Obesity related health problems - other fun things

--not necessarily co-morbid but co-major-pain in the neck

• Heel spurs – A condition making it painful to walk. The heavier you are, the more weight you put into every step. As you lose weight and walk more, these improve. Sometimes heel spurs require surgery, but often your friendly podiatrist can treat them with some inserts for your shoes.
• Stress incontinence – Your bladder spills urine when you laugh or sneeze. The more weight you have on your bladder from your belly, the more pressure there is on the bladder. Losing weight not only decreases that pressure, but also reduces your risks should you require surgery for stress incontinence.
• Heartburn – Some people notice that they have heartburn when they reach a certain weight. Pregnant women notice that heartburn goes away after delovery of their newborn and returns once the newborn becomes a teenager! The weight in the abdomen puts pressure on the diaphragm and increases heartburn. Some patients will still require medicine for heartburn or acid production, but weight loss decreases this problem for many patients.
• Swelling of the legs – Swelling of the legs and ankles has a number of different sources, as do all of these conditions. There is no doubt that decreasing the amount of weight on your legs and ankles diminishes the swelling.
• Tight airline seats – Some of my patients can’t travel anywhere unless they buy a first-class seat, they are just too uncomfortable in small seats on the airline. Losing weight makes it much easier to sit in those airline seats—although the food is still better in the front seats.
• Polycystic ovarian syndrome (PCOS) – Patients with this problem have difficulties with their cycles, have multiple ovarian cysts, and some have over production of certain hormones that cause excess facial hair on women.
• Infertility – Some women have difficulty becoming pregnant because of obesity. The first line of treatment, your gynecologist will tell you, is to lose weight. As with PCOS, there are a lot of hormonal changes when someone is morbidly obese. Even as patients lose weight, the hormones fluctuate quite a bit. Most bariatric surgeons recommend that patients wait two years after weight loss surgery to become pregnant.
• Varicose Veins—Okay, I admit it—I am Norwegian, and my Norwegian medical textbook defines Varicose Veins as veins that are too close together. Varicose veins are caused by a backward flow of blood. As the blood pools in the veins, they slowly enlarge and those nasty spider veins develop. This can be unsightly, but it can also cause you to have tired legs at the end of the day, your feet can swell, and you may feel tenderness over the veins. Excess weight definitely contributes to this problem.

All these conditions are aggravated by obesity. As people lose weight, these conditions are much easier to control and some disappear entirely. Some insurance companies will designate these as “co-morbidities” of obesity, but most will not.

Major Disclaimer Here

Skinny people die young. Skinny people develop diabetes, cirrhosis, sleep apnea, joint problems, heart disease, infertility, heel spurs, and all the rest. We all know skinny people with bad hearts. We all know thin folks who have diabetes. Weight loss will certainly eliminate a source of problems, but it may not eliminate the problem. I have plenty of patients who no longer need medicines for high blood pressure or diabetes—and many patients who need less medicine than before. While I don’t think of weight loss as a cure for diabetes as one of my colleagues does (I tell patients they still have that predisposition), but it sure is a lot easier to avoid problems by losing a hundred pounds.

One of my favorite patients was a very nice young man named Fred. When he came to me, he weighed over 560 pounds and had a problem with congestive heart failure. Fred went home and lost 100 pounds within the first six weeks. Unfortunately, he died of heart failure a bit later. He was happy to be getting around better, and was a wonderful inspiration to a lot of people in my support group. Surgery can help you lose weight, but it cannot cure the damage caused by years of obesity or the underlying diseases.

Who can’t have lap-band weight loss surgery?

Weight loss surgery is elective, meaning you can plan the time of the surgery. It is not an emergency like that for a ruptured appendix. Most people who decide this surgery is for them want the surgery today or tomorrow. After an article of mine was published in a local paper, I was called to the hospital to do an emergency consultation for weight loss surgery—kind of funny if you think about it.

Some patients are too ill to have the surgery. It is sad when obesity plays a major role in the heart disease or other problems these patients suffer from, but sometimes these diseases are too far advanced to make surgery a safe option. When I have patients like this I feel sad because, had they been referred for weight loss surgery sooner, they could have avoided the ravages of obesity.

Sometimes patients may need other medical procedures prior to weight loss surgery—for example, if they need their heart stented or bypassed, this is better done before obesity surgery (heart beats guts like rock beats scissors).

Some surgeons refuse to operate on patients who continue to smoke, and some even go so far as to do random testing of blood for nicotine. It may seem a bit odd to some people, I realize, but I am one of those who will not operate on smokers. There are several reasons for this. The main reason is that smokers have a higher incidence of problems following surgery, including pneumonia, leaks from the anastomosis (more about this later), as well as hernias. We even make our patients sign a contract that they will quit smoking and it has been quite successful. It’s a great way to change a few bad habits and chose life over obesity and smoking.

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