guidelines:
Changing Life Style
Consists of changing diet, include physical activity and modify behaviors. A low calorie diet (800 – 1200 kcal / day) is recommended instead of a VERY low calorie diet (below 800 kcal / day). Low calorie diets reduce weight by 8% on average, resulting in reduction of body fat after a period of approximately six months. Physical activity, of 3-7 sessions per week for 30-60 minutes, can cause a weight reduction of 2-3%. Behavioural therapy aims to change the dietary behavior, identifying food stimuli, self assesment, group support, etc. The combination of a low calorie diet with physical activity and behavioral therapy has proven to offer better results compared to isolated diets or physical activity. Changing the lifestyle alone is generally ineffective in morbid obesity.
Is recommended when lifestyle modification is ineffective. National Institute of Health in the United States recommends that these drugs should be used only in a global terapautic approach, in combination with lifestyle modifications. For a drug to be effective in the treatment of obesity it must meet two criteria:
- the average weight loss in one year should be at least 5% higher than in the control group
- a greater number of patients receiving medication must lose during that year at least 5% their weight compared to the number of patients in the placebo control group
Federal Drug Association approved two drugs that meet these criteria: Sibutramine, an inhibitor of reabsorption of serotonin and orlistat, an inhibitor of pancreatic lipase. These drugs lead to a weight loss of 6-10% of initial weight in one year, but with a significant increase in weight once the medication is stopped. Because obesity is a chronic disease, short-term use of medication has no effect.
The Surgical Approach
According to recommendations of consensus conferences, obesity surgery should be reserved for patients with BMI> 40 or BMI> 35 with associated co-morbidity. Surgery should be considered only after the failure of conventional therapy of obesity: diet and behavior modifications, physical activity and pharmacotherapy.
The French consensus conference on obesity recommends that surgery should be tried after at least a year in which medical treatment was sought. Also, in order to receive surgical treatment, obesity must be stable or may have worsened in the last five years.
The contraindications for surgery are: psychiatric disorders, adrenal, or thyroid diseases, chronic inflammatory pathology of the digestive tract, alcoholism and addiction.
Surgery For Morbid Obesity
The excessive accumulation of fat and lipid metabolism disorders, obesity leads to the emergence and aggravation of many morbid conditions: diabetes mellitus type II, hypertension, severe deficiencies of respiratory function, sleep apnea, metabolic syndrome, hormonal disorders, to mention only some of diseases.
Obesity, through the pathological states it determines and associates, but also by dangerous global spread, is a therapeutical problem of great emergency. On the other hand, despite the enormous progress of the modern medicine, obesity remains an incurable disease. Consequently, if it can not be cured, obese patients should receive effective treatment for life.
The surgical intervention is considered today the most effective treatment of morbid obesity.
Bariatric Surgery (Obesity Surgery)
The operatory techniques that address obesity are grouped under the bariatric surgery.
Bariatric surgery groups all surgical maneuvers addressed to obese
patients in order to normalize their weight status, without including
the removal of fat or other cosmetic surgery techniques.
Bariatric surgery techniques influence the balance of energy, significantly decreasing the intake and causing the body to consume energy from the reserves previously accumulated.
The Gastric Bypass
The gastric bypass is an effective method to treat morbid obesity, providing a significant reduction of overweight, a significant improvement in comorbidities, under the conditions of a high quality of life.
Because of anatomical and functional changes induced by surgery, patients with GBP show an important decrease in appetite and a reduction in the quantity and frequency of meals and snacks over 24 hours. Therefore a negative energy balance occurs, because the body resorts to the tissue reserves (deposits in the fat layer). The GBP surgery is statistically credited with a decrease in the percentage of the overweight ranged between 72% and 82% in the first year.
The Gastric Sleeve
Is the partial removal of the vertical portion of the stomach, thereby reducing its volume by about 80-85 percent. The vertical part is reduced to a tube, similar to that of the esophagus, which is also continuous. The gastric sleeve further reduces the horizontal part of the stomach as well, which is called gastric antrum.
Meanwhile, the peripheral nervous formations of the stomach and pyloric sphincter, which ensure the gastric emptying, are not affected by the stomach surgery. During this surgery, the patient is sits under general anesthesia in the operating room for about an hour. By this, the stomach is cut, not removed. This action does not involve implantation of foreign bodies, which the patient’s body might reject.
The Gastric Banding
The band is a simple silicone ring with an inflatable balloon mounted on the inside by laparoscopy.
The balloon is connected to an injection port by a long tube, made from thin and tangled resistant silicone. Like a wrist-watch band, it is fixed around the upper stomach, about 15mm below the gastro-oesophageal junction. It divides the stomach into an upper pouch (15ml), and the rest of the lower stomach.
Developed to help long-term weight loss, the adjustable gastric band system has been used by leading laparoscopic surgeons worldwide to overcome severe obesity. The sustained weight loss by gastric band is achieved by reducing stomach capacity.