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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Of the patients undergoing gastric bypass for treatment of morbid obesity, 75 per cent are female. A common question both pre-and postoperatively concerns the advisability of a pregnancy following surgically-induced weight loss. Of all patients, 45 became pregnant on 54 occasions following gastric bypass and 46 infants were delivered. There were two spontaneous abortions (4.0%) and six early terminations of an undesired pregnancy. Seven infants were delivered prematurely. One child was born microcephalic and has developed severe retardation in both growth and development. In contrast to reports of infants born to mothers with jejunoileal bypass, 12 of the babies that were born to mothers after gastric bypass were heavier at birth than older siblings. An additional ten infants were the first born to women who had lost more than 100 pounds following gastric bypass. All but one of the women became pregnant more than six months following surgery. This corresponds to the period of maximum weight loss and reversal of menstrual abnormalities associated with massive obesity. Pregnancies were well tolerated by the mothers, with no excessive increase in weight loss or development of metabolic deficiencies. Since the gastric bypass is modeled on the Billroth II gastrectomy, additional iron supplementation was recommended during the pregnancy. While we cannot recommend pregnancy during the period of rapid weight loss in the initial postoperative period, our data indicate that neither the mother nor the developing fetus is unduly endangered by a pregnancy which develops after the period of rapid postoperative weight loss.
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PMID:Pregnancy following gastric bypass for the treatment of morbid obesity. 711 2

This a a survey or morbid obesity in man, its causes and possibilities of conservative and surgical treatment. The different aetiological types of obesity are dealt with. Special attention is focused on the mitochondrial oxidation-process.
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PMID:[Obesity--a surgical problem?]. 713 28

In this study, dietary intervention before and after weaning was used to produce body fatness in adult rats ranging from severe obesity (61% body fat) to the lean condition (18% body fat). To produce severe obesity, rats were programmed for a high caloric intake during suckling. After weaning, they were provided unrestricted access to a diet in which approximately 40% of the calories were derived from fat (high-fat diet). The high-fat diet appeared to cause hyperphagia such that appetites were highly stimulated between 29 and 58 wk of age. Body weight in these rats stabilized at 1,213 +/- 62 g. Severe obesity was also observed in rats programmed for a low caloric intake if, after weaning, they ate the high-fat diet (59% body fat). These results provide evidence that the fat content of the diet may play a regulatory role in the development of severe obesity.
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PMID:Dietary-induced severe obesity: a rat model. 719 27

Morbid obesity, defined arbitrarily as greater than 100 percent excess weight, is only rarely the immediate or sole cause of illness or death. In addition to the Pickwickian syndrome, localized adiposity can cause obstruction and/or organ compression resulting in clinical disorders. Most of the obesity-associated risk factors interact to (a) diminish quality of life, (b) impair health, and (c) shorten survival. Severe obesity in childhood and adolescence impairs scholastic achievement and final educational levels are lower than in the nonobese. For the adult, opportunities and promotions are fewer, the quality of jobs and pay are lower. Unemployment is more common. The obese are more apt to remain single or to lose their marriage partners. Sexual adjustment and reproductive capabilities may be impaired. Regarding morbidity, the obese are "high-cost patients'. The specific and common complications or morbid obesity have been extensively examined and are the major factors causing more severe, more prolonged and more frequently recurring illness. Some obscure risk factors are related to "sudden death', to serious hazards of various medical treatment regimens, and to complication arising out of rapid or repeated regain. Excess mortality has been documented in the morbidly obese to be greatest in the younger age categories while morbidity increases with age in the surviving obese population. The dismal results of non-surgical treatment require an alternative approach. Indications for surgery in a particular patient have to be individualized. Rigid criteria are not practical, but in general, surgery is indicated and justified if the benefits expected from surgical treatment can prevent or reverse the hazards arising from unrelieved obesity. Therefore, the resulting weight losses have to be sufficient to reduce the patients to within 30 or 40 percent of desirable weight. The potential surgical complications must not equal or surpass the hazards of chronic obesity.
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PMID:Risk of obesity and surgical indications. 730 23

In a prospective study of morbid obesity at the University of Florida, 225 consecutive patients with medical complication of obesity underwent intestinal bypass during a ten-year period from 1967 to 1977. The average age was 35 years, with the average weight being 322 lb (145 kg). Oral cholecystograms were obtained preoperatively in all patients, and repeated at one and five years postoperatively. If a patient developed symptoms, ultrasonography or a cholecystogram was performed at that time. The cumulative preoperative prevalence of cholelithiasis was 30.7 percent. The 156 patients with an intact gallbladder made up the study group. These patients have been followed for an average of 36 months, and 16 have subsequently demonstrated cholelithiasis. The post intestinal bypass incidence of cholelithiasis from surgery to the time of their last oral cholecystogram was 7.2 percent per year. Analysis of variance demonstrated no significant differences between patients, with and without cholelithiasis, with respect to serum triglycerides, cholesterol, or percent weight loss. The incidence of cholelithiasis in the morbidly obese increases further with the metabolic derangements induced by jejunoileal bypass. The increased incidence of cholelithiasis after intestinal bypass, along with the other serious metabolic sequelae that follow this procedure, suggests that the continued long-term followup of these patients is mandatory.
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PMID:The incidence of cholelithiasis after jejunoileal bypass. 741 42

During the period 1979-80, 20 patients with morbid obesity underwent a gastric bypass procedure in our department. The selected patients were under 50 years old and were overweight by 45 kg or more. Previously, all the patients had unsuccessfully followed prolonged dietary regimes, some had tried dental splinting, and one had undergone three unsuccessful jejunoileal bypasses. The surgical technique used in two cases was transection of the stomach and gastrojejunostomy. In 18 cases, a gastric stapling procedure was performed. the upper gastric pouch was restricted to 5% of the entire stomach, and the gastrojejunostomy was limited to a 12-mm diameter. In the case with the failed jejunoileal bypass, dismantling of the intestinal bypass, reanastomosis, and a gastric bypass were performed in one stage. Weight loss averaged 8 kg/month for three months after the intervention, and then decreased to 2 to 4 kg/month. Laboratory studies after 6 and 12 months showed no deviation from normal. The use of the gastric bypass procedure, which does not involve metabolic complications or serious side effects, in refractory obesity results in a satisfactory long-term weight reduction, and an improvement in the quality of life.
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PMID:Gastric bypass operation in morbid obesity. 742 4

Previous studies have shown that the small-bowel shunt operation for morbid obesity may be followed by signs of enhanced cell-mediated immunity and polymorphonuclear (PMN) granulocyte bactericidal capacity. In the present study seven patients, operated 4 months--4.5 years previously and exhibiting postoperative arthralgias, arthritis, and/or skin rashes, were investigated with regard to their PMN adherence and bactericidal capacity and plasma levels of complement factors 3 and 4 (C3 and C4). There patients showed a decreased PMN bactericidal capacity compared both with 10 other shunt-operated patients without skin and joint symptoms and with healthy controls, whereas PMN adherence was lower than for the non-symptomatic patients but similar to that of the controls. Two patients had C3 levels above the reference value; all had normal C4 values. Thus, a small-bowel shunt operation for obesity, complicated by skin and joint symptoms, might be associated with decreased PMN bactericidal capacity.
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PMID:Polymorphonuclear function in patients with skin and joint symptoms after small-intestinal shunt operations. 743 90

Several new developments promise to improve the lot of the morbidly obese. Perhaps the most important of these is the gradual recognition that morbid obesity is a serious illness that is not the result of immorality or gluttony but is, in most cases, a disabling genetically determined handicap. The second advance was the agreement at the National Institutes of Health Consensus Conference, March 25-27, 1991 that medical therapies generally fail to control severe obesity and that surgery should be considered for those individuals who have a body mass index over 40 and, if the comorbidities of obesity, such as diabetes or sleep apnea, are present, to consider surgical intervention when the body mass index is greater than 35. The third development has been the improvement of bariatric surgery, ie, the surgery for morbid obesity, with better operations, better quality controls, and rigorous follow-up. This article reviews the newer concepts of morbid obesity as a disease, delineates the indications for surgery, describes the currently recommended operations, and presents the risks and benefits of these procedures.
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PMID:The surgical treatment of morbid obesity. 758 66

Patients with morbid obesity have high rates of sudden, unexpected cardiac death. The mechanism of death in these patients is uncertain. Twenty-eight patients with morbid obesity (22 sudden cardiac deaths, 6 unnatural deaths) were compared to 11 age-matched nonobese patients with traumatic deaths. Heart weight, left ventricular cavity diameter, left and right ventricular wall thickness, ventricular septal thickness, epicardial fat thickness, and extent of coronary artery atherosclerosis were determined; myocyte size, nuclear size, and degree of interstitial fibrosis were calculated morphometrically. Mean heart weights in the patients with morbid obesity were increased but remained constant as a percentage of body weight. Of the gross parameters, only heart weight and left ventricular cavity size were independent predictors of obesity. Of microscopic parameters, only nuclear area was an independent predictor of obesity. Of 22 patients with morbid obesity, dilated cardiomyopathy was the most frequent cause of sudden cardiac death in (10 patients), followed by severe coronary atherosclerosis (6), concentric left ventricular hypertrophy without left ventricular dilatation (4), pulmonary embolism (1), and hypoplastic coronary arteries (1). The cardiomyopathy of morbid obesity is characterized by cardiomegaly, left ventricular dilatation, and myocyte hypertrophy in the absence of interstitial fibrosis. It is the most common cause of sudden cardiac death in these patients.
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PMID:Sudden death as a result of heart disease in morbid obesity. 763 12

The Symptom Checklist 90-Revised (Derogatis, 1975) was administered to 37 obese adults in outpatient treatment for obesity. Individuals who had become obese during childhood showed greater interpersonal sensitivity and exhibited more psychotic symptoms than those who had become obese later in life. The findings support the belief that morbid obesity is characteristically associated with elevated levels of internal psychological conflict.
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PMID:A note on interpersonal sensitivity and psychotic symptomatology in obese adult outpatients with a history of childhood obesity. 765 Jun 31


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