Medical Complications Resulting from Severe Obesity
Obesity impacts every aspect of life and diminishes virtually all measures of health, from the ability to engage in meaningful work and relationships to cardiorespiratory function, memory, and fertility. Obesity increases the risk of several debilitating,
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Medical Complications Resulting from Severe Obesity Patti Kastanias, Karyn Mackenzie, Sandra Robinson, and Wei Wang
Obesity impacts every aspect of life and diminishes virtually all measures of health, from the ability to engage in meaningful work and relationships to cardiorespiratory function, memory, and fertility. Obesity increases the risk of several debilitating, and potentially fatal, diseases, including diabetes, cardiovascular disease, and some cancers (see Fig. 5.1 for medical conditions associated with obesity). It has been estimated one in ten premature deaths for Canadian adults aged 20–64 is directly caused by obesity [2, 3]. However, it can be difficult to accurately estimate this number because obesity is very closely related to many other potentially fatal diseases [3, 4]. It is anticipated that mortality rates associated with obesity will continue to increase in the coming years [5]. We are still learning how and why visceral obesity, excess intra-abdominal adipose tissue accumulation typically measured by waist circumference, leads to increased morbidity and
P. Kastanias, M.Sc.(A.), N.P. (*) K. Mackenzie, M.N., N.P. • S. Robinson, M.N., N.P. W. Wang, M.N., N.P. Toronto Western Hospital Bariatric Surgery Program, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 e-mail: [email protected]; [email protected]
mortality. Visceral obesity is associated with a chronic, low-grade inflammatory state and the pro-inflammatory theory has been proposed as a critical step contributing to the emergence of many of the pathologic features associated with obesity. This includes insulin resistance—a key component of metabolic syndrome (see Table 5.1 for diagnostic criteria). Other components of metabolic syndrome include elevated waist circumference, hypertension, hyperglycemia, and dyslipidemia. This cluster of symptoms is associated with increased prevalence of obesity and risk for diabetes and cardiovascular disease (CVD) [7, 8]. Adipose tissue is now recognized as an endocrine organ that secretes various immunomodulatory and inflammatory markers such as adipokines, cytokines, and hormones [9–12], which are involved in the pathogenesis of many medical complications resulting from severe obesity. This chapter will give an overview of the vast array of health conditions caused by obesity in a review of systems framework. This overview will be followed by two case studies highlighting typical patient presentations in the primary care setting with workup suggestions. The goal of this chapter will be to provide health professionals with a summary of relevant medical conditions that should be considered in the management of obesity and comorbid mental illness.
© Springer International Publishing AG 2017 S. Sockalingam, R. Hawa (eds.), Psychiatric Care in Severe Obesity, DOI 10.1007/978-3-319-42536-8_5
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Neurological
Psychological
• Headache • Stroke • Dementia, including Alzheimer’s • Vision loss from diabetes complications • Pseudotumor cerebri (
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