Answering this question may give you the courage you need
to take the first step. Below are tools you can use to determine
if you are morbidly obese and potentially a candidate for
weight loss surgery.
There are several
medically accepted criteria for defining morbid obesity.
You are likely morbidly obese if you are:
| • |
more
than 100 lbs. over your ideal body weight, or |
| • |
have a Body
Mass Index (BMI) of over 40, or |
| • |
have a BMI of
over 35 and are experiencing severe negative health
effects, such as high blood pressure or diabetes, related
to being severely overweight |
| • |
unable to achieve
a healthy body weight for a sustained period of time,
even through medically supervised dieting |
Select your gender,
and then move the red slider handles or select your height
and weight to calculate your BMI. The results of the BMI
calculations are displayed below. Note that these are approximate
values, and are intended to be used only as a rough guide.
(If you cannot
see the sliders on the chart below, you need to install Java.
You can do that by clicking
here. This will run a diagnostic and allow you to complete
the installation.)
Ideal Body
Weight Chart
Male
Height |
Ideal
Weight |
4'
6" |
63
- 77 lbs. |
4'
7" |
68
- 84 lbs. |
4'
8" |
74
- 90 lbs. |
4'
9" |
79
- 97 lbs. |
4'
10" |
85
- 103 lbs. |
4'
11" |
90
- 110 lbs. |
5'
0" |
95
- 117 lbs. |
5'
1" |
101
- 123 lbs. |
5'
2" |
106
- 130 lbs. |
5'
3" |
112
- 136 lbs. |
5'
4" |
117
- 143 lbs. |
5'
5" |
122
- 150 lbs. |
5'
6" |
128
- 156 lbs. |
5'
7" |
133
- 163 lbs. |
5'
8" |
139
- 169 lbs. |
5'
9" |
144
- 176 lbs. |
5'
10" |
149
- 183 lbs. |
5'
11" |
155
- 189 lbs. |
6'
0" |
160
- 196 lbs. |
6'
1" |
166
- 202 lbs. |
6'
2" |
171
- 209 lbs. |
6'
3" |
176
- 216 lbs. |
6'
4" |
182
- 222 lbs. |
6'
5" |
187
- 229 lbs. |
6'
6" |
193
- 235 lbs. |
6'
7" |
198
- 242 lbs. |
6'
8" |
203
- 249 lbs. |
6'
9" |
209
- 255 lbs. |
6'
10" |
214
- 262 lbs. |
6'
11" |
220
- 268 lbs. |
7'
0" |
225
- 275 lbs. |
Ideal
Body Weight Chart
Female
| Height |
Ideal
Weight |
| 4' 6" |
63 - 77 lbs. |
| 4' 7" |
68 - 83 lbs. |
| 4' 8" |
72 - 88 lbs. |
| 4' 9" |
77 - 94 lbs. |
| 4' 10" |
81 - 99 lbs. |
| 4' 11" |
86 - 105 lbs. |
| 5' 0" |
90 - 110 lbs. |
| 5' 1" |
95 - 116 lbs. |
| 5' 2" |
99 - 121 lbs. |
| 5' 3" |
104 - 127 lbs. |
| 5' 4" |
108 - 132 lbs. |
| 5' 5" |
113 - 138 lbs. |
| 5' 6" |
117 - 143 lbs. |
| 5' 7" |
122 - 149 lbs. |
| 5' 8" |
126 - 154 lbs. |
| 5' 9" |
131 - 160 lbs. |
| 5' 10" |
135 - 165 lbs. |
| 5' 11" |
140 - 171 lbs. |
| 6' 0" |
144 - 176 lbs. |
| 6' 1" |
149 - 182 lbs. |
| 6' 2" |
153 - 187 lbs. |
| 6' 3" |
158 - 193 lbs. |
| 6' 4" |
162 - 198 lbs. |
| 6' 5" |
167 - 204 lbs. |
| 6' 6" |
171 - 209 lbs. |
| 6' 7" |
176 - 215 lbs. |
| 6' 8" |
180 - 220 lbs. |
| 6' 9" |
185 - 226 lbs. |
| 6' 10" |
189 - 231 lbs. |
| 6' 11" |
194 - 237 lbs. |
| 7' 0" |
198 - 242 lbs. |
For anyone who
has considered a weight loss program, there is certainly no
shortage of choices. In fact, to qualify for insurance coverage
of weight loss surgery, many insurers require patients to
have a history of medically supervised weight loss efforts.
Most non-surgical weight loss programs
are based on some combination of diet/behavior modification
and regular exercise. Unfortunately, even the most effective
interventions have proven to be effective for only a small
percentage of patients. It is estimated that less than 5%
of individuals who participate in non-surgical weight loss
programs will lose a significant amount of weight and maintain
that loss for a long period of time.
According to the National Institutes of
Health, more than 90% of all people in these programs regain
their weight within one year. Sustained weight loss for
patients who are morbidly obese is even harder to achieve.
Serious health risks have been identified for people who
move from diet to diet, subjecting their bodies to a severe
and continuing cycle of weight loss and gain known as "yo-yo
dieting."
The fact remains that morbid obesity is
a complex, multifactorial chronic disease.
For many patients, the risk of death from
not having the surgery is greater than the risks from the
possible complications of having the procedure.
That is the key reason
why American Society for Bariatric Surgery estimates that
100,000 surgical weight loss procedures were performed in
2003. Patients who have had the procedure and are benefiting
from its results report improvements in their quality of
life, social interactions, psychological well-being, employment
opportunities and economic condition.
In clinical studies,
candidates for the procedure who had multiple obesity-related
health conditions questioned whether they could safely have
the surgery. These studies show that selection of surgical
candidates is based on very strict criteria and surgery
is an option for the majority of patients.
Weight
Loss Surgery
Diet & Behavior
Modification
Exercise
Over-the-Counter &
Prescription Drugs
Weight Loss
Surgery
Weight loss surgery is major surgery. Its growing use to
treat morbid obesity is the result of three factors:
| • |
Our
current knowledge of the significant health risks of
morbid obesity |
| • |
The relatively
low risk and complications of the procedures versus
not having the surgery |
| • |
The ineffectiveness
of current non-surgical approaches to produce sustained
weight loss |
| |
|
Surgery should
be viewed first and foremost as a method for alleviating
debilitating, chronic disease. In most cases, the minimum
qualification for consideration as a candidate for the procedure
is 100 lbs. above ideal body weight or those with a Body
Mass Index of 40 or greater. Occasionally a procedure will
be considered for someone with a BMI of 35 or higher if
the patient's physician determines that obesity-related
health conditions have resulted in a medical need for weight
reduction and, in the doctor's opinion, surgery appears
to be the only way to accomplish the targeted weight loss.
In many cases, patients are required to show proof that
their attempts at dietary weight loss have been ineffective
before surgery will be approved. More important, however,
is the commitment on the part of the patient to required,
long-term follow-up care. Our surgeon requires patients
to demonstrate serious motivation and a clear understanding
of the extensive dietary, exercise and medical guidelines
that must be followed for the remainder of their lives after
having weight loss surgery (see Life
After Surgery).
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Diet &
Behavior Modification
There are literally hundreds of diets available. Moving
from diet to diet in a cycle of weight gain and loss - yo-yo
dieting - that stresses the heart, kidneys and other organs
can also be a health risk.
Doctors who prescribe
and supervise diets for their patients usually create a
customized program with the goal of greatly restricting
calorie intake while maintaining nutrition.
These diets fall
into two basic categories:
| • |
Low
Calorie Diets (LCDs) are individually planned so that
the patient takes in 500 to 1,000 fewer calories a day
than he or she burns. |
| • |
Very Low Calorie
Diets (VLCDs) typically limit caloric intake to 400
to 800 a day and feature high-protein, low-fat liquids. |
Many patients on
Very Low Calorie Diets lose significant amounts of weight.
However, after returning to a normal diet, most regain the
lost weight in under a year. Ninety percent of people participating
in all diet programs will regain the weight they've lost
within two years.
Behavior modification
uses therapy to help patients change their eating and exercise
habits. Like low-calorie diets, behavior modification, in
most patients, results in short-term success that tends
to diminish after the first year.
If diet and behavior
modifications have failed you and surgery is your next option,
it is important to understand that diet and behavior modification
will be instrumental to sustained weight loss after your
surgery. The surgery itself is only a tool to get your body
started losing weight - complying with diet and behavior
modifications required by our surgeon and this will help
determine your ultimate success.
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Exercise
Starting an exercise program can be especially intimidating
for someone suffering from morbid obesity. Your health condition
may make any level of physical exertion next to impossible.
Check with your primary care physician before you start
an exercise program. The benefits of exercise are clear,
however. And there are ways to get started.
A National Institutes
of Health survey of 13 studies concludes that physical activity:
| • |
results
in modest weight loss in overweight and obese individuals |
| • |
increases cardiovascular
fitness, even when there is no weight loss |
| • |
can help maintain
weight loss |
New theories focusing
on the body's set point (the weight range in which your
body is programmed to weigh and will fight to maintain that
weight) highlight the importance of exercise. When you reduce
the number of calories you take in, the body simply reacts
by slowing metabolism to burn fewer calories. Daily physical
activity can help speed up your metabolism, effectively
bringing your set point down to a lower natural weight.
So when following a diet to attempt to lose weight, exercise
increases your chances of long-term success.
Examples to get you
started:
| • |
Park
at the far end of parking lots and walk |
| • |
Take the stairs
instead of the elevator |
| • |
Cut down on
television |
| • |
Swim or participate
in low-impact water aerobics |
| • |
Ride an exercise
bike |
Overall, walking
is one of the best forms of exercise. Start out slowly and
build up. Your doctor, or people in a support group, can
offer encouragement and advice. Incorporating exercise into
your daily activities will improve your overall health and
is important for any long-term weight management program,
including weight loss surgery. Diet and exercise play a
key role in successful weight loss after surgery.
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Over-the-Counter
& Prescription Drugs
New over-the-counter and prescription weight loss medications
have been introduced. Some people have found them effective
in helping to curb their appetite. The results of most studies
show that patients on drug therapy lose around 10 percent
of their excess weight and that the weight loss plateaus
after six to eight months. As patients stop taking the medication,
weight gain usually occurs.
"Since many people
cannot lose much weight no matter how hard they try, and
promptly regain whatever they do lose, the vast amount of
money spent on diet clubs, special foods and over-the-counter
remedies, estimated to be on the order of $30 billion to
$50 billion yearly, is wasted." (New England Journal
of Medicine)
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TO TOP
Surgeons first
began to recognize the potential for surgical weight loss
while performing operations that required the removal of large
segments of a patient's stomach and intestine. After the surgery,
doctors noticed that in many cases patients were unable to
maintain their pre-surgical weight. With further study, surgeons
were able to recommend similar modifications that could be
safely used to produce weight loss in morbidly obese patients.
Over the last decade these procedures have been continually
refined in order to improve results and minimize risks. Today's
bariatric surgeons have access to a substantial body of clinical
data to help them determine which surgeries should be used
and why.
Today, the American Society for Bariatric
Surgery describes two basic approaches that weight loss
surgery takes to achieve change:
| 1. |
Restrictive
procedures that decrease food intake. |
| 2. |
Malabsorptive
procedures that alter digestion, thus causing the food
to be poorly digested and incompletely absorbed so that
it is eliminated in the stool. |
Restrictive
Procedures
Malabsorptive Procedures
that Alter Digestion
Restrictive
Procedures
The theory is simple.
When you feel full, you are more likely to have reduced
feelings of hunger and will no longer feel deprived. The
result is that you are likely to eat less. Restrictive weight
loss surgery works by reducing the amount of food consumed
at one time. It does not, however, interfere with the normal
absorption (digestion) of food. In a cooperative and compliant
patient, the reduced stomach capacity, along with behavioral
changes, can result in consistently lower caloric intake
and consistent weight loss.
During recovery,
patients must adhere to the strict specific dietary guidelines
and restrictions their surgeon prescribes. When the time
comes to resume eating "regular" food, the patient must
learn to adapt to a new way of eating. At each meal, they
are restricted to consuming approximately 1/2 to a full
cup of food before feeling uncomfortably full. Patients
who see the best results from a restrictive procedure are
those who learn to eat slowly, eat less, and avoid drinking
too many fluids, particularly carbonated beverages. The
effectiveness of a restrictive procedure is reduced by constant
snacking or by drinking high-calorie, high-fat liquids.
Failure to achieve the expected level of weight loss is
usually the result of a patient failing to comply with the
recommended dietary and behavior modifications, such as
increased exercise and regular support group attendance.
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Malabsorptive
Procedures that Alter Digestion
It can be said that
some of the restrictive approaches discussed above have
not always achieved the excess weight loss surgeons and
patients anticipated. For this reason, procedures that alter
digestion, known as malabsorptive procedures, were developed
to work in conjunction with restrictive approaches. Some
of these techniques involve a bypass of the small intestine,
thus limiting the absorption of calories. On balance, malabsorptive
or malabsorptive/restrictive procedures have resulted in
an overall increase in the loss of excess weight. The risk
of complications and side effects generally increases with
the lengthening of the small intestine bypass. You and your
surgeon must determine the risks and benefits over your
lifetime with the type of weight loss surgery you choose.
Basically, weight
loss operations fall into three categories:
| |
|
| • |
Restrictive
procedures make the stomach smaller to limit the amount
of food intake. |
| • |
Malabsorptive
techniques reduce the amount of intestine that comes
in contact with food so that the body absorbs fewer
calories. |
| • |
Combination
operations take advantage of both restriction and malabsorption. |
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TO TOP
To better understand
how weight loss surgery works, it is important to understand
how your gastrointestinal tract functions. As the food you
consume moves through the tract, various digestive juices
and enzymes are introduced at specific stages that allow
absorption of nutrients. Food material that is not absorbed
is then prepared for elimination. A simplified description
of the gastrointestinal tract appears below. Your doctor
can provide a more detailed description to help you better
understand how weight loss surgery works.
| 1. |
The
esophagus is a long muscular tube, which moves food
from the mouth to the stomach. |
| 2. |
The abdomen
contains all of the digestive organs. |
| 3. |
The stomach,
situated at the top of the abdomen, normally holds
just over 3 pints (about 1500 ml) of food from a
single meal. Here the food is mixed with an acid
that is produced to assist in digestion. In the
stomach, acid and other digestive juices are added
to the ingested food to facilitate breakdown of
complex proteins, fats and carbohydrates into small,
more absorbable units. |
| 4. |
A valve
at the entrance to the stomach from the esophagus
allows the food to enter while keeping the acid-laden
food from "refluxing" back into the esophagus, causing
damage and pain. |
| 5. |
The pylorus
is a small round muscle located at the outlet of
the stomach and the entrance to the duodenum (the
first section of the small intestine). It closes
the stomach outlet while food is being digested
into a smaller, more easily absorbed form. When
food is properly digested, the pylorus opens and
allows the contents of the stomach into the duodenum. |
| 6. |
The small
intestine is about 15 to 20 feet long (4.5 to 6
meters) and is where the majority of the absorption
of the nutrients from food takes place. The small
intestine is made up of three sections: the duodenum,
the jejunum and the ileum. |
| 7. |
The duodenum
is the first section of the small intestine and
is where the food is mixed with bile produced by
the liver and with other juices from the pancreas.
This is where much of the iron and calcium is absorbed. |
| 8. |
The jejunum
is the middle part of the small intestine extending
from the duodenum to the ileum; it is responsible
for digestion. |
| 9. |
The last
segment of the intestine, the ileum, is where the
absorption of fat-soluble vitamins A, D, E and K
and other nutrients are absorbed. |
| 10. |
Another
valve separates the small and large intestines to
keep bacteria-laden colon contents from coming back
into the small intestine. |
| 11. |
In the
large intestines, excess fluids are absorbed and
a firm stool is formed. |
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