Wed, 05/23/2012

Growing Obesity Becomes Threat to Overall Health

Guest Editorial by Professor Dr. Jan Langrehr, Head of the Department of General, Vascular and Visceral Surgery at Martin Luther Hospital

Dear Readers,

severe overweight stigmatizes and even makes you sick in the long run. Despite that, being fat is becoming a national epidemic, emotional eating a popular sport. The numbers speak for themselves: More than half of all women, 75 percent of men and almost one in six children are overweight. The problem is known. Nationwide, broad-based prevention programs based on education, sports and nutritional advice, are installed to help. However, the results are hardly measurable.

The affluent society shapes their descendants: do children watch television for three hours a day and are their parents only low educated and/or smokers, the risk increases that their offspring is being overweight by 30 percent. Children of obese parents barely can escape their fate. In this case, studies show a 300 percent higher risk of becoming overweight. If the normal weight is passed by 60 percent or more, obesity becomes a disease, with concomitant diseases such as diabetes, cardiovascular disorders, orthopedic and psycho-social problems. Most obese people share the same experiences: The years of suffering and exclusion, the diet madness and frustration when the yo-yo effect destroys a long dry spell of hunger and sacrifice.

The longing for getting rid of the fat with a simple injection, magic diets or miracle pills often sets off the body's early warning system. But at a certain point neither diets nor sports can help. Are the conventional methods such as diet and psychological care being exhausted, surgical therapies are available, such as gastric band, gastric sleeve or bypass procedures. With those therapies the aim is to take the patient's hand and accompany him gently with an individual program on his long journey. This begins with the presentation of the surgical options and goes on with the right support in motivation in tough moments.

But the results are measurable and are rewarded with a new attitude towards life, social re-integration and a more stable health. We know patients, who could reduce their weight within a year more than halve. They have discovered themselves entirely new. Still an interdisciplinary team of specialized surgeons, internists, psychologists, nutritionists, etc. has to continue to give the patient a long-term, caring and helpful support to prevent relapse.

Morbid Obesity:

Morbid obesity has many causes and is difficult to cure.

After the birth of her first child, with 79 kilos at 174 centimeters in body length Sabine S. felt a little bit too chubby. The native of Fankfurt wanted to lose five kilograms. The star of a real weight-loss odyssey. Despite various diets, inpatient spa stays and a psychotherapy after a few years Sabine S. did not weigh five pounds less as intended but 59 pounds more.

The nurse finally brought 138 kg on the scales. At this time she was already suffering from back and joint pain, menstrual irregularities and depression. Finally, she opted for a gastric band surgery and for the first time in years she was able to reach her normal weight of 74 kilograms. For more than four years, Sabine could old her weight around 70 Kilos. She exercises regularly and once again she can master the courage to enjoy a visit at the public pool - as she puts it. Sabine's struggle against her obesity is exemplary for many overweight people who are suffering the consequences of their obesity. Who brings a body mass index (BMI) between 25 and 29.9 on the scale is considered to be overweight. A real adipostas, as Sabine S. endured, begins with a BMI of 30. About half the European population is already overweight or obese. In Germany, as a result of an unhealthy lifestyle 75 percent of all men and 56 percent of all women are overweight. Every fifth person is obese, according to the national food consumption survey.

Lethal accompanying diseases

Obesity impairs quality of life enormously and one can lead to serious health problems. The list of - sometimes life-threatening - concomitant diseases is long: serious overweight can lead to gall bladder problems, dyslipidemia, diabetes mellitus, high blood pressure, angina pectoris, sleep apnea, heart attack or stroke. Excess weight also impacts the joints and can cause arthritis. Certain cancers such as breast or colon cancer may be the result, as well as sterility, reduced fertility and miscarriage. In addition, obesity shortens life expectancy - depending on the severity those affected die, statistically up to 20 years earlier as with a healthy lifestyle. In addition to smoking and alcohol, obesity is the most common reason for illness and deaths that are preventable through consistent countermeasures.

Many causes

The lush pounds also weigh on the soul and limit self-confidence. Severe obesity can lead to social isolation. "An environment, that associates thinness with beauty, health and productivity, leads to a stigmatization of obese people," says Professor Dr. Stephan Herpertz, director of the Clinic for Psychosomatic Medicine and Psychotherapy at LWL-University Hospital in Bochum. "The consequences are psychological symptoms and disorders."
The reasons why someone would bring 120 or more kilos on the scale are, according to experts, "multifactorial". Education and genetics play a role, as internalized eating habits, with which the affected have grown up. Even emotional wounds acquired in childhood are a significant factor. "People who have suffered in childhood or adolescence with depression have a greater risk of obesity later," explains Herpertz. "I have many patients in my practice who have not experienced enough love as a child or even have suffered sexual abuse," Dr. Anke Rosenthal adds, who runs a practice focused on obesity. For years, more and more obese people come into her practice – and: "They are getting younger," the medic shares her observation.

Many obese children

In Germany alone, 1.72 million children and adolescents are overweight. This represents 15 percent of the three to 17-year-olds. 720.000 of them are already considered obese. The consequences are disastrous. "Obese children may already suffer from a metabolic syndrome, which means high blood pressure, fat metabolism and preforms a sugar disease," says Dr. Susanna Wiegand, director of obesity surgery at the pediatric clinic of the Charité. On top comes a tendency to knock knees and posture disorders of the spine. These children suffer mentally, because they are more exposed than other adolescents ridicule and social exclusion.

Social Causes

According to studies especially children from families with low socioeconomic status and adolescents with immigrant backgrounds are at risk. Sometimes obesity comes with asthma or attention deficit disorder. Also a role plays the family history. "When a child is too plump, the reason can be found in a genetic predisposition as well as in behavior and the social environment," says the pediatrician Wiegand. Also the problem for teenagers and children often are long school days without a regular full school day that includes free lunch. Who comes back home in the late afternoon half starved and whose parents are out working, tends to allay his cravings with french fries or sweets.

Family therapy

Prevention still is the best therapy. If the child or teenager is already obese, quite a lot must change in the life of the adolescent and his family so that on a long run he can recover a healthy body weight. "But inpatient rehabilitation services usually are not sustainable," Dr. Wiegand points out. "It only makes sense if a follow-up takes place with the family involved." Sport and physical activity are supportive in any case, both as a preventive as well as when the child is already chubby or even obese. "It makes sense for parents go out regularly with their children and have many activities with them," advises the obesity expert. Children should be in motion every day between one and one and a half hours. In addition, the medical examiner warns, not to let the kids consume too much media. TV, PC, game consoles and mobile phones could develop into serious opponents of the urge to move. Obesity is a complex problem. "The parents are also asked to reconsider their own eating and addictive behaviors. This is not always very convenient, but they have a great role model, "says Wiegand.

Last Hope Operation

For many obese people after many unsuccessful attemps of weight loss an operation the last hope. "Conservative therapies such as psychotherapy, diet and exercise provide no lasting effect with severe adipostas - not even in this combination," says Professor Dr. Volker Lange, director of adipostas surgery at Vivantes Hospital in Berlin-Spandau. "Only two percent of obese patients are able to reduce their weight to normal levels and to keep it permanently. With all the others a yo-yo effect is inevitable, and they cannot maintain their acquired weight loss," says the doctor. However, the regulations for an obesity surgery are severe. Anyone who is considering an intervention has to suffer at least for three years from morbid obesity, which means a BMI of over 40 or a BMI of over 35 and suffering from at least two comorbidities.

Several methods

One option is gastric banding. With the procedure the stomach is reduced by a custom band. After that it can only take small amounts of food. Thus, the affected can remove about half of their body weight. "This operation is only one of several options, also possible is a gastric bypass, but this means a considerably more serious intervention," says Professor Dr. Rudolf A. Weiner, chief of the Surgical Clinic Hospital Sachsenhausen. "However, if the intervention is to succeed, the patient must participate actively in advance and must show discipline in diet and exercise," says Weiner. This kind of intervention is also possible for children and young people, but more than 80 percent of patients who ask for a gastric band surgery, are women. "Two thirds of the patients operated lose enough weight. They lose between 40 and 60 percent of their excess weight, which corresponds to an average weight loss of 32 kilograms, "says Weiner," this is quite a good success rate. "

Better blood sugar levels

With the gastric bypass the surface which the food absorbes is reduced considerably. "The results of such surgery are very impressive: after two to three weeks after the procedure most patients show a striking improvement in blood sugar levels before the body weight falls", says Professor Lange. "An existing sugar disease improves or even disappears, so that those affected will not need insulin anymore." In those cases, the weight loss can be enormous. "With surgery, patients lose about 70 percent of their body weight," says Professor Lange's colleague Dr. Yasar Sezgin, bariatric surgeon at Berlin's Martin-Luther Hospital. But the method also has risks. "It may come to leaks at the seams, favoring peretonitis. In addition, bleeding and vascular injury is possible," Sezgin adds. In addition, vitamin B12, fat-soluble vitamins and calcium have to be replaced separately for the rest of the patients life as the body cannot take them in with normal food anymore. A third variant is the sleeve gastrectomy surgery. Here, a large part of the stomach is removed so that only the tube portion and the pylorus remain. Here as well, the weight loss of about 60 percent of body weight is larger than after a gastric banding surgery. But the tube method involves risks similar to a gastric bypass. But no matter which surgical technique is chosen, it is beyond dispute that the affected have to change their lifestyles and eating habits. "The most important of all bariatric surgeries is that the change happens in the heads," Sezgin concludes.