What is obesity?
Food for thought …
2.1 billion people – that’s nearly one third of the world’s population that are classified as overweight or obese. A sizable amount of these individuals are children and teenagers. In 2015, it was reported that 42 million pre-school children around the world were overweight (compared to 41 million children under the age of 5 tallied in 2014). The publishing of these statistics raises an alarming concern – overweight children are likely to become obese adults, and or / develop serious medical conditions that could lead to higher chances of premature disability and even death.
At least 2.8 million overweight or obese individuals die from related complications each year. Numbers of individuals falling into the overweight and obese range doubled between 1980 and 2014. It is also estimated that at least 57% of the world’s population now live in a country where there are more members of the community who are overweight or obese, than underweight.
These alarming statistics, as released by the Centers for Disease Control and Prevention (CDC) mean that weight in excess is now considered not only an epidemic, but a disease in its own right. Obesity was once only associated with high-income populations, however in recent years, prevalence has grown considerably in low and middle-income communities too.
An excess amount of body fat is at the core of defining obesity, making it not just a cosmetic issue. Obesity is as a result of an imbalance between calories consumed and those which are expended.
Thus, an increased consumption of energy dense foodstuffs and a lack of physical activity contributes greatly to excess body fat. A lifestyle without sufficient physical activity can also deplete a person’s energy reserves, causing an imbalance which also contributes to weight gain.
Obesity places enormous strain on the body’s ability to function and can lead to additional medical health conditions such as cardiovascular disease, high blood pressure, various cancers and type 2 diabetes.
It is excess body fat that leads to various health concerns and complications, but it can be reversed with proper weight loss programmes. Even a modest amount of excess fat loss can prevent an array of ill health and obesity-related medical concerns.
A person with excess body fat is considered obese when their bodyweight exceeds 20% of what it should be (or if they have a BMI / body mass index of 30 or more).
The fact is that obesity is preventable and health organisations around the world are using this fact as the basis to gain control over the growing problem. Currently, the WHO (World Health Organisation) has implemented an action plan known as the ‘Global Strategy for the Prevention and control of Noncommunicable Diseases,’ which aims to both establish and strengthen surveillance and prevention management. The approach needs to be one that is population-based, multi-disciplinary, multi-sectoral and culturally relevant.
Common causes of obesity
The primary reasons weight gain occurs is due to genetic, hormonal and behavioural influences (and sometimes a combination of these). Medical conditions which produce genetic, hormonal and other symptom related causes are rare, however. The main reasons for the majority of obesity cases are almost entirely behaviourally related.
The most common reasons obesity occurs include the following:
- Leading a sedentary lifestyle (being inactive) – a person burns off far less calories through daily activity and exercise than are consumed daily.
- Consuming a non-nutritious diet or one that is higher in fats and calories and deficient in essential nutrients. Overeating goes hand-in-hand with poor diet. It has been noted that the type of foods consumed contributes greatly to rapid weight gain – with carbohydrates and sugars, as well as a variety of other processed beverages and food products all being common culprits. Poor nutrition is closely linked with lipid metabolism interferences. High levels of fructose (hypertriglyceridemia), which is normally metabolised in the liver, accumulate and cause a fatty liver. This results in problems with insulin, diabetes hypertension (diabetes related high blood pressure), and weight gain (obesity).
- Inadequate sleep which, often in combination with general physical activity, leads to hormonal changes (i.e. an increased production of Ghrelin, which stimulates appetite and a reduction in leptin which normally suppresses appetite) and unstable insulin levels, which affect hunger patterns (often causing a person to crave high-calorie foods).
- Genetic influences which affect how the body is able to process foods (energy), as well as how fats are stored. Research teams are looking at a potentially faulty gene, FTO which may cause certain individuals to overeat due to trouble being able to reach satiety.
- Aging bodies can result in a reduction of muscle mass and a slower metabolism, which makes it easier for a person to gain weight.
- Weight gained in pregnancy which is not under control or lost can lead to future excess weight problems, including obesity.
- Medical conditions such as polycystic ovarian syndrome (PCOS), Cushing’s syndrome, hypothyroidism (an underactive thyroid), osteoarthritis and Prader-Willi syndrome (excessive hunger) can all contribute to difficulties with weight control and lead to obesity. Conditions such as arthritis may prevent a person from being active, which can then also lead to weight gain.
Other contributing causal factors include:
- The use of certain medications
- Lower smoking rates / weight gain due to smoking discontinuation
- Self-perpetuating behaviours, such as binge eating
- Childhood sexual abuse and trauma
Overweight versus obesity
Is there a difference between being very overweight and obese?
Both terms define an abnormal or excessive accumulation of body fat which has adverse effects on a person’s state of health.
A simple index of weight-for-height, known as the body mass index (BMI) is used to classify a person’s weight. BMI determines a person’s weight divided by the square of their height.
- In adults: A BMI that is equal to or greater than 25 indicates a higher than normal / healthy weight. A person is classified as overweight when their total body weight is between 10% and 20% higher than the average standard. A BMI that is equal to or higher than 30 indicates obesity, which means that a person’s total body weight is in excess of 20% or more. There are three different classes of obesity as related to BMI scores. A BMI of between 30 to 35 is known as ‘class 1’. A BMI of between 35 to 40 is known as ‘class 2’. A person will be classified as morbidly obese (extreme or severe) when excess body weight clocks at between 50% and 100% more than the normal standard (i.e. having a BMI of 40 or higher).
- In children: The composition of a child’s body varies during stages of growth, and is also calculated differently as a result between the sexes. BMI is thus typically calculated according a set standard (sex-specific BMI for age chart) for children of the same age and sex (specific percentile). This indicates whether or not a child is within a healthy range. Body fat in children also changes with age, making certain growth stages such as puberty tricky to determine an accurate BMI. Body fat also varies between boys and girls during childhood and must be factored in to measurements taken. Standard charts have been developed in order to make a relative comparison and assign a BMI rating. If a child scores 85%, they will be classified as overweight (85 out of a 100 as compared with children of the same age and sex). A score of 95% or higher will be considered obese.
BMI can be calculated using any of the following formulas:
- Metric formula: Weight (kilograms) / height (in either centimetres or metres squared) – weight in kilograms is divided by height in metres or centimetres squared (height in centimetres can be divided by 100 to determine metres). Example – A person with a height of 1.73 metres and a weight of 90 kilograms would have a BMI of 30.1 (classified as obese) calculated as follows:
Weight (Kg’s) / Height (square cm)
90 / (1.73) x (1.73)
= 90 / 2.9929
Rounding up: 30.1
- Imperial formula: Weight (pounds) multiplied by 703 / height (inches) – weight in pounds and inches multiplied by 703, and divided by height in inches squared. Example - A person with a height of 68.1 inches and a weight of 198 would have a BMI of 30 (classified as obese), calculated as follows:
(Weight (lbs) x 703) / Height (square ins)
(198 x 703) / (68.1) x (68.1)
= 139194 / 4637.61
It is important to understand that although BMI scores can give a person a good idea as to where on the scale they stand when it comes to overall health and weight, body fat is not measured directly in order to determine this rating.
A BMI is, however, a useful general population-level measure, that provides a fairly accurate guide for indicating excess weight. A BMI score for children will likely change from month to month for each sex, as they age. Weight ranges will change as a child’s height increases.
A BMI is not a diagnostic tool, but fares best when used as one for screening in order to determine problems with weight.
Age, sex, ethnicity and muscle mass are all factors that can influence the relationship between body fat and a BMI score. BMI does not factor all of these specifics into a measurement. Women tend to have more body fat than men (with the same BMI). Likewise, older individuals have more body fat than those younger too, also with the same BMI score. A very muscular individual can have a high BMI based on weight and height calculations, but in reality, not be classified as obese, this is why the BMI index is not always an accurate measure for performance athletes and bodybuilders with high muscle mass. Muscle weighs more than fat but this is not a factor in BMI calculations. An inactive or even frail individual can also have a low BMI but can have more body fat that leads to health concerns and ailments.
Thus, a BMI score cannot be used to distinguish between excess fat (or the distribution of fat), bone mass, or muscle mass. A doctor must assess the true nature of health in order to determine the most effective means of treatment.
There are other means of directly measuring body fat, which can be obtained from skinfold thickness assessments (with callipers), waist-to-hip measurements, underwater weighing methods, bioelectrical impedance, dual energy X-ray absorptiometry (DXA), isotope dilution and more. All directly measure body fat obtaining an accurate percentage.
When assessing weight versus health risk, it is best to take into account a person’s BMI and waist circumference. Abdominal (visceral) fat is known to pose the most debilitating health risks, such as heart disease or type 2 diabetes. A waist circumference that is greater than 35 inches (or 88.9 centimetres) for women and 40 inches (101.6 centimetres) for men is the benchmark for when health risks associated with weight typically begin.
How will a BMI be used in the medical field?
A healthcare provider will make use of BMI calculations during initial assessments as part of a weight issue consultation. A doctor will likely recommend and perform other evaluations in order to determine more accurate measurements and assess any adverse effects caused by excess body fat.
- Diet and physical activity evaluations
- An assessment of medical / health-related family history
- Skinfold thickness measurements
- A variety of other health screenings and tests as appropriate to an individual’s general condition (ultrasounds, blood tests, urine samples and more)
Associated health risks
What are the most common risk factors?
Factors which have an influence on a person’s potential for obesity can include the following:
- Psychological influences: Emotional eating is problematic when it comes to weight gain and may occur for a number of reasons. This coupled with mood disorders, such as depression can result in excessive weight gain, which if not controlled or reversed, can lead to obesity.
- Environmental factors: The environment in which we live has a lot of influence over behavioural choices, and in this case, when it comes to eating. Influences in the home, school, place of work and general community can impact what a person eats and how active they are likely to be. A safe neighbourhood to live in may promote more outside activity versus one that is rife with crime, for instance. Convenience cooking products and fast food outlets may promote unhealthy eating habits or choices more frequently when it comes to diet. It’s not uncommon for obesity to run in families – many families tend to develop and share very similar habits when it comes to eating and physical activity.
- Genetics: Specific genes that a person is born with may make it more challenging for a person to ‘feel full’ (satiated) following a meal. Genes have an influence on the amount of body fat a person can store and how it is distributed. Genes also contribute to how efficiently food is converted into energy, which can then be burned off during physical activity. Research teams are looking into this more carefully to determine how genes may cause this and the best ways to treat it in order to avoid problems with obesity.
- Use of substances: Weight gain can also be influenced by the use of certain medications, such as steroids, birth control pills (oral contraceptives) and some anti-depressants, anti-seizure drugs, beta blockers, antipsychotics and those used to treat diabetes. Cessation of smoking can also result in the gaining of weight if not carefully managed with diet and exercise.
- Childhood sexual abuse and trauma: Research has shown that those who suffer from childhood sexual abuse (CSA) and specifically intrafamilial sexual abuse, as well as those who have been exposed to significant childhood trauma such as domestic violence coupled with physical and emotional abuse, ongoing neglect, living without biological parents, having a parent who is mentally ill, addicted to drugs or incarcerated have an increased risk of obesity in adulthood.
Medical concerns and potential complications
When a person puts on excess weight, the ratio of body fat to muscle can begin to strain body tissues, muscles, bones and even organs. Inflammation in the body also increases, which can result in the development of a variety of diseases and conditions.
The development of health conditions can be serious, and is one of the main reasons, obesity-related death figures are so high across the world. Health conditions that are of the greatest concern include:
- Coronary heart disease
- Hypertension (high blood pressure – often as a result of excess insulin in the body)
- High cholesterol and elevated fats or lipids (Dyslipidemia) - High triglycerides and low high-density lipoprotein (HDL) cholesterol
- Type 2 diabetes
- Metabolic syndrome
- Cancer (especially the colon, uterus or endometrium, cervix, ovaries, rectum, oesophagus, liver, breast, kidney, gallbladder, pancreas, or prostate)
- Gallbladder disease (as a result of excess production of cholesterol which becomes super-saturated) or gallstones
- Fatty liver disease
- Gout (excess uric acid in the blood, leading to crystal formations to accumulate on the joints)
- Arthritis and osteoarthritis (bone and cartilage degeneration)
- Sleep apnoea
- Respiratory problems (such as breathing difficulties or even asthma due to the lungs decreasing in size and the chest wall becoming heavy)
- Irregular menstrual periods (females)
- Erectile dysfunction (males)
Did you know? Reducing the risk of developing heart disease or having a stroke can be achieved by losing at least 5% to 10% of excess weight.
Seeking medical assistance and diagnosis
The starting point for positive change may be an acknowledgement of excess weight. The most important thing is for an individual to recognise the health risks excess weight places on the functions of the body.
The first port of call should be a consultation with a general practitioner (GP) or family physician. If at the stage of obesity, it’s advisable to consult with a medical doctor for a check-up before attempting any other means of weight loss. Chances are, strain on the body due to excess weight has had other physical effects which will require the experienced eye of a medical professional to determine and treat.
He or she will conduct a full medical check in order to determine relevant obesity-related health risks or concerns, which may very well need to be taken into consideration when adopting new lifestyle habits. It’s best to ensure that a person’s full medical condition is known before attempting to make such drastic changes, so as to avoid any potential complications or health-related problems.
A doctor will likely begin with a medical review which involves a series of questions that will help to determine the overall status of health. Questions will likely cover the following areas:
- Weight: a brief history of weight gains and losses (possibly since childhood).
- Eating habits: What does an average day’s diet consist of? How much is eaten during the course of a day?
- Physical activity and exercise: How much of a day is spent in sedentary positions? Is any exercise activity performed? If so, how often?
- Life events: Have any major life changes or experiences potentially contributed to weight gain? Are high levels of stress being experienced?
- Previous or current medical conditions: Are any existing medical conditions being treated? Have any health concerns arisen in the past?
A doctor may also question a person regarding their general lifestyle and address possible concerns and goals. This is to assess things such as how daily life may be affected by excess weight and to determine whether a person is at the stage where they are ready to proactively make positive changes. A doctor may also ask about measures that may already have been taken to address excess weight (i.e. steps taken such as diet adjustments and exercise regimes – with or without the guidance of a nutritionist or exercise trainer - with the goal of losing weight).
From there, a doctor will conduct a physical exam which entails calculating BMI, evaluating vital signs (temperature, blood pressure and heart rate), an examination of the abdomen and listening to the lungs and heart. A doctor will also wish to measure the circumference of the waist.
Tests may be necessary to either diagnose or rule out possible physical ailments or conditions, and include blood samples to assess glucose (fasting glucose) and cholesterol levels, as well as liver function tests, screenings for the thyroid or to assess diabetes. An electrocardiogram (ECG or EKG) may be recommended to assess heart function. Imaging tests can include ultrasound scans, computerised tomography (CT scans) or magnetic resonance imaging (MRI scans).
A medical doctor will likely recommend what he or she feels is most beneficial based on the nature of a person’s overall physical condition. The more health concerns that apply, the more medical and / or specialist attention may be frequently required.
Treatment focussed on two primary objectives:
- Determine the best way/s to achieve a healthy weight
- Develop means that maintain a healthy weight
If no major health conditions are a factor, a doctor may wish to work with a person to periodically monitor their condition during their weight loss journey, ensuring that all vitals are functioning as they should and no further problems develop. If medications are required, monitoring will also be important. A doctor may also recommend others to join ‘the team’ for the journey, such as a dietician, councillor or therapist. In extreme circumstances, weight loss surgery may come up for discussion.
The physical benefits of getting to, and maintaining a healthy weight will be one of the primary areas of discussion when it comes to implementing a treatment plan. All of which are essential for healthy living and are achievable. Key benefits include:
- Improved energy levels and the ability to participate in more types of activity
- Fewer muscle aches and joint pains
- Improved heart function and reduced strain on the circulatory system and risk of heart disease
- Improved blood pressure levels and the regulation of bodily fluids
- Reduced risk of diabetes, affecting blood triglycerides and blood glucose levels
- Improved sleeping habits
- Decreased risk of cancer
1. Lifestyle and behavioural changes
One of the first steps which may be integrated into any medical treatment are adjustments to a person’s lifestyle. If a person can start and maintain a 3% to 5% weight loss (at the very least), they can achieve clinically meaningful improvements that lower their risk of developing serious conditions such as high blood pressure, diabetes and heart disease. Even greater weight loss achievements further improve blood pressure and cholesterol levels.
Forming a healthcare team is one way to achieve weight loss success. Obese individuals stand to gain far more by working with a team that can best take care of their condition in their quest to achieve significant weight loss and a healthier physical state, than going it alone. Structured eating plans with healthier choices and exercise regimes that help to build strength and endurance, and improve metabolism can make a significant difference.
- Diet: Calorie control and healthier choices implemented in a slow and steady manner is considered the safest way to lose excess fat and maintain a healthy weight (in the long-run). Drastic or unrealistic changes to a diet are not an effective long-term solution. Many diet programmes for long-term weight loss focus on an initial 6-month weight loss goal, followed by a year-long maintenance phase (gradual weight loss) as a means to further boost long-term success. Healthier eating choices include consuming more plant-based foods, whole-grain carbohydrates, lean protein, low-fat dairy, small amounts of heart-healthy fats and limited sugar and salt. Fad or crash diets and quick fixes are not the best solutions for weight loss, especially for those in the obese category.
- Physical activity: As with eating changes, physical activity (aerobic exercise) is critical for weight loss and healthy weight management. If a person is able to maintain a steady amount of weight loss over a year, are generally able to do so with the help of regular exercise. At least 150 minutes of moderate intensity physical activity (spread out over at least 3 days) will help to prevent further weight gain and maintain a modest amount of excess loss. Once this becomes achievable and a person wishes to lose more weight, increasing weekly minutes to 300 can prove effective. It’s important to make increases gradually and build strength, fitness and endurance. The important thing is to keep moving. The more a person moves, the more calories can be burned and weight can be lost.
Obesity is not just a physical condition. A person’s mental and emotional state have a significant impact on a person’s wellbeing too, and require just as much attention and care as the physical side of things. Counselling and support is an important part of treatment. Much of the adjustments required involve behavioural changes and these are considerably influenced by a person’s mental and emotional state. Support in this area can help to identify unhealthy triggers and provide coping measures that address the source of adverse behaviours.
2. Medications for weight loss
Once at the stage of obesity, often, lifestyle changes alone may not be sufficient to simple lose weight. Prescription medications for weight loss are available to be taken in addition to healthier lifestyle choices (diet and exercise). Medications should not be used in place of a good diet and exercise regime. A doctor will consider recommending medications if lifestyle adjustments are not showing a marked improvement or if a person has obesity-related health problems and a high BMI.
Prescription medications can help things along by preventing the absorption of fat and suppressing appetite, but there are side effects. All prescription medications will require periodic check-ups to ensure that a person is at their most comfortable taking the drug and that no adverse reactions are occurring, especially if taken in combination with others. Some unpleasant side-effects include frequent or oily bowel movements, increased bowel urgency or gas.
Some of the most common prescription medications are:
- Orlistat (Xenical): Blocks the body from absorbing about a third of all fatty foods consumed. Side-effects are generally mild at the start of dosages and include flatulence, abdominal cramping, increased frequency of bowel movements, a leaking oily stool, and problems controlling bowel movements. A change to a low-fat diet is recommended before taking this medication, as well as incorporating a multivitamin into a daily routine (2 hours before or after taking the drug). The medication may be used long-term, accompanied by frequent medical check-ups.
- Contrave: An extended-release formula, this medication combines naltrexone and bupropion (FDA-approved medications). Independently, naltrexone is commonly prescribed to treat opioid or alcohol dependence, and bupropion to treat depression and smoking habits. Common side-effects of the combination drug include headaches, nausea, vomiting, constipation, insomnia, diarrhoea, dizziness and dry mouth. The medication does have a warning for neuropsychiatric problems and an increased risk for suicidal thoughts. The drug is high risk for those who have problems with seizures, blood pressure and heart rate. The FDA recommends that if a person is not able to lose 5% of their body fat within 12 weeks, medication use should be discontinued.
- Belviq: An appetite suppressant. Non-diabetics commonly experience headaches, nausea, dizziness, dry mouth, fatigue and constipation as side-effects while on this drug. Those with diabetes may experience hypoglycaemia (low blood sugar), headaches, fatigue, a cough and back pain. Caution should be taken for those taking certain medications used to treat depression. A doctor may not recommend this medication for women who are planning to become pregnant or who are already. The FDA recommends that if a person is not able to lose 5% of their body fat within 12 weeks, medication use should be discontinued.
- Other appetite suppressants include: Saxenda (mimics the intestinal hormone and vagus nerve functions that signal fullness in the stomach), Qsymia (combines phentermine and topiramate which helps burn more calories and leaves a person feeling satiated) and Phentermine (also known as Adipex or Suprenza, is only prescribed for short term use due to a high risk of dependency and the nature of side-effects).
3. Weight loss surgery (bariatric surgery)
Surgery options are also available to help a person better control the amounts of food that can comfortably be eaten or prevent a certain amount of food or calorie absorption.
A doctor (or bariatric surgeon) will not usually recommend surgery outright. There are serious risks associated with surgical intervention as a means to achieving weight loss. Surgery is not a weight loss cure and cannot be considered a quick fix. To be considered a surgery candidate, a doctor will ensure that very specific requirements are met beforehand, often including a serious commitment from an overweight or obese individual to adhere to lifelong eating and exercise regimes. Following surgery, a person can run serious risks of falling ill and experiencing health complications if they attempt to return to their previous lifestyle habits.
A doctor will assess benefits over risks in order to make a decision regarding surgery as an option. A candidate will more often than not need to have a BMI of at least 40 (teenagers may be considered if their BMI is over 35) in combination with other serious obesity-related medical issues or conditions.
There is also a certain amount of weight (15 to 30 pounds or 6 to 14 kilograms) which will be required to be lost before it is deemed safe to perform surgery. Counselling is also a requirement for any candidate ahead of a surgical procedure. Surgery is a serious consideration and needs to be treated as such by both the medical professionals involved as well as the candidate.
Smokers will be asked to discontinue completely as this can result in post-surgery complications, such as pneumonia. A doctor may also request that a candidate consult with a nutritionist and start making a change to eating patterns and specifically portions, for a set time prior to surgery. Many find that this helps a candidate adapt a little easier to eating smaller portions, slowing down when eating and becoming more aware of the nutritional value of foods consumed.
Common surgery options include:
- Gastric bypass (or Roux-en-Y / RYGB): A small pouch (i.e. portion of the stomach) is created at the top of the stomach, which connects to the small intestine (a surgeon divides the stomach into one small pouch and another larger one). A surgeon disconnects the first portion of the small intestine (duodenum) from the larger portion of the stomach and then connect the smaller pouch to the jejunum portion further down the small intestine. Sometimes referred to as ‘stomach stapling’, this allows for food and liquid to be directed straight to the smaller pouch, passing through the jejunum, bypassing the duodenum and remainder of the stomach. A smaller amount of food can thus be held in this smaller pouch, and consequently ‘forces’ a person to develop the habit of eating less than they were before, as well as curbing the absorption of some calories and nutrients. The procedure is often done laparoscopically involving several small incisions. A surgeon will use a laparoscope (small camera device) to perform the procedure through the incisions as a way of ‘seeing inside the body’. A mini-gastric bypass is also an option done through a laparoscope. The procedure effectively creates a new size stomach which restricts the amount of food that may be digested. Sometimes laparoscopic methods are not possible. In this instance, larger incisions are made in the middle of the abdomen (laparotomy).
- Gastric sleeve (sleeve gastrectomy): This procedure involves removing part of a person’s stomach (more than half) and can also be performed laparoscopically. A thin, vertical or narrow ‘sleeve’ (tube-shape) remains of the upper stomach. The surgery effectively curbs the ‘hunger hormone’ ghrelin, which also suppresses appetite enough to promote smaller portions being consumed.
- Laparoscopic adjustable gastric banding (LAGB or lap band surgery): This surgery is less invasive. The procedure uses a silicone band (or ring) to separate the stomach, effectively creating ‘two pouches’. The silicone band is placed around the upper stomach and the tightness adjusted with injections of saline filling the band (to loosen, the saline with be extracted). Once the surgeon is happy with the size, a person’s small incisions are closed up for recovery. Care is taken to ensure that the band is not too tight as this will cause side-effects, nutritional problems and complications. If necessary, the tightened bands can be loosened. The tighter the band, the more the stomach shrinks. The procedure results in less dramatic weight loss than a gastric bypass, but is still a successful surgery.
- Biliopancreatic diversion (with duodenal switch): This procedure is similar to that of a RYGB. The small pouch created is connected to a portion of the small intestine that is further down than the jejunum, known as the ileum. This effectively means that more of the small intestine is bypassed and a person absorbs even fewer calories, running the risk of not being able to get enough nutrients (vitamins and minerals) in the body. Nutritional problems are thus a risk of this procedure and can be a more complex surgery to perform. If performed with a duodenal switch, a gastric sleeve is used to bypass most of the small intestine.
Another potential option is …
- An electric implant (Maestro Rechargeable System): Similar to a pacemaker, this implant works by delivering electrical pulses to the vagus nerve between the brain and the stomach (which is responsible for signalling stomach fullness to the brain). The device is surgically implanted in a person’s abdomen and can be adjusted using a remote control.
What to expect following surgery
A hospital stay of 2 to 3 days is normally required to monitor a person’s adjustment following surgery, prevent infection or adverse complications (such as digestive problems, internal bleeding or ulcers). Rare complications that may be life-threatening can include pulmonary embolism (blood clots), leakage in the intestinal surgical connections, a heart attack, or severe bleeding (visible in the stools or faeces) and wound infection.
The majority of candidates may experience side-effects of nausea, vomiting, diarrhoea, abdominal bloating, flatulence (increased gas), dizziness or excessive sweating.
Normally, recovery for a gastric banding (less complex procedure) takes around 1 week. A gastric bypass can take about 4 weeks for a person to recover. A person may generally return to normal activity within 2 to 3 weeks following surgery. Weight loss is often quite dramatic following gastric bypass surgery, with many losing between 50% and 70% of their excess weight within 18 to 24 months (a gastric sleeve procedure can accomplish about a 40% loss of excess weight). This has dramatic effects on a person’s overall health and can sometimes reduce serious health complication risk virtually to zero (with some improvements becoming evident in the short term and others over a longer period of time). Few ever regain lost weight.
In the short-term, a person may wish to have sagging skin surgically removed, as well as take supplements to ensure that nutritional deficiency doesn’t occur. Following weight loss surgery, it is fairly common for the body to struggle to absorb iron, vitamin B-12, folate, vitamin D and calcium effectively.
Weight loss surgery may result in long-term problems. These risks will have been discussed in full prior to surgery. Common problems include:
- ‘Dumping syndrome’: Often experienced in gastric bypass candidates, whereby food and liquid moves through the small intestine too quickly. A person will experience nausea, diarrhoea, feeling faint, and sweating following a meal. High sugar foods and beverages, such as fruit juices and sodas may also cause a person to feel very weak, but can be replaced with those higher in fibre content to curb the side-effect.
- Gallstones: When a person loses a substantial amount of excess body fat in a short space of time, gallstones can occur. Supplemental bile salts may be recommended before surgery as a foreseeable measure to try and curb this potential occurrence. These will be taken for 6 months following surgery.
- Constipation: A surgeon may recommend that a person avoids granular fibre following surgery which can result in bowel obstructions.
Women of reproductive age who undergo weight loss surgery will also have to have a serious conversation with their doctor about potential future pregnancies following their procedure. A doctor will strongly advise that a woman takes measures to avoid falling pregnant until such time as it is medical deemed safe and her weight is stable. Rapid weight loss and nutritional problems or deficiencies can have adverse effects on a developing baby and cause congenital problems, as well as cause a woman to become anaemic.
Lifestyle changes after surgery
Surgery forms just one part of a dramatic lifestyle change. The rest is up to the candidate, once recovered from surgery. Changes which will help to ensure the best results following surgery include:
- Consuming smaller, frequent meals: Having surgery to combat excess body fat effectively means the end of binge-eating habits. And for good reason. A smaller stomach cannot hold as much, making larger meals problematic.
- Making a commitment to a healthier diet: Choices will now need to revolve around more nutritious options. For those who have difficulty sticking to a new diet, a nutritionist can provide a healthy eating plan. This will ensure balance and stability when it comes to daily nutrition (yo-yo dieting will not be comfortable or advisable).
- Maintaining a healthy exercise programme: Keeping weight off is somewhat easier than working to lose it. Exercise post-surgery and initial weight loss is often a lot easier on the body, especially where a person was affected by joint aches and pain before. There are plenty of exercise activities that a person need not develop a grudge against doing. Many activities can be enjoyable as much as beneficial for the body. Those that a person finds they most enjoy doing generally maintain regular participation, and as such, offer great benefits.
Achieving and maintaining weight loss
It can be done. Any treatment for obesity begins with achieving a modest amount of weight loss – 3% to 5% of total body fat / weight. The more weight that is lost at a consistent or gradual pace, the better. Treatment methods do depend on a person’s level or class of obesity, as well as overall health condition.
Lack of quality sleep or sleep deprivation is also a contributing factor to weight gain as it causes increased cortisol (the stress hormone) levels which leads to increased appetite while fatigue often leaves one reaching for sugary, carb loaded snacks with high calorie content in an attempt to boost energy levels. A good 7 to 8 hours every 24-hours is best.
Some of the best ways to avoid weight gain after seeking treatment for obesity include:
- Learning all there is to know about obesity. Once a person is able to identify the reasons why they became obese, the more they can assert control over the future of their health.
- A significant amount of weight loss to be achieved can be daunting. Setting realistic goals – daily, weekly, monthly – can help make the primary objectives more achievable. Realistic goals make for achievable changes.
- Part of goal setting is implementing lifestyle changes and alterations to behavioural patterns that compounded the problem. Working closely with healthcare teams can make sticking to a treatment plan a lot simpler and less problematic. What works for one, may not work for all. Treatment plans will always be tailored for an individual. All involved will ensure that recommendations are tailored to achieved the optimum result.
- It’s all too easy to become isolated and hide. An obese person should be encouraged to get the support of family and friends during their journey. Those who generally have a positive impact on a person are the best kind of support to have. Where close friends and family may be lacking, support groups are also beneficial for a person to gain understanding along the way, learn to cope and even help others on a similar path.
How to handle to psychological and emotional effects of dramatic weight loss
For many, the psychological adjustments of dramatic weight loss are an intensely emotional experience, and a very personal one at that. Many find themselves thinking ‘I wish someone had told me that about losing so much weight’ …
Some describe losing excess body fat as being easier than dealing with the aftermath when it comes to dramatic weight loss. Others feel that along with the weight lost, so too is their ability to ‘be happy’ or feel content. Dramatic weight loss isn’t just a physical adjustment. It’s psychologically complex too, and may not always bring about as much happiness as a person may expect.
It is a good idea to pay as much attention to the psychological changes as those physically experienced. Losing such a dramatic amount of weight may feel like being on a rollercoaster ride for some. In one moment, a sense of achievement and pride may be felt, and in others, a low self-esteem.
Part of a person’s healthcare team should be a psychologist or councillor who can help a person through the emotional effects. It’s important to understand that such dramatic change may not be a simple or easy journey and will not automatically lead to happiness and improved confidence.
Emotional challenges could be…
- Realising that losing weight doesn’t necessarily equal happiness: A person may not feel as happy or content as they may have expected. This can come as a shock following dramatic weight loss if a person is not yet mentally prepared for it. Counselling can help to do this and ensure that a person going through dramatic weight loss understands the process and will still be able to recognise themselves (who they really are) through the process. The mantra, “You are still you” can serve as a great reminder through the process.
- Losing weight can make a person feel vulnerable: For an obese person, a larger frame may have provided a degree of emotional protection and a sense that they could ‘hide’ their true selves. Psychologically, it enables a person to feel as though others cannot truly see who they really are. Losing this ‘fleshy protective barrier’ can leave a person feeling somewhat ‘exposed’.
- Losing weight casts a spotlight on a person: Adding to feelings of vulnerability, dramatic weight loss can bring about a certain amount of attention from others which may not be all that welcome. Although comments received about the change in physical appearance may be glowing and show approval of the accomplishment, it can make a person feel all the more exposed and vulnerable. Losing such a lot of weight is quite an adjustment, on multiple levels, for the person concerned. Coping with the attention of others in a way that isn’t as familiar at the same time can be challenging, and can sometimes feel a little ‘too personal’ for others to be acknowledging. It can also become emotionally problematic for some people when all of the attention dies down and passing comments no longer happen. Eventually others ‘get used to the new look’ and may stop acknowledging the change. A person can also use counselling to mentally prepare for this.
- Losing a lot of weight can lead to feelings of anger: When others notice such a dramatic physical change, it can spark a little annoyance or anger. Not all positive remarks will necessarily be flattering. It may be difficult for a person to want to acknowledge the approval of others who never gave them the time of day before, and who are now expressing positive comments or asking how the weight loss was achieved. In learning to cope emotionally with physical changes (outside appearance), it can make a person feel that others are shallow and superficial if they’re only now treating a person positively after they have lost weight. Some people have also experienced negative remarks, commenting that they no longer look ‘healthy’. Counselling can also help a person to understand that others may have trouble getting used to a physically ‘new person’ or assist in dealing with jealousy.
- Dramatic weight loss can affect relationships: For those already in relationships, tension can occur if a person’s partner is also overweight or obese. A person going through such a dramatic change may wish the same for their partner which can create obstacles and challenges within the relationship. On the opposite end of things, a partner may experience problems with self-esteem, feel threatened, or worry that temptation to be with another may force the relationship apart. A change in lifestyle habits can also create tension between a couple who used to share certain things together, such as meals or time spent not being active.
- Losing a lot of weight can cause intense fear and anxiety: Along with or instead of a sense of accomplishment, a person may become fearful about putting any amount of weight back on once the ultimate goal has been reached. This fear may lead to anxiety and stress over every morsel that is eaten, or cause a person to deprive themselves of food that would give them satisfaction or enjoyment. The pressure to maintain weight loss can become overwhelming if not dealt with appropriately. In extreme cases, constant obsession and restriction can lead to eating disorders if a person is not careful. With the right support on hand a person can learn self-control without feeling that one food related indulgence will place them right back to where they started.
- Dramatic weight loss can make a person a little self-absorbed: Making such a dramatic change in day-to-day life can become a little all-consuming for the person going through it all. A person may not be feeling all that negative about the changes they’ve been through but can still become very lost within themselves. While this can be understandable, others (family, friends, colleagues) may not be as gracious about it if taken too far.
What can a person do?
- ‘Comparison is the thief of joy.’ A person should try and focus on themselves (internally) without comparing themselves to others. For an obese person, dramatic weight loss is primarily about getting to a healthy physical state, and should not lean towards a superficial outcome (which often leads to a perpetual state of disappointment).
- Losing weight may not automatically give way to self-confidence, and this shouldn’t be expected. Being thinner will not make a person who was not in the habit of being outgoing before more so once a lot of weight has been lost. Self-confidence will need to come ‘from the inside’ and learning how to cope with the physical changes, happening ‘on the outside’. Counselling can be highly beneficial in helping a person understand that solving one problem will not necessarily solve every challenge a person has. Learning to ‘dress a new person’ in smaller sizes may also help contribute to positive feelings about such a dramatic physical change. It’s not all that uncommon for a person to find themselves still shopping for clothes at the size they were before or dressing in the usual ‘over-sized’ comforts. Counselling can also help a person to understand that sometimes dramatic physical changes have an impact on the body’s hormonal cycles. This means that depressive symptoms are normal for a person to go through post weight loss. Hormonal imbalances can affect a person’s mood, which in turn exacerbates feelings of stress, apprehension and anxiety.
- Lose the mindset that weight defines a person. “You are not your weight.” Thin does not necessarily mean happy, either. Losing weight may also not necessarily mean that the battle with weight is over – pressure to maintain weight can be just as challenging if not understood sufficiently and managed with care. From a psychological perspective, it may be beneficial for a person to adopt new labels for themselves – ‘fat’ or ‘out of shape’ can be replaced with ‘healthy’ and ‘energetic’.
- Think of losing and maintaining a healthy weight as a lifestyle, which implies a lifelong commitment. A person may have goals to set and accomplish, but there is no real end to ‘the journey’. Losing and maintaining a healthy weight will continue every day.
- A person can also better benefit from finding things that make them feel happier, good about themselves or healthier. If travelling was difficult to do before, book a holiday. Learn new hobbies, and indulge in beneficial projects that add value to life, not take away from it. It’s also a good idea to include less of the things that don’t meet these objectives in a day-to-day lifestyle.
- Celebrate achievements, as they happen, however small. Any achievement of success is one to feel good about.
- Set aside some time for self-reflection. Physical activity and constantly thinking about calorie control can take a mental toll on a person every now and then. Some quiet time can help a person restore balance and keep negativity at bay during low points.
What are the best prevention methods?
The best way to avoid obesity is to never reach that stage. Unhealthy weight gain and associated health problems can be avoided. The best means of preventing obesity is to recognise the lifestyle patterns worsening a problematic weight condition and to take action to turn away from that path.
Good lifestyle choices can reverse the adverse effects of unhealthy weight and prevent further gain. Whether a little overweight or at risk of falling into an obesity category, the best things to do are:
- Develop a regular, moderate-intensity workout plan (150 to 300 minutes every week) that includes aerobic activity such as swimming or walking.
- Develop healthier eating habits. Cut out saturated fats and unhealthy sugars and replace meals with those that a high in nutrients and low in calories. By focussing on foods that promote good health, especially heart health, and ensure minimal weight gain, a person is better able to burn off calories.
- Take note of habits that trigger bad habits. Once in the know, it is easier to stay in control of the behaviours that trigger the kind of habits that ultimately lead to weight gain.
- Monitor subtle changes so as to ensure that setbacks do not become more than can be handled.
- Get into the habit of being consistent – with eating habits, activity etc.
How many calories should a person eat daily to lose weight effectively?
This is best answered by taking age, gender and activity level into consideration. The more active a person is, the more calories are best burned. A dietician can best assist with the most beneficial targets which can be achieved in a healthy way.
Recommended daily calorie consumption (average) for …
- Women (aged between 19 – 51): 1 800 to 2 400
- Women (ages 51+): 1 800 to 2 200
- Men (aged between 19 - 51): 2 200 to 3 000
- Men (ages 51+): 2 000 to 2 800
- Children and teenagers (aged between 2 – 18): 1 000 to 2 400 (female) and 1 000 to 3 200 (male)