Download Morbid Obesity

By Prof Dr
WALEED IBRAHIM
Obesity has been defined as excess
body fat relative to lean body mass.
 The most widely accepted measure of
obesity is the body mass index (BMI).
 BMI= Patient’s weight in kg / square
of patient’s height in meters (kg/m²).
 A normal BMI ranges from 18.5 to
24.9 kg/m²

BMI
 BMI
 BMI
 BMI
 BMI

25-29.9 = overweight.
≥30 = obesity.
≥35 = severe obesity.
≥40 = morbid obesity.
≥45 = super obese.
GENETIC ( rare )
A. SYNDROMES INDUCING OBESITY:
 Prader- Willi : Hypotonia, Hyperphagia, M R, Facial
features

Laurence- Moon :
Ret. Pig, M R , Sp. Pplegia,
Hypogonad

Bardet-Biedl :
Polydactyly, Renal failure
B. CHROMOSOMAL DEFECTS:
NUTRITIONAL : Intra-uterine, Infancy,
Dietary.
 PHYSICAL INACTIVITY : TV., Internet,
Lifestyle, Technology.
 TRAUMA :
NEUROLOGICAL : Post op., Head injuries.
PSYCHOLOGICAL : Stresses, Abuse….
 MEDICATIONS : Steroids, Psychotropic
drugs.
 SOCIAL : Economic, Ethnic.

HYPOTHALAMIC-PITUITARY
 GONADAL : Polycystic Ovary
 ADRENAL : Cushing
 THYROID
 PANCREATIC : Hyperinsulinaemia

COMBINATION OF :
OBESITY ( Esp. CENTRAL ) + 2 of :
 HT.
 DM.
 DYSLIPIDEMIA




The American Heart Association and the National
Heart, Lung, and Blood Institute recommend that
the metabolic syndrome be identified as the
presence of three or more of:
Elevated waist circumference:
Men —Equal to or greater than 40 inches (102 cm)
Women — Equal to or greater than 35 inches (88
cm)
Elevated triglycerides:
Equal to or greater than 150 mg/dL

Reduced HDL (“good”) cholesterol:
Men — Less than 40 mg/dL
Women — Less than 50 mg/dL

Elevated blood pressure:
Equal to or greater than 130/85 mm Hg

FBS equal or greater than 100mg/dL



Morbidly obese patients are classified
according to area of main fat mass:
Peripheral (Gynecoid) obesity: associated
with degenerative joint disease and venous
stasis in the lower extremities.
Central (Android) obesity: associated with
the highest risk of mortality related
problems due to the “Metabolic Syndrome”
as well as increased intra-abdominal
pressure.
1.
2.
3.
4.
Dietary therapy
Physical activity therapy
Drug therapy
Behavioural therapy
Candidates for surgery
1)
2)
3)
4)
5)
BMI ≤ 40 Kg/m² or ≤ 35 Kg/m² with
significant cormobidities.
Failure of non surgical weight loss programs.
Capability of tolerating surgery.
Absence of endocrine disorders that can
cause massive obesity.
Psychological stability with supportive social
environment.
6)
7)
8)
9)
10)
Age less than 60 years
Basic understanding of how obesity surgery
causes weight loss.
Realization that surgery itself does not
guarantee weight loss
Absence of active alcohol and drug abuse.
Commitment to post-operative follow up.
1- Restrictive procedures:
A)Vertical banded gastroplasty (VBG)
B) Adjustable gastric banding (AGB)
C) Sleeve Gastrectomy (SG)
2- Malabsorptive procedures :
A) Roux en Y Gastric bypass(RYGBP)
B) Minigastric bypass


The aim of bariatric surgery is to induce weight
loss that is sufficient to reduce obesity-related
morbidities to acceptable levels.
Loss of visceral fat is associated with improved
insulin sensitivity and glucose metabolism , also
reduces intra-abdominal pressure and this
change may result in improvement in urinary
incontinence, gastroesophageal reflux, systemic
hypertension, venous stasis disease, and
hypoventilation.

70-80% IMROVEMENT OF CO-MORBIDITIES :
- TYPE 2 DM.
- HYPERTESION.
- DYSLIPIDAEMIA.
- HYPERURICAEMIA.
- SLEEP APNOEA.
- CARDIAC RISK.
- CANCER RISK.
- GERD.
- PCOS.
QUALITY OF LIFE:
- SOCIAL.
- WORK.
- SEXUAL.
- PSYCHOLOGICAL
 IT WAS FOUND THAT THESE POSITIVE
CHANGES START (& PERSIST) AS EARLY
AS WHEN 10% EWL OCCURS.


1 st, 3 rd,6 th, 12 th MONTH POSTOPERATIVELY,
THEN ANNUALLY.

DO NOT FORGET:
-ELECTROLYTES.
-B. SUGAR.
-RENAL FUNCTIONS.
-LIVER FUNCTIONS.
-TRANSFERRIN.
- LIPID PROFILE.