Comorbidities for weight loss surgery

Written on April 14, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• Obesity and BMI
• Losing weight
• Weight loss surgery
• Obesity comorbidities for weight loss surgery
• Criteria for weight loss surgery: BMI and comorbidities
• Weight loss via Everlywell
• Related content

Many people don’t get enough exercise or eat healthy foods in the United States [1]. It’s not a surprise that up to approximately 42% of Americans are obese [2]. The extra body weight contributes to numerous medical health conditions, with obesity-related medical expenses costing nearly $175 billion in 2019.

Obesity and BMI

Obesity is a chronic condition where an individual’s weight is higher than normal or what is considered healthy based on their height [3]. The Centers for Disease Control and Prevention considers being overweight as having a body mass index (BMI) between 25 kg/m^2 and 30 kg/m^2 and defines obesity as a BMI of 30 kg/m^2 or higher. Obesity is further subdivided into three classes. Class 1 is a BMI of 30 kg/m^2 to less than 35 kg/m^2. Individuals in class 2 have a BMI of 35 kg/m^2 to less than 40 kg/m^2. Severe obesity is class 3, and this is defined as a BMI of 40 kg/m^2 or higher.

Losing weight

Weight loss is difficult but can have a lot of advantages when achieved. A weight loss of 5% to 10% of total body weight can lead to beneficial improvements with obesity and its associated comorbidities [4]. Lifestyle changes including a healthy diet, regular exercise, and stress management can all contribute to losing weight. Here are five steps to consider with your healthcare provider to help you manage your obesity and lose weight [5]:

1. Recognize obesity as a chronic condition that warrants treatment.
2. Assess and identify causes, comorbidities, and barriers to obesity treatment.
3. Evaluate and discuss obesity treatment options and adjunctive therapies.
4. Establish goals of obesity therapy focusing on the value and improvement of the interventions.
5. Engage healthcare providers for continued follow-up and reassessments to improve care.

Weight loss surgery

Weight loss surgery, also called bariatric surgery, is a therapeutic option that can serve as part of the overall management plan for obesity [5,6]. Types of weight loss surgery include gastric bypass, sleeve gastrectomy, gastric band, and duodenal switch [6]. Healthcare providers may recommend weight loss surgery for obesity treatment if other weight loss approaches have failed and the benefits of the surgery outweigh the risks [6]. Potential side effects associated with weight loss surgery include malabsorption and malnutrition, bile reflux, gallstones, and dumping syndrome (a collection of symptoms such as nausea, diarrhea, abdominal cramping, and hypoglycemia occurring when the stomach dumps food too fast into the small intestines) [6]. Bariatric surgery can help you lose weight, normalize your metabolism, and improve blood pressure, glucose levels, and cholesterol.

Obesity comorbidities for weight loss surgery

Obesity is associated with many prolonged diseases that pose health risks that can be improved with weight loss surgery [5-7]. Conditions that are commonly considered significant comorbidities for weight loss surgery include [5-7]:

• Type 2 diabetes or hyperglycemia: elevated blood sugar can increase insulin resistance and contribute to damaging nerves, blood vessels, and organs. Each 1-point increase in BMI accounts for around a 20% increase in risk for developing type 2 diabetes.
• Dyslipidemia: high cholesterol or lipid levels can block your blood vessels and put you at risk for stroke and heart attack.
• Hypertension: increased blood pressure can wear down the blood vessel walls and pose a higher risk for heart disease.
• Non-alcoholic fatty liver disease (NAFLD): NAFLD deposits excess fat in the liver and, in the long-term, damages the liver.
• Metabolic syndrome: a constellation of risk factors involving increased heart disease, insulin resistance, and obesity is a major comorbidity for weight loss surgery.

Additional comorbid conditions are obstructive sleep apnea, GERD, asthma, venous stasis disease, severe urinary incontinence, and osteoarthritis [5,7].

Criteria for weight loss surgery: BMI and comorbidities

Weight loss surgery recommendations for obesity management are based on body mass index and the presence of various comorbidities [5,7]. You may qualify for weight loss surgery if you fit one of the following criteria [5,7]:

• BMI of 40 kg/m^2 or more without any coexisting medical conditions
• BMI greater than or equal to 35 kg/m^2 and one or more comorbidities
• BMI of 30 to 34.9 kg/m^2 with diabetes or metabolic syndrome

Weight loss via Everlywell

Weight loss surgery is a therapeutic option for obesity with various benefits. However, you and your healthcare provider must consider your comorbid diseases, BMI, and other risks to determine if surgery is the best choice for you.

As for starting other treatment options for weight loss, consulting with a healthcare provider is essential. If you are concerned with your weight and would like to speak with a healthcare provider about your health goals, consider online weight loss telehealth via Everlywell. You can get monthly support from a certified clinician to optimize your care plan.

Related content

What is comorbidity?

Is hypothyroidism a comorbidity for weight loss surgery?

What is a weight-related comorbidity?

References

1. Overweight and Obesity: Why it matters. Centers for Disease Control and Prevention. URL. Published July 14, 2022. Accessed April 11, 2023.
2. Adult obesity facts. Centers for Disease Control and Prevention. URL. Published May 17, 2022. Accessed April 11, 2023.
3. Defining adult overweight & obesity. Centers for Disease Control and Prevention. URL. Published June 3, 2022. Accessed April 11, 2023.
4. Losing weight. Centers for Disease Control and Prevention. URL. Published September 19, 2022. Accessed April 11, 2023.
5. Wharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, Adamo K, Alberga A, Bell R, Boulé N, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875-E891. doi: 10.1503/cmaj.191707. URL.
6. Bariatric (weight loss) surgery: Types & requirements.Cleveland Clinic. URL. Accessed April 11, 2023. URL.
7. Stahl JM, Malhotra S. Obesity surgery indications and contraindications. 2022. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. URL.