Disease of the month: Morbid obesity and Bariatric surgery

The UK's population is getting fatter, so what can be done to tackle the obesity timebomb? Mary Randell takes a look at some of the drastic measures being used

If we look up the definition of morbid obesity on the internet, there are a number of descriptions. However, they all agree that an obese individual is classified as being ‘morbid’ once their weight exceeds their ideal body weight by 45kg (100lbs) or is two times their ideal body weight:

“Morbid obesity – the condition of weighing two or more times the ideal weight; so called because it is associated with many serious and life-threatening disorders.”

“Morbid obesity – an excess of body fat or weight of 100 pounds over ideal body weight, that increases the risk of developing cardiac and endocrine disturbances as well as some cancers.”

The diagnosis of obesity is generally made using the body mass index (BMI), where the weight in kilograms is divided by height in metres squared. An ideal BMI is between 20 and 25. The following table describes the degree of obesity above this figure:

It should be noted that an individual who is very muscular may have a high BMI due to the weight of their muscles, rather than a result of them carrying excess fat. In this instance, an individual may not be classified as being morbidly obese.

But it is also worth adding that when an exercise regime changes or stops, this extra muscle may be replaced with fat.

Examples of height and weight ratios that could fall into the morbid category include:

• Male aged 40, height 5ft 10 (178cm), weight 20st 7 (130kg), giving a BMI of 41
• Female aged 40, height 5ft 4 (163cm), weight 17st 10 (112kg), giving a BMI of 42

It is recommended that when calculating the increased health risks, the waist circumference is also taken into account. This is because abdominal fat can often be a more accurate predictor of cardiovascular disease.

Obesity is increasing in the Western world and other developed countries. In addition, it is ­predicted that by 2050, up to 90% of adults will be either overweight or obese.

Causes

There are several factors that are commonly known to be linked to the development of obesity, such as lifestyle, diet, socio-­economic factors and a family history of obesity. There are also certain medical conditions and drugs that can be responsible for an increase in weight. These include:

• Underactive thyroid (hypothyroidism)
• Polycystic ovary syndrome
• Cushings syndrome
• Oral steroids
• Antidepressants
• Beta-blockers
• Oral contraceptives
• Hormone replacement therapy (HRT)
• Treatment

If diet, exercise, lifestyle changes or anti-obesity drugs haven’t been effective, then more drastic treatment, such as surgery, may need to be considered. Bariatric surgery is rapidly becoming one of the preferred options for treating morbid obesity. There are several procedures available on the NHS and private care. But NICE have clear guidelines on who can be considered for weight-loss surgery. They include people:

• With a BMI greater than 40
• With a BMI between 35 and 40, with other significant disease such as diabetes or hypertension
• Who have failed to achieve or maintain weight loss via non-surgical means for a period of at least six months
• Who are generally fit for anaesthesia and surgery
• Who are receiving, or will receive, intensive specialist management
• Who will commit to the need for long-term follow-up treatment