What Is Morbid Obesity and What Can Be Done?

DAVID PROVOST, MD: America is becoming overweight. It really is an epidemic. Nearly two-thirds of Americans are now overweight, over a third of us are obese. There have been even higher estimates that as many as eight million Americans are morbidly obese.

KEVIN MONTGOMERY, MD: Morbid obesity is a condition where people have gained enough weight where they're actually beginning to experience medical problems as a result of their obesity.

ANNOUNCER: Morbid obesity is generally defined as being 100 pounds or more above one's ideal body weight or having a body mass index, or BMI, of 40 or greater.

DAVID PROVOST, MD: We define obesity based on the body mass index, which is a calculation based on a person's height and weight. A body mass index that's over 25, that person's considered overweight. A body mass index over 30 represents obesity. And severe obesity or morbid obesity is defined by a body mass index over 40.

KEVIN MONTGOMERY, MD: There are charts that are available that people can look up their height and weight and get their BMI from the chart. Probably the most convenient way is to log on to a website such as the American Society for Bariatric Surgery and put in their height and weight and it will automatically calculate their BMI for them.

ANNOUNCER: Obesity is a major health concern as it can cause medical illnesses or worsen pre-existing ones.

KEVIN MONTGOMERY, MD: Some of the ones that are most common and more severe are things like type 2 or adult onset diabetes, high blood pressure, sleep apnea, and other kinds of lipid disorders like elevated cholesterol or elevated triglycerides, many of which are risk factors for developing coronary artery disease.

ANNOUNCER: There are several strategies that obese people are encouraged to try, including exercise, dieting, behavior modification, as well as drug therapy. But while these tactics may help obese people reduce their weight initially, experts say that the likelihood of people maintaining that weight loss is slim.

DAVID PROVOST, MD: If we look at patients who undergo the medical management of obesity, whether it be dietary, exercise, behavioral, or ideally a combination of all of those, while a certain subset of patients may be able to lose up to fifty pounds, the percentage who can maintain that weight loss out beyond two years is much less than five percent.

Now with the morbidly obese, while certainly attempts at medical weight reduction are important and should be tried, the fact is, is that 99 percent of these people are not going to be able to achieve sustained weight loss through medical management alone.

ANNOUNCER: Because of the ineffectiveness of standard weight loss strategies, many morbidly obese people are turning to surgery in an attempt to try to lose the weight.

DAVID PROVOST, MD: The number of weight loss operations performed in the United States has really been increasing, almost exponentially. It's estimated that this year over 150,000 weight loss operations will be performed.

Patients who are candidates for weight loss surgery are those who are morbidly obese, meaning they have a body mass index over 40, or patients who have a body mass index over 35 but have associated serious, obesity-related comorbid illnesses.

ANNOUNCER: There are two basic categories of weight loss operations: restrictive procedures and malabsorptive procedures.

BRAD WATKINS, MD: Restrictive operations are basically turning the stomach into a very small pouch. And the way that works is patients get full feeling on a very small number of calories. So the purely restrictive operation, there is a vertical banded gastroplasty or VBG, the public calls that stomach stapling, where you simply staple the stomach into a very small pouch. More commonly, that's associated with putting some type of a fixed ring around that to prevent the failure rate that's been associated with it.

The newest purely restrictive operation is the adjustable gastric band whereby you place a ring or a band around the upper part of the stomach and it's an adjustable ring. It has an inner balloon that can be tightened or loosened. A section of tubing connects the band to an adjusting cord under the skin whereby you can add or remove saline to it.

Malabsorptive operations: most everyone is familiar with the gastric bypass. That's actually considered a combined procedure because you have a restrictive component whereby you cut the stomach into a small pouch and a malabsorptive component whereby you're bypassing some of the small intestines.

And then there are purely malabsorptive operations such as a biliopancreatic diversion or what we consider a distal gastric bypass, where a tremendous portion of the small intestine is bypassed so it's radically reducing the efficiency of digestion and absorption.

ANNOUNCER: Weight loss surgery is not for everyone. And for those whom surgery is an option, the choice of surgery depends very much on the individual patient's needs and goals. The first step is to calculate your BMI, and the second is to talk to your doctor. But morbidly obese people should keep in mind that weight loss surgery is not "the easy way out" and that permanent weight loss will take considerable post-surgery effort.

KEVIN MONTGOMERY, MD: These surgeries are just tools to help them lose weight. There is no magic answer. In the end, all of the surgeries help people to eat less, to fill up on a small amount of food and not be hungry all the time. However, they're all a major decision and the people that ultimately do best are people that use them as a tool to help them make a lifestyle change such that they make good food choices, that they eat less and that they're more active.

ANNOUNCER: Although there are many variables involved in losing weight for a morbidly obese person, surgery can greatly increase an obese person's chance of taking the weight off and keeping it off. And for many obese people whose past efforts have failed, weight loss surgery has been shown to be the only successful method of maintaining long term weight loss.

Produced 2005