Obesity and Bariatric Surgery: The Physical, Social and Emotional Factors

The U.S. obesity prevalence was already approaching an alarming 45 percent of the population before the COVID pandemic. That rate has likely risen as the world nears the two-year mark of dealing with the pandemic, U.S. public officials say. Moreover, obesity is a risk factor for severe disease from COVID.  

For many years, weight-loss surgery — or bariatric surgery — has been a vital treatment option for severely obese adults. The U.S. rate of severe obesity is estimated as high as 10 percent, according to the U.S. Centers for Disease Control and Prevention (CDC).

However, the general category of obesity is sufficient to substantially increase someone’s risk for serious, chronic disease. If your BMI is 30.0 or higher, it falls within the obesity range.

What are the consequences of obesity and why is it important? Anthony Gonzalez, M.D., medical director of bariatric surgery at Baptist Health South Florida, answers the question succinctly.

“Obesity will reduce your life expectancy because of the multitude of medical problems that obesity causes … ones like high blood pressure, high cholesterol, hyperlipidemia, elevated lipids, heart disease, stroke, heart attacks, increased cancer risk and, obviously, that is the importance of obesity in its medical context,” explains Dr. Gonzalez.

In a new Baptist HealthTalk podcast on the topic of obesity and bariatric surgery, host Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Miami Cardiac & Vascular Institute, was joined by Dr. Gonzalez and Carmen Barresi, L.M.H.C., psychotherapist with Baptist Health’s Community Health and Wellness.

Below are question-and-answer excerpts from the podcast:

How do we define obesity?

Dr. Gonzalez:

“Obesity is obviously a lifelong disease. It’s progressive, it’s costly, and it’s multifactorial, but the bottom line is obesity is an excessive amount of fat storage. Obesity can be easily measured and the simplest way that a viewer can measure obesity is by their body mass index, their BMI. The BMI is a calculation of your weight versus your height and, of course, your weight will vary depending on how tall you are. There are multitude of online calculators you could plug in your weight in pounds or in kilograms, and your height in meters or in inches, and you could figure out your BMI. So, obesity can be well defined. It could be well classified.”

What are some of the psychosocial triggers that might lead someone to gain weight and become obese — and how can we recognize those triggers?

Carmen Barresi:

“There are multiple factors that contribute to obesity. When we’re looking at the external factors and environmental factors, some of the things to keep in mind are eating disorders and medications that are being prescribed to individuals can impact weight. In addition to that, poverty, even though one would think if populations are malnourished maybe they won’t have the obesity concern. But, actually, access to diet that’s high in sugar, high in fat and high in calories contributes to obesity and the increase that we’re seeing, as well as lack of sleep. And even decisions like deciding to quit smoking can actually contribute to higher rates of obesity as well. Having a lifestyle that’s less mobile can also contribute to gaining weight and obesity.”

Who would be considered a candidate for bariatric surgery?

Dr. Gonzalez:

“The risk of being at a level of obesity that is life threatening is when we begin to consider a bariatric surgery. So, the guidelines since 1991 by the National Institutes of Health are that if your BMI is 35, which is about 75 pounds overweight, and you have diabetes, or high blood pressure or sleep apnea, you should be a candidate for bariatric surgery. And if your BMI is 40, which is about a hundred pounds of excess weight, no matter whether or not you have medical problems or comorbidities, you’re a candidate for bariatric surgery. So, as you can see, it’s not somebody who’s 10- or 20-pounds overweight. It’s beginning at around 75 pounds of excess weight, and really a hundred pounds of excess weight is when we start considering bariatric surgery.”

When someone comes to you are they generally meeting those criteria for bariatric surgery? What do you find in your experience?

Dr. Gonzalez:

“What we find in our experience is that most patients have actually looked into bariatric surgery for at least two years prior to even coming to see us, and they have been on multiple diets. Usually, the average is about a handful of different types of diet programs and lifestyle modifications. But we don’t take that for granted. We obviously put the patient through the preoperative medical evaluation. We put them through nutritional counseling preoperatively, a psychological evaluation, and then obviously we have a very robust educational program as part of the preoperative rehabilitation of our surgical program. No doubt about that. Surgery, in and of itself, is not going to solve the problem. It’s a lifestyle change and obviously we have to put the patient’s mind in the correct location.”

What’s the expected emotional results that you see in patients who undergo successful bariatric surgery?

Carmen Barresi:

“This decision can be very life-changing. And just like any changes in our life, our body responds to that with different emotions. And when we look at the process, it’s a way of us reacting and responding to the physical changes that are taking place in our body post-surgery. So, there’s hormonal differences and changes that are occurring that can contribute to maybe individuals feeling a little bit more anxious or a little bit sadder. In addition to that, there’s a new sense of attention that can warrant someone feel maybe uncomfortable or not accustomed to that reaction from others. That can prompt someone to maybe want to isolate or not feel as comfortable in social situations. So, it’s important to keep that in mind as you go into this journey and also take it with this approach of a time for self-discovery. So, it’s a change and how can you welcome that and embrace it?”