Terms and definitions
Adipositas
Lat. adeps = fat
Obesity (fat addiction, corpulence), obesitas gynoide A., android A.
Anorexia
(Anorexia nervosa, mentalis). Psychogenic eating disorder with fear of being overweight, disturbed body image, denial. Prevalent ages 10 – 25yrs. Prevalence: 1% of all females, 0.08% of all males. Causes cachexia (extreme weight-loss), mortality 10% (see also Eating Disorders).,
Antiadipositum
Drug used for weight-reduction
Band occlusion
Congestion of the gastrostoma (pouch passage) by food (e.g. meat chunks). Result is a total halt of passage of food or fluid. This is an emergency situation requiring that the gastric band be completely opened within 6 hours and further treatment.
Bariatric surgery
(Greek Baros = weight, iatros = physician). Surgical treatment of adiposity
See also chapter 4 - Surgical therapy,
Body Cell Mass (BCM)
See also (Body composition)
Concomitant diseases
See also Secondary disease, comorbidity
Binge-eating
see Eating disorders
Bioelectrical Impedance Analysis (BIA)
Used to calculate body composition (water, fat tissue, cell mass) and basal metabolic rate. By using a relatively simple device, the electrical resistance (body cell mass = good conductor, fat tissue = bad conductor) and capacitive resistance (created at the cell membranes of the cell mass) is measured and used to calculate impedance. Further calculations are made using empirically developed algorithms.
Based on the basal metabolic rate determined and body composition, deficiencies like catabolism can be documented, which is important during progress of weight loss. When reducing bodyweight, fat tissue should be reduced, not actual muscle mass. Thus the bioelectrical impedance analysis is especially suitable for monitoring the progress of morbidly obese patients after surgical treatment. Aside from the clinical application (e.g. IC stations) such devices are increasingly being used when training athletes, but also in common fitness centers.
BMI = Body Mass Index
BMI is defined as the nowadays common formula to express weight in relation to body height. Invented by the Belgian Lambert Adolphe Jaques Quetelet 1796 – 1874.
- Body weight in kg divided by body height squared (m) = kg/m² or = weight in kg: height (m)²
| BMI kg/m2 | ||||
|---|---|---|---|---|
| Normal weight* | Females: Males: |
22 24 |
||
| - | 18.5-24.9 | |||
| Obese* | 25-29.9 | |||
| Adiposity level I* | 30-34.9 | |||
| Adiposity level II* | 35-39.9 | |||
| Adiposity level III* Morbid adiposity |
> 40 | |||
| Super - Obesity | > 50 | |||
| * WHO Expert Panel "Physical Status: The Use and Interpretation of Anthropometry," 1995 Classifications valid for adults only | ||||
| Tab.1: BMI (kg/m2) Weight definitions | ||||
Broca number
Normal weight using the Broca method (Paul Broca, 1824 – 1880). It is calculated in Kg by subtracting 100 from the subject’s height in centimeters, i.e. for a height of 170 cm the normal body weight should be 70 kg. It is a very rough measurement and too simple as men, short people and older people are evaluated too severely and women, tall people and younger people too leniently. The formula cannot be used for children at all. Today the BMI (Body Mass Index) is used internationally (see Ideal weight and normal weight).
Bulimia
See also Eating disorders
Surgical treatment
see also Bariatric surgery
Compliance
Active participation of the patient, cooperation
Diet
(Greek: diatia)
Energy content of nutritional components
| Fat | 9.3 kcal/g |
| Sugar (glucose) | 4.5 kcal/g |
| Proteins | 4 kcal/g |
| Tab.2: Energy content | |
Eating disorders
There is a difference between eating incorrectly (eating too fast, eating excessively large portions, too much fat, etc.) and actual eating disorders, which are psychogenically related dysfunctions of eating behavior (30 – 40% of all obese people).
- Binge-eating
Uncontrolled ravenous eating attacks or compulsive eating where anything edible within reach is devoured (e.g. "wiping out the fridge") - Bulimia
Same as binge-eating except that after "eating-attacks" deliberate vomiting is induced; often seen in combination with anorexia, thus patients are usually very thin. - Night-eating
Ravenous eating attacks at night in which the patient will get up at night to eat, often with subsequent diminished daytime appetite. - Stress eating
Increased food intake to solve personal problems/situations
Eating habits
See also Eating disorders
Excess weight
Difference between actual weight and normal weight (or ideal weight) before surgery
Excess weight loss (EWL)
Is treated as a "reference value" to measure the success of treatment as a percentage (% EWL) in international literature
Secondary diseases
Comorbidity
Gastro-intestinal bypass
Surgery to reroute passage from stomach to small bowel resulting in stomach volume reduction.
Gastroplasty
The stomach is separated into a small pouch and a remaining large main stomach; a tight connection in between obstructs passage, thus reducing food intake
Basal metabolic rate
Daily energy demand for keeping organs functional without considering physical activity (approx. 1600 kcal/d). May vary considerably between individuals. Depends on body weight (many times also on body cell mass, meaning musculature), metabolic activity, thermogenesis. Can be calculated by calorimetry A; newer method is the bioelectrical impedance analysis (see related chapter).
Horizontal gastroplasty
A constriction is created along the longitudinal axis of the stomach entrance thus creating a small pouch (compare Horizontal gastroplasty)
Feeling of hunger
Often experienced by adipose people, respectively diminished sensation of satiety; (complex control circuits: nervous, humoral controlled). Foods rich in fats carry the most energy, but in turn have the smallest impact on a feeling of satiety
Ideal weight
Corresponds to the weight associated with the lowest mortality. In adults, 18-years-old and up, the BMI should range between 18.5 to 25 kg/m². According to insurance company calculations (see related chapter), the highest life expectancy at ideal weight is achieved by maintaining weights of the Broca-value minus 10% in males, and minus 15% in females.
IFSO
International Federation for the Surgery of Obesity
Ileum
Second section of the small bowel which is split into two halves, the ileum and jejunum.
Indication
Reason for applying a therapeutic or diagnostic procedure in case of an illness:
- absolute indication : imperative reason (vital indication: in life-threatening situations)
- relative indication : conditional, alternative contraindication: counter-indication
Intestinal bypass procedure
Surgically disabling the small bowel by connecting the upper part with the much lower part positioned just above the transition to the large bowel. Thus, the surface capable of absorbing nutrients is reduced. Good results regarding weight reduction.
Many severe side-effects are known: Malnutrition, vitamin deficiencies, liver abnormalities. For these reasons, this method is seldom used now.
Incidence
Number of new patients per year
Jejunum
First segment of the small bowel See also Ileum
Yo-Yo Effect
Phenomenon occurring rather often: Upon completion of a diet, the original weight will quickly be regained or even exceeded. In radical diets with fasting or unbalanced nutrition, protein deficiency causes muscle mass to be reduced (largest protein depot). The daily caloric demand or basal metabolic rate correlates closely to the present muscle mass. If muscle mass is reduced disproportionably during a diet, the basal metabolic rate will decrease accordingly and the proband’s daily caloric demand after the diet will be extremely reduced. Accordingly, his/her fat depots will be filled rather quickly and weight will be regained. In addition, humoral (hormonal) factors affected by the diet will signal hunger to the brain more often; thus an increased sensation of hunger after ending the diet will influence eating habits accordingly.
Caloric demand
Required daily energy intake, calculated from basal metabolic rate and daily physical activity
Catabolic metabolism caused by reduction, often of muscle mass (reduction of structural proteins)
Comorbidity
see also Secondary disease, comorbidity
Conservative treatment
Reduction of excessive weight by diets (often reduction diet), behavioral therapy, psycho-therapeutic approaches, physical therapy and alternative approaches like acupuncture and hypnosis. In morbidly adipose people, these (at times) very cost-intensive therapies have not shown significant success do far.
Contraindication
See Indication
Costs
See Epidemiology and costs. In Switzerland, direct and indirect costs due to adiposity amount to 3 – 4 billion SFR per year, representing approx. 8% of total health care expenses.
Body composition
| Nominal values (% bodyweight) |
|
|---|---|
| Body fat ( BF ) | < 20 |
| Lean body mass ( LBM ): | > 80 |
| = body mass without fat | |
| = lean mass | |
| = BCM + ECM | |
| Tab.3: Two-compartment model | |
| BF ( Body Fat ) | < 20 |
| BCM ( Body cell mass ) | 40 |
| ECM ( Extracellular mass ) | 40 |
| Tab.4: Three-compartment model | |
| TBW ( Total body water ) | 100% |
| ICW ( Intracellular water ) | 60% |
| ECW (Extracellular water) | 40% |
| Tab.5: Body water (60% of body weight) | |
With adiposity, the fat content is > 20%, the body cell mass (BCM) is <40% and extracellular water is raised (>40%).
Kuzmak band
See LASGB
Laparoscopic Adjustable Silicon Gastric Banding (LASGB)
Kuzmak band, LAP-Band™
Lubomir I. Kuzmak developed this method in the US and introduced it in 1983. It was developed as an advancement in the restrictive procedures of adiposity surgeries, without the necessity of incision, clipping, and bypass procedures on the stomach and bowels. At first it was inserted using an "open" technique by way of an upper abdomen laparotomy (incision in the upper abdomen to enter the abdominal cavity), the so-called Adjustable Silicon Gastric Banding (ASGB). Since the 90’s the lap band has increasingly been implanted using laparoscopic techniques ("keyhole surgery"), which actually accounted for its breakthrough and rapidly growing worldwide popularity and application (Laparoscopic Adjustable Silicon Gastric Banding, LASGB). The LAP-Band™ is manufactured by Bio Enterics Corporation, California, USA.
A band made of silicon divides the stomach into a small preset stomach pouch and the remaining stomach while creating an adjustable pouch exit (gastronoma). The inner diameter of the band can be adjusted by filling the inner membrane. Adjustments are made by filling fluid into the infusion reservoir (chamber system, port system), which is placed on the costal arch or the abdominal wall and connected to the lap band by a flexible tube (catheter). The gastrostoma may be tightened or opened if warranted by weight-loss progress, by relatively simple percutaneous puncturing of the reservoir.
It is made of a silicon elastomer, which has proven itself in many other clinical applications. Silicon distinguishes itself through its elasticity, tissue compatibility, and durability – no degradation from bodily reactions. The body forms a coat of fibrous tissue around the material, which will then remain in the organism without triggering any bodily reactions. Only in very rare cases does this cause rejections. Until now, no incompatibility reactions caused by lap bands have been reported. The severe, but rare, side effects commonly known from breast implants should in no means be seen as being possible in lap bands. Liquid silicon was used in breast prostheses, which is capable of triggering heavy tissue reactions and is no longer in use.
Laparoscopy
Surgery performed using the "keyhole technique"
Lean Body Mass
Body mass free of fat (see Body composition)
Lethality
Mortality: every surgical therapy has a certain rate. It is determined statistically. In modern adiposity surgery the mortality rate is less than 1%.
Stomach restrictive surgery
Surgical procedure to reduce stomach volume, thus reducing meal sizes and caloric intake.
Gastric band
see horizontal gastroplasty
Malabsorptive procedures
By disabling part of the small bowel (resorptive surface) absorption of nutrients is significantly reduced.
Morbid adiposity
- Obese to the extent of its being a disease
Excessive weight (according to Broca) > 45 kg
BMI > 40 kg/m²
BMI > 35 kg/m² with secondary diseases
Recognized as a disease by the WHO (World Health Organization). Usually seen in conjunction with secondary diseases (comorbidities). There is often social isolation and discrimination to a certain extent. May aggravate or trigger psychological disorders, thus decreasing life quality and expectancy.
At a BMI >30 kg/m² the mortality rate is increased by 1/3, at 40kg/m² by a factor of 3, and at >40kg/m² by a factor of 3 -20 depending on weight. Increases cancer risk (gynecological carcinoma (endometrial carcinoma 4x, mama- and cervix-carcinoma 2x), prostate-, gallbladder-, and colon-carcinomas)
Morbidity
Prevalence of a specific disease; see also Secondary disease, comorbidity
Mortality
Rate of patients dying
Muscle mass
It is a metabolically active tissue as opposed to merely depositing fat, and thus influences the basal metabolic rate severely; With increasing muscle mass the daily turnaround at a state of rest increases disproportionally in relation to bodyweight. Muscle mass defines the main component of BCM (body cell mass); See also BIA, body cell mass
Nutritional requirements
Corresponds to the amount of energy needed to cover basal metabolic rate plus energy needed for physical activity. Components: Water, carbohydrates and fats as energy carriers; essential amino acids and fatty acids as "building materials," minerals, trace elements, vitamins (table 6)
| Proteins | 0.9 g | (60-65 g) |
| Fats | 0.9 g | (60-65 g) |
| Carbohydrates | 5g | (350g) |
| Tab.5: Daily demand per kg body weight (Example: 70kg body weight) | ||
Night-eating
See Eating disorders
Normal body weight
According to Broca: Height in cm minus 100cm = kilograms normal weight See also Broca-value
Obesitas
Lat. ob-edere = devour See also Adipositas
Orlistat
Agent developed by Roche Pharma Schweiz AG (Xenical™) used as antiadipositum. Basically it is a lipase-blocker that applies its therapeutic effect in the stomach’s lumen as well as the upper small bowel (blocking gastric and pancreatic lipase). The inactive enzymes are no longer capable of changing (hydrolyzing) fats contained in food (often in form of triglycerides) into easily absorbable free fatty acids and monoglycerides. Thus undigested fats are evacuated unused with the stool, and weight reduction is achieved. This reduction is limited to 10% of the body’s weight, thus rendering these drugs unsuitable for treatment of morbid adiposity. Those who consume opulent, fatty meals despite taking this drug, will have to face the consequences of foul-smelling fatty stools.
Pouch complications
see surgical complications
Prevalence
Number of cases of a certain disease, or frequency of a characteristic occurring at a defined time.
Restrictive procedures
see Stomach restrictive procedures
Slippage
see surgical complications
Silicone
Inert elastic material very well accepted by the body in its solid state that very rarely causes rejections. It is used for wide variety of different medical implants. See also LASGB.
Swedish Band
See Laparoscopic Adjustable Silicon Gastric Banding (LASGB), LAP-Band™. Gastric band with same functional principle as the LAP-band but somewhat wider and adjustable to a higher fill-volume (8.5ml). Swedish Adjustable Gastric Banding (SAGB) is distributed by the Swiss company: Obtech Medical AG
Stress-eating
See Eating disorder
Swiss Study Group for Morbid Obesity
Founded in Switzerland to keep the public and physicians informed regarding the disease "obesity," to establish integral therapy approaches, and to install a form of quality control for nutritional-therapeutic, psycho-therapeutic, drug-related and surgical approaches. It is supposed to help motivate patients to form self-help groups. The declared mission of the Study Group is to ease the suffering of obese people and to help reduce the costs of an increasing health problem.
Obesity
(Excess weight) Difference between actual weight and normal weight
Vertical Banded Gastroplasty = VBG
Reduction of stomach volume by using a mechanical staple suture along the longitudinal axis of the stomach entrance thus creating a small pouch with a non-adjustable exit. Stomach restrictive procedure.