Disease Severity and Staging of Obesity: a Rational Approach to Patient Selection

Current Atherosclerosis Reports

Volumn 16, Issue 11, 2014, Pages

  Whyte, M B ^a   Velusamy, S ^b   Aylwin, S J B ^b  

^a UNIVERSITY OF SURREY   (United Kingdom)

^b KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST   (United Kingdom)

Author keywords

Bariatric; Obesity; Staging; Surgery

Indexed keywords

ABDOMINAL PRESSURE; AIRWAY OBSTRUCTION; BARIATRIC SURGERY; BODY IMAGE; BODY MASS; CARDIOMYOPATHY; CARDIOVASCULAR MORTALITY; CARDIOVASCULAR RISK; COMORBIDITY; DIABETES MELLITUS; DISEASE ASSOCIATION; DISEASE CLASSIFICATION; DISEASE SEVERITY; GASTROESOPHAGEAL REFLUX; HUMAN; INTRACRANIAL HYPERTENSION; INTRAUTERINE GROWTH RETARDATION; KIDNEY DYSFUNCTION; NONALCOHOLIC FATTY LIVER; OBESITY; OBESITY HYPOVENTILATION SYNDROME; OVARY POLYCYSTIC DISEASE; PATIENT SELECTION; PREVALENCE; PRODUCTIVITY; QUALITY OF LIFE; REVIEW; SLEEP DISORDERED BREATHING; SMALL FOR DATE INFANT; SOCIAL INTERACTION; SOCIAL STATUS; TREATMENT INDICATION; TREATMENT OUTCOME; URINE INCONTINENCE; WAIST CIRCUMFERENCE; COMPLICATION; COST BENEFIT ANALYSIS; ECONOMICS; PROCEDURES; TIME;

BARIATRIC SURGERY; COST-BENEFIT ANALYSIS; HUMANS; OBESITY; PATIENT SELECTION; PREVALENCE; TIME FACTORS;

EID: 84910602157     PISSN: 15233804     EISSN: 15346242     Source Type: Journal    
DOI: 10.1007/s11883-014-0456-7     Document Type: Review

References (72)

1. Eastwood P. Statistics on obesity. England: Physical Activity and Diet; 2013.
2. Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care. 2010;33(9):1933–9.
3. Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr. 2000;72(3):694–701.
4. Krakauer NY, Krakauer JC. A new body shape index predicts mortality hazard independently of body mass index. PLoS One. 2012;7(7):e39504.
5. Guerrero-Romero F, Rodriguez-Moran M. Abdominal volume index. An anthropometry-based index for estimation of obesity is strongly related to impaired glucose tolerance and type 2 diabetes mellitus. Arch Med Res. 2003;34(5):428–32.
6. Ciudin A, Salvador R, Budoy A, Ciudin A, Spinu C, Diaconu MG, et al. Measurement of waist circumference for retrospective studies—prospective validation of use of CT images to assess abdominal circumference. Endocrinol Nutr: Organo Soc Esp Endocrinol Nutr. 2014;61(3):147–52.
7. Visscher TL, Seidell JC, Molarius A, van der Kuip D, Hofman A, Witteman JC. A comparison of body mass index, waist-hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study. Int J Obes Relat Metab Disord: J Int Assoc Study Obes. 2001;25(11):1730–5.
8. Onat A, Hergenc G, Yuksel H, Can G, Ayhan E, Kaya Z, et al. Neck circumference as a measure of central obesity: associations with metabolic syndrome and obstructive sleep apnea syndrome beyond waist circumference. Clin Nutr. 2009;28(1):46–51.
9. Carey VJ, Walters EE, Colditz GA, Solomon CG, Willett WC, Rosner BA, et al. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. Nurses’ Health Study Am J Epidemiol. 1997;145(7):614–9.
10. Yang L, Samarasinghe YP, Kane P, Amiel SA, Aylwin SJ. Visceral adiposity is closely correlated with neck circumference and represents a significant indicator of insulin resistance in WHO grade III obesity. Clin Endocrinol. 2010;73(2):197–200.
11. Gruberg L, Weissman NJ, Waksman R, Fuchs S, Deible R, Pinnow EE, et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol. 2002;39(4):578–84.
12. Kalantar-Zadeh K, Streja E, Kovesdy CP, Oreopoulos A, Noori N, Jing J, et al. The obesity paradox and mortality associated with surrogates of body size and muscle mass in patients receiving hemodialysis. Mayo Clin Proc. 2010;85(11):991–1001.
13. Curtis JP, Selter JG, Wang Y, Rathore SS, Jovin IS, Jadbabaie F, et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med. 2005;165(1):55–61.
14. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.
15. Jakobsen GS, Hofso D, Roislien J, Sandbu R, Hjelmesaeth J. Morbidly obese patients—who undergoes bariatric surgery? Obes Surg. 2010;20(8):1142–8.
16. Romeo S, Maglio C, Burza MA, Pirazzi C, Sjoholm K, Jacobson P, et al. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care. 2012;35(12):2613–7.
17. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685–96.
18. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21 Suppl 1:S1–27.
19. Aylwin S, Al-Zaman Y. Emerging concepts in the medical and surgical treatment of obesity. Front Horm Res. 2008;36:229–59.
20. Aasheim ET, Aylwin SJB, Radhakrishnan ST, Sood AS, Jovanovic A, Olbers T, et al. Assessment of obesity beyond body mass index to determine benefit of treatment. Clin Obes. 2011;1(2–3):77–84. This paper showed how individual health domains improved after bariatric surgery and provides a rationale for use of staging criteria in selecting patients for bariatric surgery.
21. Kuk JL, Ardern CI, Church TS, Sharma AM, Padwal R, Sui X, et al. Edmonton Obesity Staging System: association with weight history and mortality risk. Appl Physiol Nutr Metab = Physiol Appliquee, Nutr Metab. 2011;36(4):570–6. Demonstrated how a scoring system could improve upon the BMI as a mortality predictor.
22. Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A. Sleep apnea and sleep disruption in obese patients. Arch Intern Med. 1994;154(15):1705–11.
23. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA:J Am Med Assoc. 2003;290(14):1906–14.
24. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J. 2004;25(9):735–41.
25. Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. Epworth Sleepiness Scale Chest. 1993;103(1):30–6.
26. Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. J Can Anesth. 2010;57(5):423–38.
27. Dixon JB, Schachter LM, O’Brien PE. Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Chest. 2003;123(4):1134–41.
28. AARC-APT (American Association of Respiratory Care-Association of Polysomnography Technologists). Clinical practice guideline. Polysomnography Respir Care. 1995;40(12):1336–43.
29. Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Cote CJ, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2006;104(5):1081–93. quiz 117-8.
30. Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med. 2009;122(6):535–42.
31. Bogers RP, Bemelmans WJ, Hoogenveen RT, Boshuizen HC, Woodward M, Knekt P, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Arch Intern Med. 2007;167(16):1720–8.
32. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67(5):968–77.
33. Prospective Studies C, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96.
34. Williamson DF, Thompson TJ, Thun M, Flanders D, Pamuk E, Byers T. Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes care. 2000;23(10):1499–504.
35. Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321(4):225–36.
36. Sasson Z, Rasooly Y, Bhesania T, Rasooly I. Insulin resistance is an important determinant of left ventricular mass in the obese. Circulation. 1993;88(4 Pt 1):1431–6.
37. McCloskey CA, Ramani GV, Mathier MA, Schauer PR, Eid GM, Mattar SG, et al. Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2007;3(5):503–7.
38. Miranda WR, Batsis JA, Sarr MG, Collazo-Clavell ML, Clark MM, Somers VK, et al. Impact of bariatric surgery on quality of life, functional capacity, and symptoms in patients with heart failure. Obes Surg. 2013;23(7):1011–5.
39. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.
40. Sjostrom L, Peltonen M, Jacobson P, Sjostrom CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65. The Swedish Obesity Study is a landmark trial of outcomes after bariatric surgery. This paper highlights the cardiovascular benefit of bariatric surgery.
41. Kwok CS, Pradhan A, Khan MA, Anderson SG, Keavney BD, Myint PK, et al. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol. 2014;173(1):20–8.
42. Look ARG, Wadden TA, West DS, Delahanty L, Jakicic J, Rejeski J, et al. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity. 2006;14(5):737–52.
43. Buse JB, Caprio S, Cefalu WT, Ceriello A, Del Prato S, Inzucchi SE, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.
44. Brethauer SA, Aminian A, Romero-Talamas H, Batayyah E, Mackey J, Kennedy L, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–36. discussion 36-7.
45. Carlsson LM, Peltonen M, Ahlin S, Anveden A, Bouchard C, Carlsson B, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367(8):695–704. Showed that surgery is more effective at preventing the onset of type 2 diabetes than conventional therapy.
46. Ogden J, Clementi C, Aylwin S, Patel A. Exploring the impact of obesity surgery on patients’ health status: a quantitative and qualitative study. Obes Surg. 2005;15(2):266–72.
47. Brunner EJ, Marmot MG, Nanchahal K, Shipley MJ, Stansfeld SA, Juneja M, et al. Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study. Diabetologia. 1997;40(11):1341–9.
48. Karlsson J, Taft C, Ryden A, Sjostrom L, Sullivan M. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31(8):1248–61.
49. Turchiano M, Saunders JK, Fernandez G, Navie L, Labrador L, Parikh M. Bariatric surgery may improve employment status in unemployed, underserved, severely obese patients. Obes Surg. 2014;24(5):692–5.
50. Nicolai A, Ippoliti C, Petrelli MD. Laparoscopic adjustable gastric banding: essential role of psychological support. Obes Surg. 2002;12(6):857–63.
51. Pasquali R, Patton L, Gambineri A. Obesity and infertility. Curr Opin Endocrinol Diabetes Obes. 2007;14(6):482–7.
52. Hakonsen LB, Thulstrup AM, Aggerholm AS, Olsen J, Bonde JP, Andersen CY, et al. Does weight loss improve semen quality and reproductive hormones? Results from a cohort of severely obese men. Reprod Health. 2011;8:24.
53. Lashen H, Fear K, Sturdee DW. Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case-control study. Hum Reprod. 2004;19(7):1644–6.
54. Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod. 1998;13(6):1502–5.
55. Teitelman M, Grotegut CA, Williams NN, Lewis JD. The impact of bariatric surgery on menstrual patterns. Obes Surg. 2006;16(11):1457–63.
56. Weintraub AY, Levy A, Levi I, Mazor M, Wiznitzer A, Sheiner E. Effect of bariatric surgery on pregnancy outcome. Int J Gynaecol Obstet:Off Organ Int Fed Gynaecol Obstet. 2008;103(3):246–51.
57. Dalfra MG, Busetto L, Chilelli NC, Lapolla A. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies. J Matern-fetal Neonatal Med: Off J Eur Assoc Perinatal Med, Fed Asia Oceania Perinatal Soc Int Soc Perinatal Obstet. 2012;25(9):1537–43.
58. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43.
59. Sugerman HJ. Effects of increased intra-abdominal pressure in severe obesity. Surg Clin North Am. 2001;81(5):1063–75.
60. Vella VL, Jaffe W, Lidicker J, Meilahn J, Dandolu V. Prevalence of urinary symptoms in morbidly obese women and changes after bariatric surgery. J Reprod Med. 2009;54(10):597–602.
61. Clements RH, Gonzalez QH, Foster A, Richards WO, McDowell J, Bondora A, et al. Gastrointestinal symptoms are more intense in morbidly obese patients and are improved with laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13(4):610–4.
62. Sugerman HJ, Felton 3rd WL, Sismanis A, Kellum JM, DeMaria EJ, Sugerman EL. Gastric surgery for pseudotumor cerebri associated with severe obesity. Ann Surg. 1999;229(5):634–40. discussion 40-2.
63. Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyren O. Obesity and risk for chronic renal failure. J Am Soc Nephrol: JASN. 2006;17(6):1695–702.
64. Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. Predictors of new-onset kidney disease in a community-based population. JAMA: J Am Med Assoc. 2004;291(7):844–50.
65. Bayliss G, Weinrauch LA, D’Elia JA. Pathophysiology of obesity-related renal dysfunction contributes to diabetic nephropathy. Curr Diabetes Rep. 2012;12(4):440–6.
66. Carlsson LM, Romeo S, Jacobson P, Burza MA, Maglio C, Sjoholm K, et al. The incidence of albuminuria after bariatric surgery and usual care in Swedish obese subjects (SOS): a prospective controlled intervention trial. International Journal of Obesity. 2014.
67. Hou CC, Shyu RS, Lee WJ, Ser KH, Lee YC, Chen SC. Improved renal function 12 months after bariatric surgery. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2013;9(2):202–6.
68. Fabbrini E, Magkos F, Mohammed BS, Pietka T, Abumrad NA, Patterson BW, et al. Intrahepatic fat, not visceral fat, is linked with metabolic complications of obesity. Proc Natl Acad Sci U S A. 2009;106(36):15430–5.
69. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346(16):1221–31.
70. Kozakova M, Palombo C, Eng MP, Dekker J, Flyvbjerg A, Mitrakou A, et al. Fatty liver index, gamma-glutamyltransferase, and early carotid plaques. Hepatology. 2012;55(5):1406–15.
71. Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol: Off Clin Pract J Am Gastroenterol Assoc. 2008;6(12):1396–402.
72. Padwal RS, Pajewski NM, Allison DB, Sharma AM. Using the Edmonton Obesity Staging System to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ: Can Med Assoc J = J’Assoc Med Canad. 2011;183(14):E1059–66. This paper showed that the presence of a severe complication affects survival in all grades of obesity. This highlights the importance of obesity staging.