Bariatric treatments for adult obesity - Institute of Health Economics

genitourinary system: hypogonadism, urinary incontinence;reproductive complications: menstrual irregularity, infertility, hirsutism, polycystic ovaries,miscarriage, gestational diabetes, hypertension, preeclampsia, macrosomia, fetal distress,defects, malformation, dystocia, and primary Caesarean section;neurologic system: idiopathic intracranial hypertension, meralgia paresthetica, and stroke; miscellaneous: disrupted or inadequate sleep, proteinuria, nephrotic syndrome, skininfection, lymphoedema, complications in surgery, and poor dental health.The specific levels of health risk associated with obesity vary with BMI level, body fat content anddistribution, age, gender, ethnicity, and social conditions. 1,6,29,31,32,38-40,50,53,58Growing evidence shows that obesity (as defined by BMI and waist circumference) is not alwaysrelated to an unfavourable cardiometabolic profile or poor health outcomes. 5,15,26,36,59,60 The existenceof cardiometabolically healthy obese individuals (who present a lower prevalence of health riskfactors and less disease burden) is referred to as uncomplicated obesity; this has become a distinctclinical entity and is not an uncommon finding in clinical practice.Obesity is associated with an increased risk of premature death from chronic conditions such ascardiovascular diseases, T2DM, and certain cancers. 1,6,12,25,31,38,50,51,61-65 The association between obesityand mortality weakens with increasing age, especially for those over 75 years of age. 6,63-66 Data fromseveral epidemiological studies suggest an inverse correlation between obesity and mortality,particularly cardiovascular mortality in the elderly, often termed as the obesity paradox. 5,26,36,59,61,63,64According to the reviewed evidence, there is an association between the category of obesity andmedical complications—the more severe the obesity, the more serious the medicalcomplications. 1,6,12,15,31,39,40,50,51,53,58,67,68 Severe (class III) obesity presents a 13- to 18-fold increased riskof T2DM, a 7-fold increased risk of hypertension, and a 2-fold increased risk of all-cause mortalitycompared to normal weight. 67,69 Severe obesity can shorten life expectancy by 8 to 13 years. 69Psychological and social consequences of obesityIn addition to an increased risk of developing physical morbidity and premature mortality, obesity isassociated with debilitating psychological and social consequences. 1,6,15,19,25,39,40,48,52-55,57,58,67,68,70-73 Bodyimage dissatisfaction, low self-esteem, disturbed eating habits, depressive symptoms, mood andanxiety disorders, suicidal ideation, and psychological disturbance are common in individuals whoseek bariatric treatment and, as with obesity-related cardiometabolic health risks and complications,tend to cluster in the most susceptible individuals (especially in those with severe obesity and mostnotably in young women). 25,53-55,57,58Psychopathology may be considered a comorbidity of severe obesity, mainly consisting ofdepression, anxiety disorder, personality disorder, and impaired self-esteem. 15,25,39,40,54,58,71,73,74Individuals with severe obesity often present with binge eating disorder (BED), night eatingsyndrome, and frequent snacking or grazing, although there is some discussion concerning theprevalence of these conditions. 39,40,53-55,57,58,73 Although an individual with obesity may not meet strictcriteria for the diagnosis of an eating disorder, similar characteristics exist, including dissatisfactionwith the body image or negative body view, frequent dieting, and experiences of failure related toeating restraint. 39,40,54,55,57,58 The presence of BED is associated with increased symptoms ofdepression and the prevalence of mood, anxiety, personality, and substance-use disorders. 39,40,53-55,57,58Bariatric treatments for adult obesity – March 2012 7