27 November 2019
Frequent Asked Questions about Obesity
Obesity is a chronic, progressive pathology that has no cure and requires specific treatment to lose weight and continuous follow-up to avoid weight regain. There are several treatments for obesity but none of them cures it definitively. Unfortunately, physiological adaptations to weight loss favor weight regain. These adaptations include variations in the levels of circulating hormones that regulate appetite and energy balance.
Lifestyle changes and drugs approved for obesity have limited efficacy and their effects disappear when they are discontinued and/or discontinued. Bariatric surgery produces a significant weight loss, which is maintained in the long term (> 5 years). However, approximately 20% of the subjects who undergo this type of treatment regain the lost weight because they are not able, for various reasons, to maintain the changes in their lifestyle. To avoid weight regain, people must maintain lifestyle habits that counteract the physiological adaptations and factors that favor weight regain.
There is consistent evidence that obesity is associated with certain types of cancer. These include but are not limited to: endometrial cancer and ovarian cancer in postmenopausal women, breast cancer in men and women, oesophageal cancer, stomach cancer, liver cancer (secondary to a fatty liver), gallbladder cancer, colorectal cancer, pancreatic cancer, kidney cancer, multiple myeloma, and meningioma.
The percentage of cases of cancer attributed to obesity varies widely depending on the type of cancer, with figures of up to 54% for gallbladder cancer in women or 44% for oesophageal cancer in men.
Several mechanisms have been proposed to explain how obesity increases the risk of developing these types of cancer. Fatty tissue (adipose) produces oestrogens and high levels of oestrogens has been associated with the development of breast cancer, ovarian cancer and endometrial cancer. People with obesity also have increased levels of insulin (hyperinsulinaemia or insulin resistance) and insulin-like growth factor (IGF-1). High levels of insulin and IGF-1 have been associated with the development colon cancer, kidney cancer, prostate cancer and endometrial cancer. People with obesity have chronic, low-grade inflammation, which over time can damage the body’s DNA and initiate cancer. Compared to people of a normal weight, obese people have conditions or alterations that are associated with localised chronic inflammation and these represent risk factors for certain cancers. For example, chronic inflammation that produces gastroesophageal reflux disease is a cause of oesophageal adenocarcinoma.
According to the recommendations made by scientific societies, people with the following characteristics are candidates for bariatric surgery:
- A BMI above 35 kg/m2 coupled with other major comorbidities such as type 2 diabetes, high blood pressure, sleep apnea, severe joint disease, etc.
- The recommended age range is from 18–60 years, although surgery in people over 60 is increasingly common after a medical assessment and adequate preparation.
- Patients with a serious organic disease (liver cirrhosis, severe heart disease) who may not be able to tolerate anaesthetic induction cannot undergo bariatric surgery.
- In patients for whom non-surgical weight loss treatments have been unsuccessful.
- No drug or alcohol addiction.
- Incurable oncological disease.
- Psychological stability, no severe mental illnesses or severe mental retardation.
- The patient’s commitment to following postoperative treatment in order to guarantee long-term success (since it is a functional operation that alters the anatomy of the digestive system, it causes intestinal malabsorption with nutritional alterations and therefore the patient must adhere to long-term monitoring).
- Realistic expectations regarding the results of the bariatric surgery. The patient must be aware that even though there are significant aesthetic benefits, they are not the aim of the surgery; nor is achieving an ideal weight.
- Well-informed patients must be aware that it is a high-risk procedure because of the comorbidities associated with obesity, amongst other reasons.
- It normalises weight or results in a significant and sustained reduction in weight. In this regard, all the techniques are effective. However, there is a wide range of variation in the degree of excess weight reduction depending on whether the technique employed is restrictive, malabsorptive or mixed.
- Patients have experienced an improvement in a long list of comorbidities following bariatric surgery: improvement or remission of type 2 diabetes, high blood pressure, sleep apnea, gastroesophageal reflux, venous stasis, joint pain and urinary incontinence, amongst others. The reduction in adiposity improves oestrogen levels (female hormones) and decreases androgen production (male hormones), which together with an increase in insulin sensitivity produces an improvement in polycystic ovary syndrome.
- Helps normalise fat blood levels, which reduces low-density lipoprotein (LDL) cholesterol (which is harmful when too high) and triglyceride levels, and increases high-density lipoprotein (HDL) cholesterol (beneficial).
- Improves fertility in women and increases testosterone levels in men.
- The changes in metabolic comorbidities lead to a reduction in the risk of cardiovascular mortality.
- Decreased risk of developing certain chronic diseases. Reduces the likelihood of developing type 2 diabetes, metabolic syndrome, high blood pressure and fatty liver disease.
- It is also associated with a lower incidence of cancer.
- Improves quality of life, self-esteem, patient perception of self-image and character.
- Decreases the prevalence of depressive disorder.
There are conditions associated with obesity in both men and women that can interfere with their chances of conceiving (either naturally or by means of assisted reproductive techniques) and with the normal evolution of pregnancy.
Some women suffer hormonal imbalances that affect their menstrual cycles, interfere with ovulation and cause infertility. Obesity is closely related to polycystic ovary syndrome, a condition in which the ovaries do not produce enough hormones and so the egg neither reaches maturity nor is released (anovulation), thus giving rise to infertility.
In the case of men, obesity can reduce both the quantity of sperm and their activity with functional and morphological alterations.
The good news is that losing weight (through dieting or bariatric surgery) significantly improves the chances of conceiving and having a healthy pregnancy.
Recommendations are to avoid becoming pregnant for at least 1 year after bariatric surgery, as the health of the foetus is largely dependent on the mother’s nutritional status and the possibility of nutritional deficiencies are a significant source of risk for maternal and foetal wellbeing.
Intragastric balloons have been approved for the treatment of obesity. It is a minimally invasive technique with short-term effectiveness in terms of achieving moderate weight loss of 10–20 kg. It involves using an endoscope to introduce a silicone balloon in the stomach containing 400 to 900 mL of physiological saline solution, depending on the manufacturer. The balloon is left in place for approximately 6 months. It has a restrictive mode of action because the device occupies space in the stomach, reducing its capacity and therefore producing an early feeling of fullness and decreasing appetite. Once the balloon is removed, it is vital the patient changes their lifestyle habits to avoid regaining the weight. However, the rate of weight recovery, while it depends on when the parameter is evaluated, is over 50% 1 year after removing the gastric balloon. Side effects occur frequently. Nausea and vomiting affect 70–90% of patients, while other complaints include abdominal discomfort and constipation.
At present, balloons are used as an adjuvant therapy when the patient does not wish to undergo or is ineligible for bariatric surgery, or as an initial weight loss treatment in patients with a high surgical risk. Bear in mind that, in Spain, the treatment is not paid for by the social security, so it may cost a lot depending on the centre where it is carried out.
Studies suggest that the healthiest way to lose weight is to maintain an objective of 0.5 -1 kg per week, or 2-3 kg per month.
“Miracle diets” are those that attempt to achieve rapid weight loss results without much effort, and have multiple health risks. These increase the risk of nutritional deficiencies that can cause an alteration in taste and appetite, hair loss, weak nails, as well as favouring osteoporosis or blood coagulation disorders. Furthermore, vitamin deficiency can cause irritability, ocular, cutaneous, and gastrointestinal lesions, as well as lack of memory and difficulty in concentrating, among others. They also produce negative psychological effects like anxiety, stress and depression that can trigger eating behaviour disorders. And they favour the rebound effect, when returning to previous eating habits.
Not at all, skipping meals can produce the opposite effect. Being many hours since having a meal can increase the feeling of hunger, with a higher risk of snacking generally fast and appetising foods, very high in fats and sugars.
The recommendations for starting doing regular physical exercise recommend dedicating about 30 minutes daily to physical activity, therefore it is very important to plan daily tasks, leaving this minimal space for health care. If despite this you cannot find this gap, it could be split up into several sections of not less than 10 continuous minutes.
Multiple activities can be carried out with a low economic impact: go walking at a fast pace or run, train with free APPs and tutorials, practice in parks with physical exercise equipment, “low cost” gymnasiums, swimming at the beach…
Multiple factors can have an influence on the appearance of obesity. Although the genetic component is an important risk factor, the environmental aspects are those that are more associated with the risk of the problem appearing. In the event of having an obesity problem, its appearance can be prevented in our children by promoting and maintaining a healthy lifestyle.
Despite the significant weight loss that occurs after bariatric surgery, you must always try to maintain a healthy lifestyle, following a balanced diet and a regular physical activity routine, with the aim of maintaining the weight loss.
Contrary to popular belief, people with obesity are not generally happier than others, in fact they usually have more psychological disorders than people of normal weight. The most common problems are depression, anxiety, the consumption of toxic substances and certain eating disorders. Low self-esteem and body-image issues occur frequently, even in people who do not have a mental health disorder, they may even condition their relationships with others, at work, their education, and hobbies.
There is a relationship between anxiety and eating behaviour. Some people tend to eat nothing or less than normal when they feel nervous, so they may lose weight. Others, however, tend to eat more, whether during main meals or throughout the day in small snacks, and they are often unhealthy foods. Only people who increase their calorie intake, one way or another, when they feel anxious will ultimately gain weight.
Emotional eating is the consumption of food triggered by a negative emotion, generally in stressful situations, when there is actually no physiological need for nutrients. Under these circumstances, people usually have a craving for foods with a high calorie content (sweets, ice cream, chocolate, crisps, etc.) and very little nutritional value.
The causes of emotional eating are complicated and very diverse, each case must be analysed on an individual basis. The emotions that most frequently trigger an episode of emotional eating are boredom, loneliness, sadness and anxiety. In such a situation, food acts as a means to immediately relieve the negative or unpleasant emotion, even if only temporarily. When this behaviour becomes established as a regular method for dealing with difficult situations or negative emotions then it is called emotional eating.
Emotional eating can occur in obese and non-obese people, with or without a psychiatric disorder. It can lead to the onset of obesity and make it hard to adhere to any weight loss treatments. It may also predispose the development of eating disorders. Assessment and treatment by a mental health professional, psychologist or psychiatrist can help overcome this problem.
Some people with obesity may have had an eating disorder at some time in their lives or suffered alterations in the way they eat that could be diagnosed as eating disorders. Any denial, guilt or shame associated with this problem sometimes means the disorder goes undiagnosed, which hampers the necessary referral to psychotherapy.
Patients with a favourable evolution after bariatric surgery generally feel better psychologically. This is due to the improvement in their state of health, quality of life and self-esteem, allowing them to better adapt to their work, social, and personal environments. However, surgery for obesity is not a treatment for psychiatric disorders such as depression, anxiety or eating disorders, amongst others. Individuals who suffer from a mental health disorder should be assessed in order to receive the most appropriate therapy and promote the best progress possible for any weight loss treatment.
Some research indicates so, since the changes induced by the surgery itself can modify the absorption of alcohol in the organism, increasing its toxicity, with higher values and for a longer time in the blood. This would imply a greater risk of developing a problematic consumption, even with a low consumption, at a physical and psychological level, so it is recommended not to consume alcohol after surgery.