1. Medical Complications
of Obesity

2. Medical Complications of Obesity
Pulmonary disease
* abnormal function
* Obstructive sleep apnea
* hypoventilation syndrome
Stroke
Coronary artery disease * Diabetes
* Dyslipidemia
* Hypertension
Nonalcoholic fatty liver
cirrhosis
Gastroesophageal reflux disease
Cancer
Gynecologic abnormalities * abnormal menses
* infertility
* polycystic ovarian syndrome
Phlebitis

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 pressure
Chronic 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 obesity
Type 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 cholesterol
There is a 3x risk of heart disease with obesity
As a general rule, for every pound over your ideal body weight, subtract one month from your life expectancy
For each point increase in BMI there is a 6% increase in the risk of an ischemic stroke
For 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 Disease
Over 75% of patients with obstructive sleep apnea are >120% of their ideal body weight
A neck circumference of >17 inches is also related to sleep apnea
Upper body fat deposits may increase airway collapsibility and interfere with inspiratory and expiratory muscles. This airway collapsibility will decrease with weight loss
Obesity 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 <25
There is also a link between GERD and esophageal adenocarcinoma
Fatty 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 tear
Adipose (fat) tissue produces cytokines that “destroy” the normal cartilage in joints
If 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 dystocia
C sections
 infections
Obesity is responsible for 6% of primary infertility; Impotence Polycystic ovary syndrome
Polycystic Ovary syndrome is the most common endocrine disorder in women of age. It is characterized by: chronic anovulation, polycystic ovary morphology, and hyperandrogenism

10. Cancer
The 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 esophagus
Obesity can unfavorably influence the diagnosis of cancer and the response to therapy thereby there is an increase in the likelihood of dying from cancer
Overall 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 healthcare
For 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 poverty
Depression 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 have
If they have diabetes, peri-operative blood sugars will need to be watched closely as their diet will change dramatically
Patients with ostearthritis, might need aids to support mobilization post-operatively
Patients 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. Diabetes
b. Alzheimers
c. Sleep apnea
d. Polycystic ovarian syndrome
2. Weight reduction can help all of the following complications EXCEPT
a. Diabetes
b. Hypertension
c. Cancer
d. Osteoarthritis

14. 3. What substance does fat tissue produce that destroys normal cartilage in joints?
a. Cytokines
b. lymphokines
c. Cartilagikines d. Insulin
4. A neck circumference of what is related to sleep apnea
a. > 15 inches
b. > 16 inches
c. > 17 inches

15. 5. What amount of weight loss can effect a lowering of blood pressure
a. 20 lbs
b. 5%
c. 30 lbs
d. 10% 5.