Obesity: Consequences and Solutions

Presented by: John Morton, MD, MPH, FACS
Director, Stanford Bariatric Surgery
Thursday, November 11, 2010

Lecture Overview:

• Obesity has many serious long-term health consequences and is the second leading cause of preventable deaths in the country.
• Weight-loss surgery changes your digestive system and requires long-term commitment to dietary and lifestyle changes.
• Gastric bypass is the most common surgery; other options include lap band and sleeve gastrectomy.
• Most procedures are now done laparoscopically, which decreases pain and speeds recovery.
• Health benefits are evident almost immediately after the surgery.

Obesity is an epidemic in the United States and in other developed countries and still on the rise. Three out of five Americans are overweight or obese, and studies indicate that 75 percent of obese children will remain obese as adults.

Obesity is increasing because food is abundant and physical activity is not integrated into most people’s daily lives.

“It’s a mix of ancient genes and modern environment,” said John Morton, MD, director of bariatric surgery at Stanford, at a presentation sponsored by Stanford Health Library. “Our diet has changed, and portions have gotten bigger. In the past 20 years we have dramatically changed how we eat, play, and relax. And our lifestyles are more sedentary: In the 1960s, 40 percent of kids walked or biked to school. Now it’s less than 10 percent.”

Causes and Effects
The lifestyle that is associated with obesity is influenced by many uncontrollable outside factors, from the economy to the habits of your family and associates. Studies have shown that the risk of becoming obese increases by 57 percent when friends are obese and by 37 percent when a spouse is obese. And the condition is spreading: 10 percent of China is now diabetic, and it’s predicted that by 2030 more than half of all Americans will be obese.

Obesity is defined as having a body mass index (BMI) of 30 or greater. (The BMI is a measure of your weight relative to your height.) Morbid obesity is defined as a BMI of 40 or higher, or a BMI of 35 with health complications. The average BMI in this country is about 27. From 2000 to 2005, the rate of morbid obesity increased twice as fast as standard levels of obesity, and the number of people with a BMI over 50 grew 75 percent in that time period.

Obesity has many serious long-term health consequences, including diabetes, heart disease, and high blood pressure, and is the second leading cause of preventable deaths in the country (tobacco is the first). An estimated $145 billion is spent annually on treating the diseases associated with obesity, and businesses suffer an estimated $20 billion loss in productivity each year from obesity-related absenteeism and illness.

“It’s a big problem, and we need solutions,” said Dr. Morton. “Medications often have undesirable side effects, and diet and exercise can only go so far because it’s difficult to adhere to the demands of the regimen over the long term.”

The body also readjusts to maintain its weight with a hormone called ghrelin, the “hunger hormone,” which makes you feel hungry. For morbidly obese people who need to see effective and enduring  results for the sake of their health, surgery may be the answer.

Surgical Options
Weight-loss, or bariatric, surgery, changes your digestive system, often limiting the amount of food you can eat. It requires long-term commitment to dietary and lifestyle changes, such as eating slowly, reducing sugar and fat, eating smaller and more frequent meals, chewing more, eliminating snacks, and sticking to set meal times.

“If you don’t follow the rules, there will be weight gain,” said Dr. Morton. “About 95 percent of those who undergo weight-loss surgery at Stanford keep the weight off at the five-year mark.”

Gastric bypass is the most common procedure. The small intestine is connected to a small pouch at the top of your stomach; food goes directly from the pouch to the intestine, bypassing most of your stomach.

Unlike the gastric bypass operation, a gastric band is removable and adjustable. Lap band patients experience more gradual weight loss. The stomach is separated into two pouches by an inflatable band that is pulled tight to create a narrow channel. A sleeve gastrectomy removes a large portion of the stomach, reducing it to about 15 percent of its normal size.

For bypass patients, weight drops by more than one-third; band patients lose about 15 percent their weight. In more than 80 percent of the cases, diabetes symptoms disappear almost immediately, as do conditions like sleep apnea and high blood pressure. Dr. Morton estimates that the surgery decreases mortality by at least 40 percent.

Dr. Morton said that most procedures are now done laparoscopically, with small incisions, which decreases pain and speeds recovery. He estimates that he has performed more than 2,000 of these surgeries, with zero mortality. “It’s still surgery, so there can be complications,” he said. “Choose a place that does a lot of procedures, since experience will reduce the possibility of complications.”

About the Speaker
John Morton, MD, MPH, FACS, is an associate professor of surgery and director of Stanford Bariatric Surgery. He is a specialist in minimal access surgery, particularly for the morbidly obese, and has done more than 2,000 gastric bypass and bariatric surgeries. Dr. Morton received his MD and Master’s in Public Health from Tulane University, where he completed his internship. He completed his residency at Swedish Medical Center in Seattle and fellowships at the University of North Carolina and University of Washington. He is Board Certified by the American Board of Surgery.

For More Information:

Stanford Health Library can do the searching for you. Send us your medical questions.

About Dr. Morton
http://stanfordhospital.org/profiles/John_Morton

Stanford Bariatric Surgery
http://stanfordhospital.org/clinicsmedServices/COE/surgicalServices/generalSurgery/bariatricsurgery/

National Institutes of Health
http://www.win.niddk.nih.gov/publications/gastric.htm