OBES SURG DOI 10.1007/s11695-014-1269-z
BRIEF COMMUNICATION
Bariatric Surgical Practice Revisited: Unrecorded or Overlooked Problems in the Severely Obese Mervyn Deitel
# Springer Science+Business Media New York 2014
Abstract Severe loss of activities of daily living, if noted, is a potent reason for weight-loss surgery. Keywords Disability . Severe obesity . Bariatric surgery It is clearly documented that severely obese patients have a high incidence of well-recognized serious medical problems: type 2 diabetes, hypertension, dyslipidemia, atherosclerosis, non-alcoholic fatty or even fibrotic liver, debilitating arthritis of low back and weight-bearing joints (knees, ankles), obstructive sleep apnea, hypoventilation syndrome, female infertility, amenorrhea, urinary stress incontinence in women, an increased incidence of certain cancers, psychosocial and economic problems, prejudice, etc. Innumerable articles over the years in Obesity Surgery have documented the important fact that these serious comorbidities largely decrease or disappear with loss of excess body weight.
Mervyn Deitel: Editor-in-Chief Emeritus and Founding Editor. M. Deitel (*) Obesity Surgery, 39 Bassano Road, Toronto, ON M2N 2J9, Canada e-mail: [email protected]
On the other hand, there are problems in the severely obese which are often overlooked or unrecorded and yet are very important to the morbidly obese patient and to society. In a 2001 publication in this journal [1], these specific but often overlooked features were recorded in 1,549 consecutive morbidly obese individuals (mean BMI 44.8), to establish their incidence (Table 1). These debilitating obesity-related problems are often still not being highlighted in the patient’s records. Yet, they should have a very profound effect on the decisions of health insurance providers. Moderate to severe disability has been studied in these individuals [2-4]. Massively obese patients frequently cannot walk downstairs unless backwards, in order to visualize the stairs; if descending in the usual manner looking downwards, they may not be able to see the stairs below their truncal pannus and fall. Weight loss has been shown to resolve these disabling features.
OBES SURG Table 1 Some problems associated with massive obesity % of patients Unable to: Cut toenails, put on socksa Cross legs (i.e., thighs) Buckle normal seat belt Fit in a fixed booth at McDonald’s Fit in a theater seatb Wipe self Urinate accurately (men) Walk downstairs, unless backwards Refuses to: Undress in front of spouse Wear short sleeves in summer Sleep in room with significant other (snorers)
73 85 27 33 36 21 52 16 73 68 81
a
Usually with inability to tie own shoelaces, put on winter boots
b
Problem in bus, airplane, turnstiles
Like the standard medical comorbidities recorded in the patient’s history, physical exam, and biochemical studies, the often overlooked problems indicated in Table 1 should also be routinely documented preoperatively, and the progress noted with weight loss at follow-up. When visiting the surgeon preoperatively, some obese patients deny problems; however, when questioned regarding
the features shown in Table 1, tears often come to their eyes, indicating their importance to the patient. We have heard sad anecdotes from severely obese patients: e.g., the patient who became caught in a turnstile; the patient who could get into the airplane washroom but could not squeeze out; the obese mother whose daughter did not wish to be seen with her near school; the women who complain that pantyhose wear out between the rubbing inner thighs; the lady at church who stood up with the armchair clinging to her; the hirsute women who have to shave their faces. Thus, problems often not recorded may be a major handicap in the massively obese. These features should be publicized to governmental, insurance, and other interested bodies surveying the field of obesity.
References 1. Deitel M. Overlooked problems in morbidly obese patients. Obes Surg. 2001;11:541. 2. Deitel M, Shahi B. Effect of weight loss in the morbidly obese patient with severe disability. Obes Surg. 1991;1:419–21. 3. Fabris SM, Faintuch J, Brienze SLA, et al. Are knee and foot orthopedic problems more disabling in the superobese? Obes Surg. 2013;23:201–4. 4. Deitel M, Deitel KM, Deitel WL. Orthopedic considerations in the obese and the effect of bariatric surgery. In: Deitel M, Gagner M, Dixon JB, Himpens J, Madan AK, editors. Handbook of obesity surgery. Toronto: FD-Communications Inc; 2010. p. 406–9.
BRIEF COMMUNICATION
Bariatric Surgical Practice Revisited: Unrecorded or Overlooked Problems in the Severely Obese Mervyn Deitel
# Springer Science+Business Media New York 2014
Abstract Severe loss of activities of daily living, if noted, is a potent reason for weight-loss surgery. Keywords Disability . Severe obesity . Bariatric surgery It is clearly documented that severely obese patients have a high incidence of well-recognized serious medical problems: type 2 diabetes, hypertension, dyslipidemia, atherosclerosis, non-alcoholic fatty or even fibrotic liver, debilitating arthritis of low back and weight-bearing joints (knees, ankles), obstructive sleep apnea, hypoventilation syndrome, female infertility, amenorrhea, urinary stress incontinence in women, an increased incidence of certain cancers, psychosocial and economic problems, prejudice, etc. Innumerable articles over the years in Obesity Surgery have documented the important fact that these serious comorbidities largely decrease or disappear with loss of excess body weight.
Mervyn Deitel: Editor-in-Chief Emeritus and Founding Editor. M. Deitel (*) Obesity Surgery, 39 Bassano Road, Toronto, ON M2N 2J9, Canada e-mail: [email protected]
On the other hand, there are problems in the severely obese which are often overlooked or unrecorded and yet are very important to the morbidly obese patient and to society. In a 2001 publication in this journal [1], these specific but often overlooked features were recorded in 1,549 consecutive morbidly obese individuals (mean BMI 44.8), to establish their incidence (Table 1). These debilitating obesity-related problems are often still not being highlighted in the patient’s records. Yet, they should have a very profound effect on the decisions of health insurance providers. Moderate to severe disability has been studied in these individuals [2-4]. Massively obese patients frequently cannot walk downstairs unless backwards, in order to visualize the stairs; if descending in the usual manner looking downwards, they may not be able to see the stairs below their truncal pannus and fall. Weight loss has been shown to resolve these disabling features.
OBES SURG Table 1 Some problems associated with massive obesity % of patients Unable to: Cut toenails, put on socksa Cross legs (i.e., thighs) Buckle normal seat belt Fit in a fixed booth at McDonald’s Fit in a theater seatb Wipe self Urinate accurately (men) Walk downstairs, unless backwards Refuses to: Undress in front of spouse Wear short sleeves in summer Sleep in room with significant other (snorers)
73 85 27 33 36 21 52 16 73 68 81
a
Usually with inability to tie own shoelaces, put on winter boots
b
Problem in bus, airplane, turnstiles
Like the standard medical comorbidities recorded in the patient’s history, physical exam, and biochemical studies, the often overlooked problems indicated in Table 1 should also be routinely documented preoperatively, and the progress noted with weight loss at follow-up. When visiting the surgeon preoperatively, some obese patients deny problems; however, when questioned regarding
the features shown in Table 1, tears often come to their eyes, indicating their importance to the patient. We have heard sad anecdotes from severely obese patients: e.g., the patient who became caught in a turnstile; the patient who could get into the airplane washroom but could not squeeze out; the obese mother whose daughter did not wish to be seen with her near school; the women who complain that pantyhose wear out between the rubbing inner thighs; the lady at church who stood up with the armchair clinging to her; the hirsute women who have to shave their faces. Thus, problems often not recorded may be a major handicap in the massively obese. These features should be publicized to governmental, insurance, and other interested bodies surveying the field of obesity.
References 1. Deitel M. Overlooked problems in morbidly obese patients. Obes Surg. 2001;11:541. 2. Deitel M, Shahi B. Effect of weight loss in the morbidly obese patient with severe disability. Obes Surg. 1991;1:419–21. 3. Fabris SM, Faintuch J, Brienze SLA, et al. Are knee and foot orthopedic problems more disabling in the superobese? Obes Surg. 2013;23:201–4. 4. Deitel M, Deitel KM, Deitel WL. Orthopedic considerations in the obese and the effect of bariatric surgery. In: Deitel M, Gagner M, Dixon JB, Himpens J, Madan AK, editors. Handbook of obesity surgery. Toronto: FD-Communications Inc; 2010. p. 406–9.
