An Epidemic of Excess

By Dr Feras Hamati, Anesthesiologist  

Unfortunately, the prevalence of obesity continues to increase worldwide, including Jordan. As a result, all health care, including my line of work in anesthesiology, is impacted. Did you know that being overweight or obese is the fifth leading risk for deaths globally?

Obesity puts us at increased risk of getting serious health problems, such as hypertension, diabetes, sleep apnea (characterised by snoring, a pause in breathing for 10 to 15 seconds while sleeping and morning headaches), heart disease, reflux disease.

What if a patient who’s obese is having surgery?

Preparing a patient who’s obese for surgery is different than prepares others who aren’t obese. The anaesthetist usually estimates the risk associated with the surgery and this is related to the duration and type of surgery, type of anaesthesia (whether general anaesthesia or local) and the patient’s BMI (see sidebar) and health status.

Usually, patients with BMI over 35 undergo thorough preparation and are assessed by a multidisciplinary team, which may include endocrinologists, dieticians, psychologists, specialist nurses and experienced surgeons and anaesthetists.

As an anaesthetist, I am concerned mainly about lung function and heart status, especially in long-standing obesity cases. In such cases, I prefer local or regional anaesthesia over general anaesthesia. Anaesthetising obese patients requires different size and number of equipment, drug dosage and special operating tables.

Patients who are obese face more complications after surgery which are mainly breathing problems and difficulty, low oxygen levels, nausea and vomiting and longer recovery period.

Tackling the disease

The first step is always lifestyle modification by doing more intensive and regular exercises and starting on a stringent diet. Unfortunately, people quite often cannot maintain weight loss, which has increasingly led doctor to offer bariatric surgery increasingly as a solution.

Bariatric procedures may achieve a weight loss of more than 50 per cent of excess weight. It is relatively safe and can provide long-term sustained weight loss with significant improvement in quality of life.

Usually, obese patients offered bariatric surgery have:

  •   BMI of 40 or more
  •   BMI between 35- 40 along with significant other diseases like type 2 diabetes or high blood pressure
  •   Tried all appropriate non-surgical methods but have not achieved or maintained adequate weight loss

Orlistat and sibutramine are the only two drugs that can be recommended for long-term use to achieve and maintain weight loss.

Visit Worldobesity.org for resources on reducing, preventing and treating obesity

Defining obesity

Obesity is the abnormal or excessive fat accumulation that presents a risk to health and by Body Mass Index (BMI) or by fat distribution via the waist-hip ratio. The causes of obesity are multifactorial and include genetic, environmental, hormonal components and increased calorie consumption.

Jordan’s increasing struggle with obesity

Around 1.6 million adults in Jordan aged 18 years and older are overweight in 2016,  according to the UN’s State of Food Security and Nutrition in the World 2019 report. Saudi Arabia, Syria, the UAE and Yemen have obesity numbers higher than Jordan while Kuwait, Lebanon, Oman and Qatar have fewer people struggling with obesity.