How to manage obesity-related complications?

Question

Hello Doctor,

My weight has destroyed my health, and I need serious help. I am currently 378 pounds at 5'8" height (body mass index 57.5), and I am dealing with multiple severe complications.

I have type 2 diabetes mellitus, which is completely uncontrolled, with an HbA1c of 11.2 %, despite taking the following:

Insulin: 110 units daily.

Metformin: 2000 mg daily.

Ozempic injections.

My blood pressure stays around 185/105 mmHg, even though I am on four different antihypertensive medications.

I also have severe obstructive sleep apnea, requiring Bi-level Positive airway pressure (BiPAP) at maximum settings, yet I still wake up gasping for air.

My mobility is severely limited due to lymphedema in both legs and chronic venous insufficiency. My legs constantly weep fluid, requiring daily dressing changes.

Most alarming is my recent hospitalization for heart failure. My ejection fraction is 32 %, and my cardiologist stated that obesity is the primary cause of my cardiomyopathy.

I have tried countless diets over the past 20 years, including medically supervised programs, but I always regain the weight and often more. My current daily caloric intake is approximately 1800 calories, according to my food journal, but I am still not losing weight.

My endocrinologist has now referred me for bariatric surgery, but my cardiologist is concerned about the surgical risk given my poor heart function.

Here are my questions:

Am I even a candidate for surgery with such poor heart function?

Which procedure would be safest, sleeve gastrectomy or Roux-en-Y gastric bypass?

Will my diabetes and heart function improve after surgery?

How much weight might I realistically lose postoperatively?

What is the typical recovery time for someone in my condition?

I am currently unable to work due to my mobility issues and am on disability at only 46 years old. My quality of life is miserable, and I am desperate for any solution that might help.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

As you rightly pointed out, obesity presents significant systemic health risks, including

1. Cardiovascular problems,

2. Endocrine disorders such as uncontrolled type 2 diabetes mellitus, and

3. Joint issues.

Specifically, it affects your cardiovascular health by placing undue strain on your heart and contributing to uncontrolled hypertension, atherosclerotic heart disease, obesity hypoventilation syndrome, pulmonary hypertension, and cor pulmonale.

Given the wide range of health concerns associated with obesity, addressing it is of paramount importance. Bariatric surgeries have become remarkably safe, and with the advent of advanced techniques, they are highly successful procedures.

Effective management of obesity leads to significant improvements in overall health. Weight loss can reduce:

Insulin resistance results in better blood sugar control.
Blood pressure.
Blood lipid levels.
Risk of atherosclerotic heart disease progression, ischemia, consequently decreasing the likelihood of stroke, heart failure, and sudden cardiac death.
The risks associated with bariatric surgery vary depending on the specific type of surgery and the patient's overall health status.

These risks can include:

Infection.
Bleeding.
Leakages, perioperative cardiac events, and arrhythmias.
Bowel obstruction, electrolyte imbalances, gastroesophageal reflux disease (GERD), incisional hernias, and hypoglycemia.
Considering your left ventricular systolic dysfunction, the surgical risk is slightly elevated.

However, the overall risk-versus-benefit profile generally favors undergoing bariatric surgery if your physician recommends it after a comprehensive evaluation of your cardiovascular health and surgical fitness.

I suggest you do a detailed cardiac evaluation.

The choice of procedure, such as sleeve gastrectomy versus Roux-en-Y gastric bypass, should be determined collaboratively with your bariatric surgeon, cardiologist, gastroenterologist, and endocrinologist. Each type of surgery has its advantages, and all have shown promising results in improving obesity-related health conditions.

The degree of weight loss achieved post-surgery can be substantial, although individual outcomes may vary. When bariatric surgery is combined with a tailored dietary plan and medications, such as Insulin (hormone), Metformin (biguanide class antihyperglycemic agent), and Semaglutide (brand name Ozempic – glucagon-like peptide-1 [GLP-1] receptor agonist)—under the supervision of an experienced healthcare professional, the results are typically very positive.

I hope this information proves helpful to you.

Thank you.