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Health Effects of Morbid Obesity
Severe obesity damages the body by its mechanical, metabolic and physiological adverse effects on normal bodily function. These "co-morbidities" affect nearly every organ in the body in some way, and produce serious secondary illnesses, which may also be life-threatening. The cumulative effect of these co-morbidities can interfere with a normal and productive life, cause endless frustration and can seriously shorten life, as well.
Shortened Life Span
Dysmetabolic Syndrome X
This recently recognized syndrome, involving abdominal obesity, abnormal blood fat levels, changes in insulin sensitivity, and inflammation of the arteries, is assciated with a markedly increased risk of heart and blood vessel disease. It is also a precursor to the onset of Diabetes in adults.
Severely obese persons are approximately 6 times as likely to develop heart disease as those who are normal-weighted. Heart disease is the leading cause of death in the United States today, and obese persons tend to develop it earlier in life, and it shortens their lives. Coronary disease is pre-disposed by increased levels of blood fats, and the metabolic effects of obesity. Increased load on the heart leads to early development of congestive heart failure. Severely obese persons are 40 times as likely to suffer sudden death, in many cases due to cardiac rhythm disturbances.
High Blood Pressure
Essential hypertension, the progressive elevation of blood pressure, is much more common in obese persons, and leads to development of heart disease, and damage to the blood vessels throughout the body, causing susceptibility to strokes, kidney damage, and hardening of the arteries. If your doctor finds you have high blood pressure, the first thing he or she will recommend to you is weight loss (but doctors have never been able to tell us how).
High Blood Cholesterol
Cholesterol levels are commonly elevated in the severely obese -- another factor predisposing to development of heart and blood vessel disease. This abnormality is not just related to diet, but is an effect of the massive imbalance in body chemistry which obesity causes.
Overweight persons are 40 times as likely to develop Type II, Adult-Onset, Diabetes. Elevation of the blood sugar, the essential feature of Diabetes, leads to damage to tissues throughout the body: Diabetes is the leading cause of adult-onset blindness, a major cause of kidney failure, and the cause of over one half of all amputations. It is the #4 cause of death in the United States. Diabetics suffer severely from their disease, and once Diabetes occurs, it becomes even much harder to lose weight, because of hormone changes which cause the body to store fat even more than before.
Sleep Apnea Syndrome
Sleep apnea -- the stoppage of breathing during sleep -- is commonly caused in the obese, by compression of the neck, closing the air passage to the lungs. It leads to loud snoring, interspersed with periods of complete obstruction, during which no air gets in at all. The sleeping person sounds to an observer like he is holding his breath, but the sleeper is, himself, usually unaware that the problem is occurring at all, or only notices that he sleeps poorly, and awakens repeatedly during the night. The health effects of this condition may be severe, high blood pressure, cardiac rhythm disturbances, and sudden death. Affected persons awaken exhausted and often fall asleep during the day -- sometimes even at the wheel of their car, and complain of being tired all the time. This condition really has a high mortality rate, and is a life-threatening problem.
Obesity Hypoventilation Syndrome
This condition occurs primarily in the very severely obese -- over 350 lbs. It is characterized by episodes of drowsiness, or narcosis, occurring during awake hours, and is caused by abnormalities of breathing and accumulation of toxic levels of carbon dioxide in the blood. It is often associated with sleep apnea, and may be hard to distinguish from it.
Obese persons find that exercise causes them to be out of breath very quickly, during ordinary activities. The lungs are decreased in size, and the chest wall is very heavy and difficult to lift. At the same time, the demand for oxygen is greater, with any physical activity. This condition prevents normal physical activities and exercise, often interferes with usual daily activities, such as shopping, yard-work or stair climbing, making even ordinary living difficult or miserable, and it can become completely disabling.
Heartburn - Reflux Disease and Reflux Nocturnal Aspiration
Acid belongs in the stomach, which makes it to help digest your food, and it seldom causes any problem when it stays there. When it escapes into the esophagus, through a weak or overloaded valve at the top of the stomach, the result is called "heartburn", or "acid indigestion". The real problem is not with digestion, but with the burning of the esophagus by the powerful stomach acid, getting to where it doesn't belong.. When one belches, the acid may bubble up into the back of the throat, causing a fiery feeling there as well. Often this occurs at night, especially after a large or late meal, and if one is asleep when the acid regurgitates, it may actually be inhaled, causing a searing of the airway, and violent coughing and gasping.
This condition is dangerous, because of the possibility of pneumonia or lung injury. The esophagus may become strictured, or scarred and constricted, causing trouble with swallowing. Approximately 10 - 15% of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett's esophagus, which is a pre-malignant change in the lining membrane of the esophagus, a cause of esophageal cancer. The incidence of this type of cancer is increasing in the United States, in parallel with the increase in obesity.
Asthma and Bronchitis
Obesity is associated with a higher rate of asthma, about 3 times normal. Much of this effect is probably due to acid reflux (described above), which can irritate a sensitive airway and provoke an asthmatic attack. The improvement of asthma after surgery is often very dramatic, even before much weight loss has occurred.
Gallbladder disease occurs several times as frequently in the obese, in part due to repeated efforts at dieting, which predispose to this problem. When stones form in the gallbladder, and cause abdominal pain or jaundice, the gallbladder must be removed.
Stress Urinary Incontinence
A large heavy abdomen, and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing. This condition is strongly associated with being overweight, and is usually relieved by weight loss.
Degenerative Disease of Lumbo-Sacral Spine
The entire weight of the upper body falls on the base of the spine, and overweight causes it to wear out, or to fail. The consequence may be accelerated arthritis of the spine, or "slipped disk", when the cartilage between the vertebrae squeezes out. Either of these conditions can cause irritation or compression of the nerve roots, and lead to sciatica -- a dull, intense pain down the outside of the leg.
Degenerative Arthritis of Weight-Bearing Joints
The hips, knees, ankles and feet have to bear most of the weight of the body. These joints tend to wear out more quickly, or to develop degenerative arthritis much earlier and more frequently, than in the normal-weighted person. Eventually, joint replacement surgery may be needed, to relieve the severe pain. Unfortunately, the obese person faces a disadvantage there too -- joint replacement has much poorer results in the obese, and complications are more likely.. Many orthopedic surgeons refuse to perform the surgery in severely overweight patients
Venous Stasis Disease
The veins of the lower legs carry blood back to the heart, and they are equipped with an elaborate system of delicate one-way valves, to allow them to carry blood "uphill". The pressure of a large abdomen may increase the load on these valves, eventually causing damage or destruction. The blood pressure in the lower legs then increases, causing swelling, thickening of the skin, and sometimes ulceration of the skin. Blood clots also can form in the legs, further damaging the veins, and can also break free and float into the lungs -- called a Pulmonary Embolism -- a serious or even fatal event.
Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, and cannot enjoy theatre seats, or a ride in a bus or airliner. There is no wonder, that anxiety and depression might accompany years of suffering from the effects of a genetic condition -- one which skinny people all believe should be controlled easily by will power.
Seriously obese persons suffer inability to qualify for many types of employment, and discrimination in employment opportunities, as well. They tend to have higher rates of unemployment, and a lower socioeconomic status. Ignorant persons often make rude and disparaging comments, and there is a general societal belief that obesity is a consequence of a lack of self-discipline, or moral weakness. Many severely obese persons find it preferable to avoid social interactions or public places, choosing to limit their own freedom, rather than suffer embarassment.