Yesterday I attended the 6th Annual McMaster Bariatric Conference put on by the Centre for Minimal Access Surgery. The topic was obesity management and talks ranged included those discussing the risks associated with obesity as well as lifestyle, pharmacological, and surgical management of this condition.
like myself so interested in the topic of obesity? For me, body weight is more of a continuum than a distinct divide between lean and obese. All of us are somewhere on that continuum and (based on statistics) most of us are more towards the obese end than the other.
Moreover, almost 95% of people who lose a significant amount of weight by the usual commercial weight loss practices (i.e., get ripped in 12 weeks) will gain it back plus some additional pounds leading us closer and closer to being la rger and larger throughout our lives. And I still believe that whether you’re 20 pounds away from your fat loss goal or 100 we are all subject to the same environment, marketing, and dieting practices. While surgery (if we use it at all) might be used for the most severe cases, conservative management can probably benefit anyone looking to lose body fat permanently.
Here are a few notes I took at the conference that I’ll likely expand upon in an upcoming post:
- If your BMI is over 25 you are considered overweight. If your BMI is over 30 you are considered obese (Class I). OVer 35 is Class II obesity. Over 40 is Class III.
- BMI does not account for muscle mass so lifters may not be truly obese. However, if they are carrying excess fat around their midsection, there is still reason for concern.
- The total number of obese people in North America is levelling off. However, the number of people with class 3 obesity is growing.
- Current statistics on obesity likely underestimate the number of obese because people with normal weight obesity (normal body weight, but high fat percentage) is not included.
- Normal weight obesity results in metabolic issues similar to having a BMI over 30. These are the people we call “skinny-fat”
- The only group in North America in which obesity rates are still climbing is 6-9 year olds.
- Studies have shown that parents and phsyicians are unable to accurately determine when a child is obese. In some studies as few as 18% of parents thought their children had weight problems when they were clinically obese. Doctors didn’t fair much better. You can’t treat what you don’t diagnose.
- The best predictor for adult obesity is childhood obesity.
- 90% of obese kids have a lipid abnormility (high cholesterol or triglycerides) and 50% have hyperinsulinemia.
- 20% of obese children are likely to have a heart attack and 15% will have Diabetes by age 38.
- Obesity is second only to smoking as a risk factor for Cancer.
- Some people have now created the term “Diabesity” because of the strong link between Diabetes and obesity.
- Obesity is a chronic condition very much like hypertension. When treatment is stopped, the condition reappears.
- Body weight is related more to “screen time” than to the amount of exercise you do. In other words, turn off the computer and television.
- Frequency of activity breaks is related to weight loss more than total amount of activity time.
- A 5-10% body weight reduction shows improvements in lipid profiles, blood sugars, and various other obesity related disorders. This should be the goal when health is the primary outcome.
- 50% of people on a suitable lifestyle plan (exercise + diet + behaviour modification) can maintain 5% loss at one year. In other words, you need to treat only two people to achieve this result with one.
- 20% of people on lifestyle plan can maintain 10% at one year. Need to treat 5 people to get one who does this.
- Lifestyle alone tends to maintain 5% weight loss, lifestyle + pharmacology allows 15%, and gastric bypass around 50% weight loss.
- People who do not lose weight while following a 900 calore per day VLCD (very low calorie diet) will likely not lose weight effectively with surgery. Possibly due to genetics?
- Although many blame obesity on genetics, the number of genetic mutations that actually occur to cause such conditions likely only accounts for 5% of obese people.
- The most common form of weight loss surgery is the Roux en y Gastric Bypass. The stomach is reduced to a small pouch (about 2 tablespoons) and the pouch is attached at a point further down to bypass the first part of the small intestine. The procedure is restrictive (small stomach) and malabsorptive (bypassing absorption in the intestine).
- Gastric banding is an alternative type of surgery where an inflatable band is placed around the stomach. This surgery is reversible, but gastric bypass is not.
- Gastric bypass is significantly more effective for weight loss than banding.
- Bypass surgery results in an almost immediate remission of Type II Diabetes in most patients.
- Pregnancy is discouraged for 2 years after weight loss surgery.
- After surgery a patient must never consume carbonated beverages again.
- Bariatric surgery requires supplementation to prevent nutrient deficiencies although they are still common.
- Depending on where the surgery is done, 3-40% of bands require removal (usually due to weight regain).
- In patients with BMI over 40 gastric bypass has a 20-35% failure rate at 10 years (again due to weight regain)
- Effectiveness of revision surgery is equally as high, but complications (leaks, infections, etc) are 2.5 times more common.
- Gastric bypass is also more effective than banding in children. The youngest to date was age 9.
- Craniopharyngioma is a condition of the pituitary that can cause uncontrollable eating in children. Surgery helps maintain weight.
- One presenter said that gastric bypass was “the real solution to childhood obesity because nothing else really works”. He was a giant dink.
- Bariatric surgery is the most studied surgery in history. The screening for this surgery is intense and includes surgeon, nutritionist, social worker, and phsychiatric consults to ensure suitable mental status to maintain weight loss. Tests for obstructive sleep apnea and other issues are common as well. Heart and brain surgery has much less screening.
- Patients who are not compliant with managing blood sugars or taking meds probably won’t follow post surgical instructions.
- ADHD has a strong relationship to obesity. Sometimes treating ADHD causes patients to lose weight.
- Binge Eating Disorder is now officially a diagnosis in the DSM.
- Depression can cause cravings for carbohydrates which increase serotonin. Screen and treat for depression when necessary.
- The incedence of previous sexual abuse is very high in obesity.
- The higher the BMI, the greater chance of having a history of mental health issues.
- There are increased rates of divorce after bariatric surgery. Assessment makes sure support systems are secure prior to sugery.
My hope is that these points will make for a great discussion. Thoughts?