Morbid obesity.pptx

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1. Morbid obesity

2. Definition : MORBID OBESITY is a condition where in BMI is more than 40 kg /m2 . Also defined as weight 100 Lbs or more ; 100% over ideal body weight . Weight more than double the expected weight to that age and height of the individual is also often called as MORBID OBESITY . Body weight exceeding BMI 50 kg /m2 is called as superobesity .

3. Causes : Familial Hyperinsulinism Hyperadrenocorticism Hypogonadism Abnormal eating behaviour : Hormone which control eating are – Ghrelin from stomach ; insulin from pancreas ; leptin from fat ; PYY 3-36 from colon Hypothalamus is the centre in CNS which controls eating

4. Child of a normal weight parents has 10% chance to become obesity If parents are obese then child has 80%chances to develop obesity.

5. Problems with morbid obesity Sleep apnoea Degenerative joint disease Back pain Hypertension GERD Gallstones Type 2 diabetes Hyperlipidaemia Arrhythmias Venous diseases Dvt Skin diseases Urine incontinence Ventral hernias Obesity hypoventilation syndrome Poly-cystic ovarian disease Gynaecomastia Steatohepatosis Malignancies All these conditions are called as comorbidities.

6. Surgical indications 1991 NIH consensus conference >40 BMI >35 with comorbidity (DM ,HTN) Unsuccessful non – operative weight loss Dietician/mental health clearance No medical contraindications

7. contraindications Active duty military History of VTE Non – ambulatory Smoking Uncontrolled psych disorder – depression , bipolar Cancer Chronic pain

8. Post – op requirements MVI w/Fe Calcium B12 Focus on protein Exercise No pregnancy for 12-18 months Support group Many elect plastic surgery

9. Surgical options Restrictive - Lap band (LAGB) -20% -Gastric sleeve (GS) – 5% Malabsorptive – (BPS + DS) -5% -Biliopancreatic Diversion + Duodenal Switch Combined -Gastric bypass (GBP) – 70% 5

10. MORBIDITY – 15% Early – VTE, sepsis , bleeding Late - Dumping Vomiting Gallstones Ulcers Stenosis Bowel obstruction Nutritional