What is obesity?
What is overweight, obesity and morbid obesity?

It is first necessary to define what is normal weight, overweight and obesity. 

The criteria that were retained are based on the calculation of its Body Mass Index or BMI: it is the ratio between the weight in kilograms and the height in meters squared.

 People with a BMI between 18 and 25kg / m2 are of normal weight. 

 People with a BMI between 25 and 30 Kg / m2 are overweight.

 People who have a BMI greater than 30 kg / m2 are obese. 

Obesity becomes morbid when it is responsible for the onset or aggravation of diseases

There are several grades of obesity :

  • Moderate or grade 1 obesity: BMI between 30 and 34.9 Kg / m2 

  • Severe or grade 2 obesity: BMI between 35 and 39.9 Kg / m2 

  • Morbid or grade obesity 3: BMI over 40 Kg / m2

Causes of morbid obesity?

There are 4 main categories of causes of morbid obesity :

1.The biological causes of morbid obesity are:

Age, sex, diseases, drug treatments

2.The familial causes of morbid obesity are mainly

Eating habits, physical activity, genetic background  :

3. The environmental causes of morbid obesity are :

Food overabundance, advertising, lifestyle and pace of life, diets

4. Psychological causes of morbid obesity :

Anxiety, depression, stress, various psychological traumas

Bariatric surgery techniques

There are many techniques for weight loss surgery.

We usually classify them in 3 categories :

  • gastrectomy sleeves 

  • gastric bypass

  • gastric rings

Each technique is chosen by the various people involved in the assessment during a consultation meeting at the end of your medical assessment.

Problems and consequences of obesity

Morbid obesity has harmful organic consequences:
  • High blood pressure.
  • Sleep apnea.
  • Diabetes and diseases related to hyperlipidemia.
  • Osteoarthritis of the back and knees.
  • Breast, colon and uterine cancer
  • Polycystic ovaries and infertility
Psychological consequences :
  • Nervous breakdown with its vicious food cycle..
  • Personality disorders = self-deprecation.
Obesity and diabetes

Type 2 diabetes is a serious and very common disease among obese people. Even if you are only a few pounds overweight, you have a greater risk of developing diabetes, but obviously the more obese you are, the greater the risk.
It is estimated that 80% of diabetics are overweight or obese.

In the US, type 2 diabetes is the third leading cause of death..

At present, experts in bariatric surgery and endocrinologists are convinced that the Gastric by pass or even the sleeve gastrectomy is a form of treatment for diabetes because of the hormonal consequences it entails.

In our series of operated patients we found that all diabetics stopped oral antidiabetics and normalised their glycated haemoglobin level.

Obesity is a risk factor for cardiovascular disease.

Essential hypertension, i.e. the progressive increase in blood pressure, is much more common in obese people.

It very often leads to the development of heart disease and also damages the blood vessels.

This condition leads to an increased risk of heart attacks, kidney damage and hardening of the arteries (atherosclerosis).

Obesity is the main risk factor for sleep apnoea.

Sleep apnoea, the cessation of breathing during sleep, is a phenomenon that usually occurs in obese people who have a compressed neck.

This causes snoring interspersed with periods of complete obstruction during which no air entry occurs. To an inexperienced observer, the sleeping person appears to be holding his or her breath voluntarily.

In fact, the person with sleep apnoea is either not aware of the problem at all or only notices that he or she is sleeping lightly and often wakes up during the night.

The health effects of sleep apnoea can be serious. High blood pressure, heart rhythm disturbance and sudden death can result from this problem.

People with sleep apnoea wake up exhausted and often fall asleep during the day and sometimes even while driving.

This condition is associated with a high mortality rate and even puts the lives of others at risk.

Obesity-related dyslipidaemia

Cholesterol and triglyceride levels are usually high.

Obese people generally have an enlarged liver due to fatty overload (hepatic steatosis).

This is why we suggest that all our patients follow a milk diet 5 to 7 days before the day of the operation:

  • exclusively 0% yoghurt,
  • 0% milk
  • 0% cheese
  • Tea and coffee without sugar.

We can also propose a high protein diet without carbohydrates and fats..

The aim is to reduce the volume of the liver and to facilitate laparoscopic surgery.

Gastroesophageal reflux in the obese patient

Obesity mechanically disrupts the muscular oesogastric sealing system and leads to retrosternal burning after meals.

Anatomically, the stomach can sometimes rise into the thorax (hiatal hernia).

Osteoarticular pain and obesity

Obesity generally causes pain in all joints. Some of them are particularly affected: the knees, hips and spine.

Osteoarthritis phenomena are very pronounced, with premature ageing of the joints and a state of invalidity. Herniated discs are also common, with recurrent lumbagos and sciatica.

Whatever the degree of obesity, doctors specialising in rheumatology or orthopaedics often require their patients to lose a lot of weight, not only to improve their symptoms of fatigue or premature ageing of a joint, but also before undertaking an operation with potentially poor results.

Being overweight also imposes strong constraints

For example, the fitting of a knee or hip prosthesis involves very high mechanical stress on the joints, which would lead to fears of premature wear and tear of the implanted material, whose lifespan is known to be fairly limited.

Furthermore, gout attacks are observed more frequently than in the normal population, which are linked to the rise in uric acid levels in the blood (hyperuricemia).

Other complications are tendonitis, osteoporosis, which is a loss of bone substance that usually occurs in women after the menopause and results in a greater susceptibility to fractures.

Why obesity makes women less fertile

Indeed, studies have shown that obesity in women influences the metabolism of oestrogens and androgens, which are deposited in fatty tissue..

Obesity leads to hyperinsulinism, which does not go down well with fertility and has an impact on many other functions necessary for reproduction, including the hypothalamus and pituitary gland.

Of course, there is no need to be alarmed: being slightly overweight does not lead to infertility, nor is it true to say that not all obese women are able to conceive children, but those whose body mass is above the healthy weight should think about rebalancing if they have a problem with infertility.

Overweight, obesity and conception

In any case, being overweight can also lead to miscarriages and morbid complications during pregnancy. So why not be doubly careful! A balanced diet, followed by physical exercise, could make all the difference.

Also note that underweight can cause as many problems with conception as obesity by affecting menstrual cycles and the normal function of the ovaries: women with a body mass index of less than 17 are 1.6 times more difficult to conceive.

Arteries, veins and obesity

A higher concentration of fat in the blood in the thighs and belly prevents the blood from flowing properly from the feet to the heart.

This can lead to certain venous disorders, the most common of which are heavy legs, oedema, varicose veins and phlebitis.

The fatty overload also slows down the blood in the arteries; these become loaded with atheromatous plaques and the organs that live at the expense of these arteries suffer (heart – digestive tract – brain – kidneys – liver)

In peri operative...

Our anaesthetists are very strict about anticoagulants. Their protocol is as follows :

30 < BMI < 35: Lovenox (Enoxaparin) 4000 units subcutaneously in the evening for 15 days from the day before the operation

35 < BMI < 40: Lovenox (Enoxaparin) 2000 units subcutaneously in the morning and Lovenox 4000 units in the evening for 15 days from the day before the operation

40 < BMI < 50: Lovenox (Enoxaparin) 4000 units subcutaneously in the morning and evening for 15 days from the day before the operation

50 < BMI: Lovenox (Enoxaparin) 4000 units subcutaneously in the evening and 6000 units in the morning for 15 days from the day before the operation.

Cancer risk and obesity

Today, it is clearly established that overweight (BMI > 25) and obesity (BMI > 30) can be linked to the development of several types of cancer.

Excessive abdominal circumference, due to localised fat, also increases this risk, even in the case of a healthy weight. Avoiding overweight and obesity, and achieving or maintaining a healthy weight in adulthood, is essential to reduce the risk of developing certain cancers.

Prostate cancer in men, uterine and breast cancer in women and colon cancer are more common in obese people.

Biliary lithiasis is a frequent complication of obesity

Obese people often have stones in the gallbladder.

We can offer them the possibility of having it removed at the same time as the bariatric procedure (ring, sleeve, bypass).

Weight loss can also lead to gallstones.