Pathways to Metabolic and Bariatric Surgical Conditions

Fertility Issues

Women of child-bearing age are suffering an increasing prevalent problem of obesity-related fertility compromise.  Obesity reduces fertility for both men and women and it certainly reduces the effectiveness of therapies designed to assist in fertility.

Obesity also has a significant effect on the pregnant expectant mother, both in terms of foetal morbidity as well as maternal pregnancy complications such as hypertension and even the complexity of the subsequent delivery.

Appropriately timed metabolic bariatric interventions will improve fertility rates and reduce some of these risks of pregnancy-related complications, particularly issues relating to gestational diabetes.

Fertility Facts

• Infertility issues are three times higher in obese women
• Polycystic ovarian syndrome is both a cause of and a contributor to obesity and reduced fertility levels
• Obesity has a significantly increased risk of stillbirths
• Obesity reduces success of fertility treatments
• Obese women undergoing IVF have reduced quality oocyte and lower implantation rates due to reduced uterine receptivity
• Obesity reduces sperm count, motility and morphology
• Children born from fathers with obesity are more likely to develop obesity
• Surgery for weight loss will be sufficient to reduce PCOS, gestational diabetes and pre-eclampsia
• Obesity reduction will also reduce female cancer issues, in particular breast and endometrial cancer

 

Type 2 Diabetes

Type 2 diabetes are the most devastating metabolic effects of morbid obesity.  It is having a dramatic effect on the health system and a dramatic effect on individuals suffering the condition.  Obesity prevents insulin from being effective and it is associated with significant increase in risk of cardiovascular disease and obstructive sleep apnoea.

When diet and exercise together with best medical management are not sufficient to achieve and maintain weight loss in the setting of type 2 diabetes, then metabolic surgery is now considered standard of care.

Type 2 diabetes leads to an increased risk of

• Heart failure
• Blindness
• Kidney disease
• Amputation risk
• Significant reduction in life expectancy

 

Fatty Liver Disease

What used to be called non-alcohol fatty liver disease (NAFLD) is now being referred to metabolic-associated fatty liver disease (MAFLD).  This condition is a gradual insult to the functioning of the liver and can lead to liver failure and even liver cancer.  It is tightly associated with the evolving risk of the type 2 diabetes.  Half the people with a BMI over 30 will have fatty liver disease and 90% of people with a BMI over 45 will have fatty liver disease.

 

Sleep Disturbance and Sleep Apnoea

People living with obesity have an increased risk of sleep disturbance.  Obstructive sleep apnoea affects 40% of obese patients and significantly reduces with weight loss. Sleep-related conditions can increase the risk of workplace injuries, car accidents, stroke, coronary artery disease and heart failure.  Weight loss surgery will reduce obstructive sleep apnoea in 60-70% of people.

 

Chronic Pain and Osteoarthritis

Osteoarthritis is a condition affecting the large joints of the lower limbs, hips and knees created by mechanical wear and tear and associated inflammation.  It is exacerbated in the morbidly obese and prevents meaningful exercise.  People with a BMI over 30 have seven times the risk of knee osteoarthritis.  Significant weight loss can dramatically improve outcomes prior to joint replacement surgery and reduce the complication profile and anaesthetic risk of such a surgery.