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Roux-en-Y gastric bypass for morbid obesity - Home Study Program

AORN Journal, Oct, 2002 by Cynthia J. Barrow

Being overweight and physically inactive accounts for more than 300,000 premature deaths each year in the United States alone, second only to tobacco-related deaths. (1) Surveys indicate that at any single time, 33% to 40% of adult women and 20% to 24% of adult men are trying to lose weight. (2) Americans spend $33 billion annually on weight-loss products and services, including low-calorie foods, artificially sweetened products, and commercial weight-loss centers. (3) Despite these efforts, obesity among adults has increased by nearly 60% since 1991, and this trend is likely to continue because more than 25% of children are overweight or obese. (4)

CLASSIFICATION OF EXCESS WEIGHT

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Degrees of excess weight are calculated by measuring the body mass index (BMI), which is based on a person's height and weight but is not gender specific. A person's BMI is determined by dividing his or her weight in kilograms by height in meters squared (ie, weight [kg]/height squared [[m.sup.2]]). A person's BMI does not directly measure percent of body fat, but it provides a more accurate measure of being overweight and obese than relying on weight alone. (5) The prevalence of people who are overweight and obese based on measurement of BMI is demonstrated in Table 1.

The term overweight is defined as excess body weight compared to established standards. The excess weight may come from muscle, bone, fat, body water, or a combination of these factors. The National Institutes of Health (NIH) defines overweight as having a BMI of 25 to 29.9.

The term obesity is defined as having an abnormally high proportion of body fat. Obesity generally is categorized by the NIH as having a BMI of 30 or greater. It is possible to be overweight without being obese. For example, an athlete who has a greater proportion of muscle to fat may weigh more than established standards but because he or she does not have a high proportion of fat, he or she is not considered obese. (6)

By definition, the term morbid obesity applies to patients who are 100% above the ideal body weight specified for their height. (7) Additionally, NIH categorizes patients as being morbidly obese if their BMI is greater than 40 or greater than 35 in the presence of comorbidities. Ten million people in the United States (ie, 5% to 10% of the population) are morbidly obese. (8) Life expectancy decreases proportionally in relation to the degree the person is overweight. For example, men between 25 and 34 years of age with a BMI greater than 40 have a 12-fold increase in overall mortality compared to normal weight men in the same age group. (9)

Comorbidities of obesity. Comorbidity is defined as a condition either caused or exacerbated by obesity. (10) Of the estimated 10 million Americans with diabetes, approximately 95% have noninsulin dependent diabetes, much of which can be attributed to obesity. (11) It is estimated that more than 60% of people with type 2 diabetes are women with a BMI greater than 29 and that for every 1 kg increase in measured weight, the risk of diabetes increases by 4.5%. (12) An increase in BMI also is associated with approximately five to six times greater risk of developing hypertension. (13) During pregnancy, women who are obese have an increased risk of developing gestational diabetes, chronic hypertension, preeclampsia, macrosomia (eg gigantism), labor abnormalities, postdatism, meconium staining, and caesarean delivery. (14) Table 2 contains a list of universally recognized obesity comorbidities. The diseases or comorbidities associated with morbid obesity raise annual mortality rates tenfold or more. (15)

There also is an unusual prevalence of psychopathology in people who are morbidly obese. The most frequent findings are depression and anxiety disorders. (16) In fact, emotional suffering may be one of the most painful aspects of obesity. (17) People who are morbidly obese are subject to prejudice and discrimination; they are considered to be lazy and lacking in will power. (18) Socioeconomic problems also may be contributing factors caused by their inability to find employment and difficulty maintaining personal relationships. (19)

People who are obese frequently demonstrate somatization (ie, the tendency to express psychological distress through physical complaints). Somatization serves to distance the person from emotions by allowing him or her to focus on the safer topic of physical ailments rather than emotional pain. Emotional distancing also may be accomplished by dissociation in which eating may be used as a means of separating oneself from painful feelings (eg, finding comfort in food). Compounding the situation, many people who are obese have difficulty with modulation (ie, lack of control compelling the individual to act on his or her impulses), such as eating in the absence of hunger. (20) These psychological disorders either may contribute to causing obesity or exist as a result of it.

Causes of obesity. Studies indicate that up to 70% of the variability in human body weight may be accounted for by genetic factors. (21) It is unlikely, however, that genetic factors are responsible for the 60% increase in obesity during the past two decades. This trend is more likely a result of decreased physical activity and increased availability of fast, and often high calorie, food.

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Roux-en-Y gastric bypass for morbid obesity - Home Study Program

AORN Journal, Oct, 2002 by Cynthia J. Barrow

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