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Pulmonary disease
* abnormal function
* Obstructive sleep apnea
* hypoventilation syndrome
Nonalcoholic fatty liver
cirrhosis
Stroke
Coronary artery disease
* Diabetes
* Dyslipidemia
* Hypertension
Gastroesophageal reflux
disease
Cancer
Gynecologic abnormalities
* abnormal menses
Phlebitis
* infertility
* polycystic ovarian syndrome
Hypertension
• Most common complication
of obesity
• Blood pressure is determined by a complex system of
circulating hormones, many are made in fat tissue and
the kidneys. These hormones control the diameter of the
arteries and thereby control the pressure in the arteries.
• A 10% reduction of body weight has been associated with a
decrease in blood pressure
• Chronic obesity also can reduce the efficacy of antihypertensive medications
Diabetes
• Obesity is the leading cause of diabetes
• The risk of diabetes increase 53x’s
with severe obesity
• Type 2 diabetes is almost always associated with obesity
and appears to be related to hormonal substances
(cytokines) produced by adipose (fat) tissue and to the
increase amount of blood fats that occurs in diabetes.
• The majority of obese individuals with diabetes can
eliminate the need for medications or insulin by reducing
their weight by 10%
Heart Disease and Stroke
• Increase in heart disease is associated with
obesity independent and additive of the
increased risk factors of HTN, diabetes,
and elevated cholesterol
• There is a 3x risk of heart disease with obesity
• As a general rule, for every pound over your ideal body weight,
subtract one month from your life expectancy
• For each point increase in BMI there is a 6% increase in the
risk of an ischemic stroke
• For each point increase in BMI there is a 4% increase in the
risk of developing atrial fibrillation this is related to left
atrial enlargement and congestive heart failure
Respiratory Disease
• Over 75% of patients with obstructive
sleep apnea are >120% of their ideal
body weight
• A neck circumference of >17 inches
is also related to sleep apnea
• Upper body fat deposits may increase airway collapsibility
and interfere with inspiratory and expiratory muscles.
This airway collapsibility will decrease with weight loss
•Obesity also appears to be a risk factor for airway hyperresponsiveness (  asthma)
Gastrointestinal Problems
• Obese patients are 2.5 x more likely to
have reflux symptoms or esophageal
ulcer than patient with a BMI <25
• There is also a link between GERD
and esophageal adenocarcinoma
• Fatty liver disease: NASH (Non-alcoholic Steato-hepatitis)
is caused by excessive fat deposition in the liver. This leads
to silent inflammation, usually detected by adnormal liver
function and can lead to cirrhosis or liver failure.
• Obesity is associated with cholelithiasis. There is also an
increased risk for cholelithiasis in patients who lose weight
rapidly and can affect about 38% of patients after having
bariatric surgery
Degenerative Osteoarthritis
•There is a marked  in osteoarthritis is the
obese. It is most common in the knees and
ankles as a consequence of wear and tear
• Adipose (fat) tissue produces cytokines
that “destroy” the normal cartilage in joints
• If a patient loses weight, destruction of joints does not
disappear: yet joint pain will generally diminish due to less
stress on the joint
Gynecological and Obstetrical Complications
• Obesity during pregnancy is associated with:
* Gestational diabetes
* Preeclampsia
* Delivery Complications:
• Macrosomia (big baby)
• Shoulder dystocia
• C sections
•  infections
• Obesity is responsible for 6% of primary infertility;
Impotence
Polycystic ovary syndrome
• Polycystic Ovary syndrome is the most common endocrine
disorder in women of age. It is characterized by:
chronic anovulation, polycystic ovary morphology, and
hyperandrogenism
Cancer
• The World health Organization has estimated that being
overweight and inactive accounts for 1/4 to 1/3 of all
cancers of the breast, colon, endometrium, kidney, and
esophagus
• Obesity can unfavorably influence the diagnosis of cancer
and the response to therapy thereby there is an increase
in the likelihood of dying from cancer
• Overall Overweight and obesity could account for
14% of all cancer deaths in men
20% of all cancer deaths in women
Psychosocial function
• There is a stigma associated with obesity in areas such as
education, employment, and healthcare
• For adolescents with a BMI above the 95% for age and sex:
* Completed fewer years of school
* 20% less likely to be married
* lower household incomes
* higher rates of household poverty
• Depression has been associated with obesity causing
profound sadness, crying, and loss of energy
Why is this important?
• Bariatric surgery patients will be at risk for surgical
complications but we must keep in mind what medical
complications of obesity they might already have
• If they have diabetes, peri-operative blood sugars will
need to be watched closely as their diet will change
dramatically
• Patients with ostearthritis, might need aids to support
mobilization post-operatively
• Patients with obstructive sleep apnea may need the
support of CPAP peri-operatively
Bariatric Medicine Test
1. All of the following are medical complications of obesity
EXCEPT:
a. Diabetes
b. Alzheimers
c. Sleep apnea
d. Polycystic ovarian syndrome
2. Weight reduction can help all of the following
complications EXCEPT
a. Diabetes
b. Hypertension
c. Cancer
d. Osteoarthritis
3. What substance does fat tissue produce that
destroys normal cartilage in joints?
a. Cytokines
b. lymphokines
c. Cartilagikines
d. Insulin
4. A neck circumference of what is related to sleep apnea
a. > 15 inches
b. > 16 inches
c. > 17 inches
5. What amount of weight loss can effect a lowering of
5blood pressure
.
a. 20 lbs
b. 5%
c. 30 lbs
d. 10%