3 Hypertension Most common complication of obesity Blood pressure is determined by a complex system of circulating hormones, many are made in fat tissue and the kidneys. These hormones control the diameter of the arteries and thereby control the pressure in the arteries.A 10% reduction of body weight has been associated with a decrease in blood pressureChronic obesity also can reduce the efficacy of anti- hypertensive medications
4 Diabetes Obesity is the leading cause of diabetes The risk of diabetes increase 53x’s with severe obesityType 2 diabetes is almost always associated with obesity and appears to be related to hormonal substances (cytokines) produced by adipose (fat) tissue and to the increase amount of blood fats that occurs in diabetes.The majority of obese individuals with diabetes can eliminate the need for medications or insulin by reducing their weight by 10%
5 Heart Disease and Stroke Increase in heart disease is associated with obesity independent and additive of the increased risk factors of HTN, diabetes, and elevated cholesterolThere is a 3x risk of heart disease with obesityAs a general rule, for every pound over your ideal body weight, subtract one month from your life expectancyFor each point increase in BMI there is a 6% increase in the risk of an ischemic strokeFor each point increase in BMI there is a 4% increase in the risk of developing atrial fibrillation this is related to left atrial enlargement and congestive heart failure
6 Respiratory DiseaseOver 75% of patients with obstructive sleep apnea are >120% of their ideal body weightA neck circumference of >17 inches is also related to sleep apneaUpper body fat deposits may increase airway collapsibility and interfere with inspiratory and expiratory muscles. This airway collapsibility will decrease with weight lossObesity also appears to be a risk factor for airway hyper- responsiveness ( asthma)
7 Gastrointestinal Problems Obese patients are 2.5 x more likely to have reflux symptoms or esophageal ulcer than patient with a BMI <25There is also a link between GERD and esophageal adenocarcinomaFatty liver disease: NASH (Non-alcoholic Steato-hepatitis) is caused by excessive fat deposition in the liver. This leads to silent inflammation, usually detected by adnormal liver function and can lead to cirrhosis or liver failure.Obesity is associated with cholelithiasis. There is also an increased risk for cholelithiasis in patients who lose weight rapidly and can affect about 38% of patients after having bariatric surgery
8 Degenerative Osteoarthritis There is a marked in osteoarthritis is the obese. It is most common in the knees and ankles as a consequence of wear and tearAdipose (fat) tissue produces cytokines that “destroy” the normal cartilage in jointsIf a patient loses weight, destruction of joints does not disappear: yet joint pain will generally diminish due to less stress on the joint
9 Gynecological and Obstetrical Complications Obesity during pregnancy is associated with: * Gestational diabetes * Preeclampsia * Delivery Complications:Macrosomia (big baby)Shoulder dystociaC sections infectionsObesity is responsible for 6% of primary infertility; Impotence Polycystic ovary syndromePolycystic Ovary syndrome is the most common endocrine disorder in women of age. It is characterized by: chronic anovulation, polycystic ovary morphology, and hyperandrogenism
10 CancerThe World health Organization has estimated that being overweight and inactive accounts for 1/4 to 1/3 of all cancers of the breast, colon, endometrium, kidney, and esophagusObesity can unfavorably influence the diagnosis of cancer and the response to therapy thereby there is an increase in the likelihood of dying from cancerOverall Overweight and obesity could account for % of all cancer deaths in men % of all cancer deaths in women
11 Psychosocial function There is a stigma associated with obesity in areas such as education, employment, and healthcareFor adolescents with a BMI above the 95% for age and sex: * Completed fewer years of school * 20% less likely to be married * lower household incomes * higher rates of household povertyDepression has been associated with obesity causing profound sadness, crying, and loss of energy
12 Why is this important?Bariatric surgery patients will be at risk for surgical complications but we must keep in mind what medical complications of obesity they might already haveIf they have diabetes, peri-operative blood sugars will need to be watched closely as their diet will change dramaticallyPatients with ostearthritis, might need aids to support mobilization post-operativelyPatients with obstructive sleep apnea may need the support of CPAP peri-operatively
13 Bariatric Medicine Test 1. All of the following are medical complications of obesity EXCEPT: a. Diabetesb. Alzheimersc. Sleep apnead. Polycystic ovarian syndrome2. Weight reduction can help all of the following complications EXCEPTa. Diabetesb. Hypertensionc. Cancerd. Osteoarthritis
14 3. What substance does fat tissue produce that destroys normal cartilage in joints? a. Cytokinesb. lymphokinesc. Cartilagikines d. Insulin4. A neck circumference of what is related to sleep apneaa. > 15 inchesb. > 16 inchesc. > 17 inches
15 5. What amount of weight loss can effect a lowering of blood pressure a. 20 lbsb. 5%c. 30 lbsd. 10%5.
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