Morbid Obesity

Body Mass Index (BMI) is the measurement by which we are determined to be within a healthy weight range. A measurement of weight relative to height, BMI – in a normal range – is 20 to 25. A person is considered overweight when they have a BMI between 25 and 29.9. Obesity is defined by a BMI of 30 or over.

Morbid obesity, however, is characterized by a BMI of 40 or more or 100 pounds or more over an individual’s ideal weight.

The consequences of morbid obesity can range from uncomfortable to catastrophic. For one, at this weight, normal day-to-day activities – such as walking, driving, sleeping, and even breathing – are impacted. The longer an individual is obese, the more at risk they are of developing weigh-related conditions such as hypertension, diabetes, GERD, joint disease, heart disease, fatty liver disease, sleep apnea, high cholesterol, and even cancer.

Emotional Ramifications
Morbid obesity obviously comes with significant physical ramifications. But there can also be emotional fallout from obesity. Those with obesity can often suffer from depression, isolation, breakdown of relationships, and more.

As a practice, we treat the entirety of obesity – the physical part of carrying so much weight as well as the emotional part of living a life of limitation. When we decide with our patients to pursue bariatric surgery, we do so with the understanding that we are addressing several factors:

  • The surgery. Weight loss surgery gives individuals the tools they need to lose the weight. We support our patients through the decision to have the surgery, as well as support them through the journey of the surgery itself.
  • Lifestyle changes. No weight loss surgery is a magic pill for weight loss. If the individual is not committed to a lifestyle change through a healthy diet and consistent exercise, there is no surgery that will be successful. We work with our patients to help them embrace these changes that will allow them to be successful and healthy in the long term.

Emotional factors. Obesity has an emotional price tag attached to it; so does weight loss surgery. We help our patients navigate the road to emotional – as well as physical – health.

Type 2 diabetes is a weight-related health concern that develops when the body becomes insulin resistant. This means the body either does not produce enough insulin or the body does not properly use what insulin is produced. Insulin is necessary to regulate blood sugar levels and break down the sugars and starches you eat into glucose. Insulin carries the glucose to the cells in the body, where is then used for energy. When the body does not make proper use of insulin, glucose builds up in the blood stream, which can cause damage to the eyes, kidneys, nerves or heart and the body’s cells are starved for energy.

Diabetes can lead to other health complications such as skin disorders, nerve damage (neuropathy), and eye problems like glaucoma, cataracts and diabetic retinopathy.  It also increases risk of high blood pressure, stroke and heart disease.

Blood pressure is measured by two different factors – the amount of blood that your heart pumps and the amount of resistance your arteries offer against that blood flow. The more blood pumped by your heart and the narrower your arteries, the more resistance there is and the higher your blood pressure.

The pressure of your heart pushing blood through your arteries to the entirety of your body is called systolic blood pressure. This is the top number of your blood pressure reading. The pressure in your arteries during the rest period in between heartbeats is called diastolic blood pressure. This is the bottom number of your blood pressure reading. A normal blood pressure reading is lower than 120/80 mmHg. A systolic number of 140 or higher and a diastolic number of 90 or higher are considered hypertension or high blood pressure.

Uncontrolled high blood pressure results in damage to the heart and blood vessels and increases the risk for a variety of conditions including heart disease, stroke, chronic kidney disease, vision problems, bleeding from the aorta, poor circulation, heart attack, and heart failure.

What Are The Symptoms?
There are no symptoms of hypertension in most cases, which is the most insidious part of the condition; damage can be happening behind the scenes. Some people in the early stages of hypertension can experience dizziness, headaches, and sometimes nosebleeds. However, a regular check-up by your doctor will include a reading so that you can keep blood pressure in check and treat it appropriately.

How Does Weight Loss Help?
When you are carrying extra weight, you are putting extra pressure on the body – including the pressure to pump blood throughout the body. Fat blocks and hardens arteries, narrowing the passageway through which blood flows. This blood flow restriction causes high blood pressure.

Even a small reduction in weight helps to reduce blood pressure. A lifestyle committed to healthy eating and regular exercise will help keep blood pressure in check. If necessary – even with lifestyle changes – treatment may also include medication for hypertension.

The American Sleep Apnea Association estimates that there are 22 million people in the United States who suffer from sleep apnea – a sleep disorder in which, during sleep, there are periods of shallow breathing or pauses in breath. The periods of shallow breathing are known as hypopnea and every pause in breath, which lasts at least 10 seconds but varies in length, is known as an apnea. These episodes can occur dozens of times an hour.

The most common type of sleep apnea is known as obstructive sleep apnea defined as such because, during sleep, the muscles at the back of the throat essentially collapse in from the airway, thus blocking airflow, resulting in shallow breathing or pauses in breathing.

Less common is central sleep apnea, in which the signals from the brain that control your breathing muscles are disrupted during sleep.

The American Sleep Apnea Association also recognizes complex sleep apnea, which is a combination of obstructive and central sleep apneas.

Obstructive sleep apnea is a more common condition in those with obesity; a larger neck circumference puts someone at greater risk for sleep apnea. Uncontrolled sleep apnea disrupts sleep and results in low blood oxygen levels. This is a serious – and sometimes life-threatening – condition that can cause heart disease, hypertension, stroke, and even chronic heart failure.

What Are The Symptoms?
Sleep apnea can be difficult to diagnose simply because the episodes happen during the night when no one witnesses the event. Some symptoms can include chronic snoring, ongoing fatigue that interrupts daily activities, sore or dry throat upon waking, headaches, difficulty concentrating, sleeplessness, depression, and mood changes. If you are concerned that you may have sleep apnea, it’s important to see a doctor who can order a comprehensive sleep study.

How Does Weight Loss Help?
If obesity is the root cause of sleep apnea, losing weight is imperative for getting healthy. In fact, research has shown that those who lose their excess weight are up to three times more likely to completely eliminate their sleep apnea; an act that can be literally life saving.

As its name suggests, fatty liver disease is defined as the accumulation of fat in the liver. While this particular disease is often associated with excessive alcohol consumption, nonalcoholic fatty liver disease (NAFLD) can be caused by such conditions as a hypertension, heart disease, high cholesterol, diabetes, hepatitis C, and obesity, among others.

In fact, NAFLD is a common affliction among those who are obese, especially since so many of the conditions that can cause a fatty liver also tend to occur along with obesity.

As the second largest organ in our body, the liver is a responsible for many crucial functions including the processing of the food and liquids we ingest into nutrients that we then use as energy. The liver also filters toxins from blood as it makes its way from our digestive system to the rest of our body. There is always some fat in the liver but when fat begins to accumulate (making up 5% to 10% of the liver’s weight) it can cause swelling, and eventually scarring known as cirrhosis of the liver. This, in turn – if not treated appropriately – can result in liver cancer and even liver failure over time.

Luckily, however, in the early stages, fatty liver disease is a reversible condition that can be addressed with a lifestyle program that includes a healthy diet and regular exercise.

What Are The Symptoms?
Some of the symptoms of fatty liver disease include loss of appetite, fatigue, weakness, abdominal pain, nausea, jaundice (yellowing of the skin and eyes), itching, and swelling of the legs and abdomen. If you are experiencing any of these symptoms, it is important to see a doctor so that you can be tested for fatty liver disease.

How Does Weight Loss Help?
If you are obese, weight loss is essential to controlling or reversing fatty liver disease. Weight loss also helps to control diabetes, and lower cholesterol, triglycerides, and blood pressure – all contributors to a fatty liver. If you have been diagnosed with a fatty liver, it is crucial to maintain a healthy weight through diet and exercise, as well as limit your consumption of alcohol.

Obesity leaves many casualties in its wake, simply because of the many physical ramifications that comes as a result of carrying around so much extra weight. We are not meant to support this type of weight; our bodies are not built to manage it. As a result, when we are overweight, we put a lot of pressure on the systems of our body and, eventually, these systems begin to break down.

Osteoarthritis – or joint disease – and even just joint pain is a common disorder among those who are overweight. And it’s not surprising when you consider that walking – something that we do every day – puts pressure on the knees equal to three to six times a person’s body weight. Every 10 pounds of excess weight increases this pressure on the knees by 30 to 60 pounds.

This type of pressure pertains to all the joints in the body but most often affects the spine, feet, and weight bearing joints such as the knees or hips.

What Are The Symptoms?
We are not meant to sustain such pressure and especially not for long periods of time. So when pressure of this sort continues, people will begin to experience pain in their joints, along with stiffness, tenderness, and in some cases, locking of the knees and fluid retention known as joint effusion. Most significant is the fact that osteoarthritis is a degenerative disease. Which means, that if steps are not taken to address the symptoms of joint disease, the condition will not only persist, it will worsen, which can cause debilitating pain and loss of mobility.

How Does Weight Loss Help?
Through research, we have no doubt about the link between obesity and osteoarthritis. In fact, those who are overweight are at least four or five times more likely to develop osteoarthritis. Reducing the amount of weight that our joints are supporting can therefore reduce the symptoms of joint disease and in some cases eliminate the symptoms altogether.

Gastroesophageal reflux disease (GERD) is chronic or heartburn or acid reflux. GERD can lead to cancer and other complications. Increased body mass can cause a “squeeze phenomenon” forcing stomach acid into the esophagus. The higher a person’s BMI, the more likely he or she is to experience symptoms of GERD more than once a week. When tested for GERD in a pH study, almost 70 percent of people with a BMI over 30 tested positive for GERD. Some researchers believe there may also be a hormonal link between obesity and GERD.

Symptoms of GERD can be treated with medications like proton pump inhibitors, but doing so requires the patient to be dependent on medications for the rest of his or her life. Weight loss through lifestyle changes or bariatric surgery can reduce or eliminate symptoms of GERD without medication while also addressing other health complications associated with obesity.

Heart disease refers to several conditions of the heart. The most common type of heart disease, coronary artery disease can lead to heart attack, heart failure, angina, and arrhythmias.

Coronary artery disease is caused by a buildup of plaque (cholesterol deposits) in the arteries that supply blood to the heart. When plaque accumulates in the arteries, the arteries narrow, preventing the heart muscle from getting enough blood. A heart attack occurs when an artery is entirely blocked by plaque or if plaque breaks off and clogs a coronary artery.

Obesity is one lifestyle factor that has been directly linked heart disease as it causes increased LDL (bad) cholesterol levels, reduced HDL (good cholesterol), high blood pressure and diabetes. By losing weight and addressing cholesterol, blood pressure and diabetes, one can reduce his or her risk for heart disease.

Obesity can contribute to irregularities in a woman’s menstrual cycle as well as lack of ovulation. However, studies have also shown that even women who ovulate normally but who are severely obese are less likely to become pregnant than women who are normal weight or overweight but not obese.

Obesity can also increase risk of miscarriages and cause complications for both the mother and baby. For a woman who is having difficulty conceiving, even moderate weight loss of just five percent body fat can improve fertility. Weight loss can improve the hormonal environment and restore regular menstruation and ovulation.

In men, obesity has been linked to low testosterone levels and reduced spermatogenesis (sperm production). As with women, weight loss can improve male fertility. Obese men who lose weight may experience an improvement in testosterone levels and sperm production.

According to, obesity is associated with increased risks of several types of cancer, including cancers of the:

  • Esophagus
  • Pancreas
  • Colon and rectum
  • Breast (after menopause)
  • Endometrium (lining of the uterus)
  • Kidney
  • Thyroid
  • Gallbladder

Obesity was linked to an estimated 4 percent of new cancer cases in men and 7 percent of new cancer cases in women in 2007. Some types of cancer are more commonly the result of obesity, such as endometrial cancer and esophageal cancer. Read more about the relationship between obesity and cancer on