Obesity

Obesity, Weight Loss, and Joint Replacement Surgery

If you need total knee or total hip replacement surgery—and your weight is significantly higher than it should be—your doctor may advise you to lose weight before your procedure. Even though you may feel fit and healthy at your current weight, studies show that a patient with a BMI greater than 40 is more likely to experience serious complications both during and after surgery than a patient of normal weight. Your doctor wants you to be aware of these risks so that you can take steps to minimize them before your procedure.

Causes of obesity:

  • Genetics may play a role in conversion of food into energy and how body burns calories during exercise. Genes may affect the amount of fat storage and distribution of fat in body.
  • Family history- A person is more likely to develop obesity if one or both parents are obese. Overweight and obesity tend to run in families not just because of genetics but family members tend to share similar eating and activity habits. Children’s choices, diet and physical activity   habits   are   influenced   by  their  surrounding environment.
  • Unhealthy diet- Diet rich in calories (fast foods), high calorie beverages, oversized portions, bad eating habits     (eating between meals, preference to sweets, refined foods, and fats), diet lacking with fruits and vegetables; all these factors contribute to weight gain.
  • Sedentary life  style-  With  a  sedentary  lifestyle  such  as sedentary occupation and inactive recreation (watching television) more calories are stored in the body every day than used through exercise. Thus sedentary lifestyle promotes weight gain. If there is any associated  medical  problems such as arthritis can lead to decreased activity; that contributes to weight gain.
  • Health conditions- Some medical conditions may cause overweight and obesity because of hormonal disturbances such as hypothyroidism, Cushing’s  syndrome  and  poly  cystic  ovarian syndrome (PCOS).
  • Medicines-Certain medicines such as corticosteroids, antidepressants and medicines used for seizure control may cause weight gain.
  • Emotional factors-  For  some  people,  eating  habits  are
    influenced by emotions such as sadness, stress, boredom or anger
    and they react by eating excessively.
  • Age- Obesity can occur at any age, even in young children. Infants with excessive weight have increased chances of obesity in later life. As age increases,  muscle  mass tends to decrease and  some hormonal changes also occur; these factors along with less active lifestyle increase the risk of obesity in later age.
  • Sex- Men have more muscle mass and use more calories (even at rest) than women. Thus, women are more likely to gain weight as compare to men with the same calorie intake; however midlife weight gain in women is mainly due to aging and lifestyle, but at menopause hormonal changes also play a role in weight gain.
  • Lack of sleep- Not having enough sleep or getting too much sleep
    can cause changes in hormones that may increase appetite and
    craving for foods high in calories and carbohydrates, which can
    contribute to weight gain.
  • Environment- If environment doesn’t support healthy lifestyle, it
    encourages obesity.

Now do we measure Obesity?

BMI is a measure of body fat based on height and weight. Typically, the higher your BMI, the more body fat you have. Your doctor will use the following calculation to determine your BMI.

BMI = Weight (kilogram)/ Height (Meter)2

For an adult, the following BMI ranges apply:

BMI Ranges Weight Status

18 to 24           Normal

25 to 29           Overweight

30 to 39         Obese

40 to 49         Morbidly obese

Health Conditions That May Impact Surgery

Patients with obesity are more likely to have certain diseases and health conditions that increase the risks of surgery. These include:

  • Cardiovascular disease, including high blood pressure, heart attack, heart failure and stroke
  • Type 2 diabetes
  • Obstructive sleep apnea,asthma, severe acid reflux, lower back pain, urinary stress incontinence
  • Metabolic syndrome—a group of health conditions that increase your risk for developing cardiovascular disease and type 2 diabetes

Being obese is a health hazard with mental, psychological, social, physical and economic co-morbidities.

Increased Risk of Complications

There are risks associated with every surgery. However, some risks are greater for patients with obesity.

Anesthesia. It is more difficult to administer anesthesia to a patient with

obesity. Complications may be due to the patient’s body shape and anatomy, or

to health conditions that can affect breathing. Challenges for the
anesthesiologist include:

  • Locating veins to administer general anesthesia and necessary
    medications
  • Ensuring that oxygen and airflow are sufficient
  • Properly positioning the needle when delivering spinal and epidural
    nerve blocks and other types of regional anesthesia

Operative times. There are technical challenges associated with performing surgery on a patient with obesity, so operative times are often longer.

Complications After Surgery

Compared with a patient of normal weight, a patient with obesity is more likely to experience the following complications after surgery:

  • Infection
  • Poor wound healing
  • Difficulty breathing
  • Blood clots
  • Pulmonary embolism—a blood clot in the lungs

Lesser Outcomes after Joint Replacement

Joint replacement will help relieve your pain and enable you to live a fuller, more active life.

However, if you have obesity, you may never achieve the increased mobility and range of motion experienced by a patient of normal weight.

You may also experience more implant and prosthesis complications after surgery, including:

  • Component loosening and failure
  • Dislocation of the replacement joint, especially in the hip

In some cases, a second “revision” surgery may be necessary to remove failed implants and replace them with new ones.

Reducing Your Risks

In most cases, Total hip and Total knee replacement are elective procedures. For this reason, your doctor at times may recommend that you try nonsurgical treatments—such as medications and physical therapy—in order to delay your joint replacement surgery. This will give you time to lose weight and reduce your BMI before your procedure.

OBESITY: TREATMENT

The most basic and foremost treatment of obesity is to gain control over your calories intake.

Lifestyle changes — an active and healthy lifestyle combined with healthy eating through dietician advised dietary changes is found to be the safest way to reduce weight.

If you have constant hip or knee pain, you may not be as active as you were before. Low-impact activities—such as swimming, biking— will put less strain on your joints than strenuous exercise and will still be effective in helping you lose weight.

Medications and herbal remedies.

Surgery— Surgery may help people who are obese and have not lost weight through other ways such as diet, exercise, or medicine. There are different types of weight loss surgeries done to reduce weight significantly.

What  is  Bariatric  or  weight  loss  surgery procedure ?

Bariatric surgery is a treatment option for some patients with severe obesity. It can cause significant weight reduction by altering your body’s food digestion and absorption pattern. The choice of procedure should be decided after a discussion with your Bariatric surgeon. Bariatric surgery is now  performed  la paroscopically (‘key  hole surgery’), which leads to early recovery as it minimises trauma of surgical access.

Weight loss surgery procedures

There are two basic mechanisms of weight loss surgery:

  1. Restrictive procedures: Decrease in food intake by creating a small upper stomach pouch or sleeve to limit food intake.
  • Laparoscopic Adjustable Gastric Banding (LAGB)
  • Laparoscopic Sleeve Gastrectomy (LSG)
  1. Mal-absorptive procedure: Decrease in food intake by creating a small pouch of stomach by staples. In addition to this, initial segment of small intestine is by-passed, this facilitates reduced
    calories and nutrients absorption.
  • Laparoscopic Gastric Bypass (LGB)

Who needs Bariatric or weight loss surgery?

  • BMI of more than 37.5 kg/m2     (Asians) and more than         40 kg /m2

(western) with or without co-morbidities.

  • You have BMI between 32.5        –      37.5      (Asians) and BMI between

35 – 40 (Western) with severe medical conditions e.g. diabetes, heart disease,  sleep  apnoea (a  sleep  disorder  where  a  person experiences irregular breathing at night), high blood pressure, joint pain (arthritis), etc.

  • All other methods of weight loss (exercise, dietary, medicines etc.)
    have failed to deliver a lasting solution.
  • Unable to do routine activities due to severe obesity.
  • Patients who have understood the surgical procedures for weight
    loss, the risks and after-effects of surgery and have consented for
    the same.

Benefits of Bariatric Surgery

The medical and emotional benefits of weight loss procedures begin almost after surgery:

  • Significant weight loss
  • Improvement of Type II Diabetes
  • Lower blood pressure
  • Lower cholesterol
  • Relief in sleep apnoea
  • Relief in acid reflux
  • Decreased joint pain, improved mobility
  • Improved mood and self-esteem

 Risks of weight loss surgery

Weight loss surgery, as with any major surgery, has some associated risks of which you should be made aware of. These may include :

  • Leakage of digestive juices into the body cavity.
  • Wound infection at incision sites.
  • Hernias- a weakening of abdominal wall.
  • Development of gall stones- due to rapid weight loss.
  • Blood clots – may cause a more serious condition called a

pulmonary embolism.

  • Vitamin deficiencies – may be preventable by taking daily vitamin
    supplements.

Expected weight loss after Bariatric Surgery

The expected weight loss varies with the type of surgery performed and several factors i.e. age, commitment to dietary restrictions and ability to exercise, weight before surgery etc.

Expected weight loss is between 60 – 80% of excess weight by end of

1.5 years to 2 years with significant improvement in quality of life and improvement of co-morbidities.

Making a Change Now

Patients who need joint replacement surgery often intend to lose weight after their procedure—when their relief from pain will enable them to be more physically active.

In reality, however, studies show that just a small percentage of patients with obesity actually lose weight after joint replacement—the majority of patients maintain the same BMI after surgery.

Rather than waiting, there is great value in establishing a healthier lifestyle

NOW—before your joint replacement surgery. Losing weight and reducing your BMI will decrease your risk for complications and increase the likelihood of a successful surgical outcome. In some cases, it may also decrease your pain to the point where joint replacement may no longer be needed—or can be put off for a number of years.

Work with Your Doctor

Although reaching and staying at a healthy weight can be a long-term

challenge, the payoff is significant. If you need help losing weight and lowering your BMI before joint replacement surgery, talk to your Doctor who will guide you to manage this problem professionaly.

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