What is Obesity?
Obesity is a disease involving abnormal or excessive body fat accumulation that can cause impaired health. Simply, the cause of weight gain is from consuming more energy from food and drink than is expended in daily living and physical activity.
The World Health Organisation estimates that more than one billion people world-wide are overweight, 400 million of whom are obese.
Australia is part of this growing epidemic. Around seven million Australian adults are overweight or obese – 52% of women and 67% of men. In Queensland alone it is estimated that 1 in 3 adults are overweight and 1 in 4 are obese, and if current trends continue, by 2020, two-thirds of Queensland adults will be overweight or obese.
Obesity surgery or weight loss surgery has helped over 60,000 Australians manage their hunger and weight related illnesses.
Obesity is measured by the body mass index (BMI). The BMI reflects a person’s weight in comparison to their height (weight [kg] ÷ height² [m²]. For instance, a woman who is 1.67m in height and weighs 65kg would have a BMI of 23.3, which is considered to be within the healthy weight range. A BMI of 30+ is considered obese.
||25 – 29.9
|Classifies you within a healthy weight range.
||Classifies you as overweight. Being overweight can lead to obesity and the start of life-threatening health problems.
||Classifies you as obese. This means that you are more at risk of developing:
- Heart disease
- High blood pressure
- Type 2 diabetes
- Skin problems
CAUSES OF OBESITY
Your metabolism is how your body turns food into energy. If you eat the same amount of food as another person you may gain weight and they don’t. Chances are that they have a higher metabolic rate (assuming they don’t exert themselves more). Either way, the ‘energy in to energy out’ needs to the right balance for your own body’s metabolic rate. Everybody’s metabolic rate differs and what could be the right amount of food for one person may be too much for another.
We all need to eat a certain way to maintain a healthy weight. There are a variety of eating styles which are not good for weight control, so there is a strong possibility that your eating style may be contributing to your weight problems. There are numerous eating styles which are not compatible with good weight control.
More active people use up more calories. Once you have developed a weight problem, just moving around can be exhausting and joints become painful, exercising then becomes more unpleasant. This means that overweight people tend to use fewer calories. Exercise is either formal (going to the gym, boot camp or regular sport) or informal (doing housework, speed walking to catch the train or standing up on the train). Obesity is associated with less formal exercise.
People with a weight problem usually have something about their life which makes them more likely to gain weight. This may include shift work, a busy lifestyle with not enough time in the day left to prepare healthy food or even a lifestyle which has quiet time at the end of the day, and then food becomes part of their daily wind-down ritual.
As our lives change, our diets need to follow this change. But in most cases they don’t. Middle aged men report weight gain when they stopped playing football, whereas women report weight gain after having children.
Hormones play an important role in weight control. There are so many hormones involved that it is impossible to isolate a singular hormone that will help with a wonder medication unfortunately.
There are numerous families of overweight and obese people. This is due to the family’s overall approach to food, exercise and genes. It all relates to our cultural approach to food, weight and exercise.
Many people eat for emotional reasons, it helps people deal with stress, boredom, sadness, depression or to block out a distressing thought. There are nice smells, colours and tastes and there are chemicals in food that actually make us feel different e.g. chocolate and coffee. This is all part of the psychological battle to feel good about ourselves while trying to eat the things our bodies need.
There are certainly risks associated with being obese. They can range from major health risks to psychological issues and general day to day living issues. Some of the major health risks involved are: Shorter life expectancy Diabetes (Type 2) Joint problems (e.g. arthritis) High blood pressure Heart disease Gallbladder problems Cancer (particularly bowel and hormonal-related cancers) Digestive disorders (gastro-oesophageal reflux disease or GORD) Breathing difficulties (sleep apnoea and asthma) Psychological problems (depression) Problems with fertility and pregnancy Urinary incontinence Some overweight and obese people may develop a negative self image, isolate themselves from social situations and even encounter discrimination because of their weight. Day to day activities may also become more difficult as movement is more difficult, becoming short of breath and tiring more easily. Some people even find it difficult getting around as public transport/airplane seats are too small, and sometimes even car seats may be too small. Experts estimate that between 12,000 to 17,000 Australians die prematurely from obesity each year. The good news is that major weight loss can lead to partial or complete control of a wide range of these diseases and related health problems.
If you are overweight or obese, you may have a number of different reasons for wanting to shed excessive weight, such as getting back into sport or being able to play with your children again. The most common weight loss approach is to eat less, eat sensibly and exercise more. Even small lifestyle changes can translate to great health benefits. However many who lose weight using these methods quickly regain it when the diet ends, which leads to more dieting, replacing meals with special drinks or taking diet pills. While temporary weight loss can help, the “yo-yo effect” can also make it harder to lose weight in the future. People who are clinically obese may wish to consider surgical weight control solutions when non-surgical treatments have failed. If you have tried everything to overcome obesity but failed, ask your doctor about long-term weight control solutions.
Laparoscopic gastric banding is the placement of a band around the top of the stomach through laparoscopic (keyhole) surgery. The gastric band is designed to induce weight loss by encouraging satiety (a sense of fullness) even without food and to restrict the amount of food that the stomach can hold before signalling it is full. The gastric band is made of silicone and a balloon lines the inside. An access port, connected to the band by tubing, is placed in the abdomen wall, which allows saline solution to be added or removed to change the size of the band. As the procedure is done laparoscopically, there is no major opening of the abdomen required, no cutting or potentially permanent alteration to the stomach or intestines. It is also reversible. The gastric banding procedure has helped many people shed their excess weight. It is now the most common form of weight control surgery in Australia, with more than 90% of bariatric patients electing laparoscopic gastric banding. In 2010 alone, 11,000 gastric banding procedures were performed in Australia. Over 60,000 since 1994 and 650,000 worldwide in the past 10 years. Like most who suffer from obesity, these people struggled with their weight for many years, possibly most of their lives, and tried other common weight control methods with no success. Gastric banding was their final option. If you believe that gastric banding is a good option for you, see your doctor.
Roux-en-Y gastric bypass has been available for more than 35 years and is still a commonly used procedure in the United States. Roux-en-Y gastric bypass is traditionally done with a long incision in the abdomen, but can also be performed laparoscopically. It involves cutting the stomach off near the top so that a smaller pouch may be made, which is reconnected to the small intestine. The procedure is essentially irreversible. Roux-en-Y gastric bypass involves creating a small stomach pouch which is then attached to a Y-shaped section of the small intestine. With this method, most of the stomach and top portions of the small intestine are bypassed. This procedure reduces the absorption of nutrients and therefore calorie intake. It is done through a major opening of the abdomen, requires staples, and is irreversible.
Sleeve gastrectomy (also known as gastric sleeve) is a relatively new approach to weight-loss surgery. Originally, it was the first stage of a far more complicated Roux-en-Y gastric bypass operation, but is now becoming more popular as a stand-alone procedure. With gastric sleeve, around two thirds of the stomach is cut out using a stapling device, and removed laparoscopically, leaving via a small tube. The residual stomach capacity is around 200ml. However, in contrast to laparoscopic gastric banding, sleeve gastrectomy is irreversible. Sleeve gastrectomy is believed to work by two main mechanisms first by decreasing the stomach size and thus increasing the sensation of fullness, and second by decreasing appetite. Appetite reduction apparently occurs because the level of the so-called “hunger hormone” is reduced. Sometimes, gastric sleeve is offered to patients who are super-obese to jump start weight loss so they can get down to a safe weight before undergoing a more radical Roux-en-Y gastric bypass.
The Single Anastomosis Gastric Bypass (SAGB), also known as “mini-gastric bypass” was first reported in 2001. The OAGB is a minimally invasive procedure performed with laparoscopic technique. During a SAGB procedure, the surgeon first reduces the size of the “working” stomach by separating a tube-like pouch of stomach from the rest of the stomach. This tubular gastric pouch is then connected (anastomosed) to the intestine, bypassing up to 200cm of the upper part of the intestine. This technique differs from the traditional Roux-en-Y Bypass (RYGB) which requires two connections (anastomoses).