Image source: Dr. Muffazal Lakdawala
The recent death of the world’s heaviest woman highlights the health problems faced by obese people even when they’re losing significant weight.
Eman Ahmed Abd El Aty, 37, died on September 25 at a hospital in the United Arab Emirates from heart and kidney failure, among several complications related to her weight.
Abd El Aty had a thyroid problem and a genetic disorder that led her weight to skyrocket to 1,100 pounds.
In addition to having a stroke, her health issues included type 2 diabetes, hypertension, severe obstructive and restrictive lung disease, gout, sleep apnea, severe depression, and pressure sores.
Abd El Aty was being treated by doctors from three countries. She lost 550 pounds after a laparoscopic sleeve gastrectomy was performed earlier this year.
By late April 2017, her weight was down to 389 pounds.
But it wasn’t enough to save her life.
“One of the problems for people who are that heavy is that they can get down to a lower weight but still be morbidly obese,” Dr. Peter LePort, medical director of the MemorialCare Center for Obesity at Orange Coast Memorial Medical Center in California, explained to Healthline. “So, your comorbid health conditions can get better, but they don’t usually go away completely unless you get down to about 50 pounds over your normal body weight.”
‘It’s not a miracle’
Accomplishing significant weight loss usually requires adherence to a post-surgery diet and exercise plan, said LePort, who performs LAP-BAND, gastric bypass, and sleeve gastrectomy surgery for weight loss.
“I always tell my patients, ‘This is not a miracle.’ We’re doing the surgery, but unless you follow the plan we give you, it will work for a while, but eventually it will fail.”
Still, even losing 5 to 10 percent of your body weight can ease metabolic-related problems, said Dr. Wendy Scinta, president of the Obesity Medicine Association.
She told Healthline the benefits can occur even if “mass related” health issues such as heart disease, sleep apnea, and joint problems persist.
The five-year success rate of weight loss surgery is about 60 percent — far better than the 1 to 2 percent of severely obese people who are able to get down to a healthy weight through behavioral changes alone.
However, that also means 40 percent of surgeries ultimately fail, typically because patients continue to eat excessively. This forces their stomach to regain its previous size.
Other options for addressing obesity include the Obalon balloon, which is filled with gas and occupies space in the stomach, and vBloc, a pacemaker-like device that’s surgically implanted and blocks the vagus nerve, which triggers hunger.
Medication can also be effective. Examples include hunger-suppressing phentermine (Adipex-P), liraglutide (Saxenda) to make people feel fuller, and lorcaserin (Belviq), another drug that increases feelings of satiety. While topiramate (Topamax) is approved to treat migraines, it may also be prescribed off-label to control binge eating.
Related health problems
Abd El Aty’s weight may have been exceptionally high, but experts say that the health problems she experienced were commonplace for individuals who are severely obese.
That’s defined as people with a body mass index (BMI) greater than 40, or who are 100 pounds or more over their ideal body weight.
Studies show that death rates for heart disease, stroke, and other vascular diseases rise 40 percent for every five-point increase in BMI.
In addition, life span is shortened two to four years for people with a BMI of 30 to 35, and by 8 to 10 years when BMI is between 40 and 50.
Co-occurring illnesses are added right into another definition of severe obesity, which is having a BMI of 35 or more plus a serious illness such as diabetes or hypertension.
Likewise, treatment options also can be driven by the presence of co-occurring illnesses.
Surgery is recommended for severely obese patients who haven’t been able to lose weight through diet, exercise, and drug therapy.
It’s also advised for those who have obesity-related comorbidities, Dr. Runjhun Misra, DO, an internal medicine specialist in California, told Healthline.
Sarah Bramblette, who blogs at Born2lbFat about her experience with lipedema, a condition that causes excessive fat deposits in the legs, as well as with lymphedema, a buildup of lymphatic fluid under the skin, has seen her weight fall from 502 pounds to as low as 250 pounds after gastric bypass surgery.
“I know carrying excess weight is hard on my body,” she said.
Treatment isn’t easy
Even when obese patients are motivated to make lifestyle changes, unexpected obstacles can arise.
These range from overcoming stigma in the doctor’s office to difficulty getting a stress test because their weight exceeds the limit of the treadmill used in the evaluation.
“Sometimes you can’t even get diagnosed and treated because of your weight,” Bramblette said.
Overweight people shouldn’t be made to feel embarrassed or ashamed about how they look, said Scinta.
“It’s OK to accept how you look on the outside, but you still have to be concerned about what’s happening on the inside,” she said.
A combination of training and reimbursement concerns often leads primary care physicians to treat comorbid conditions rather than the excessive weight that causes them, said Scinta, formerly a primary care doctor herself.
However, a lot of medications used to treat hypertension, diabetes, and depression can also cause weight gain.
“We’re fighting the battle but losing the war,” Scinta said.
She advises doctors to instead get obese patients on a diet and exercise plan supported by weight loss medication, which she called “highly effective.”
LePort said that more patients are motivated by concerns over health problems like heart disease than unhappiness with their physical appearance.
In that regard, surgery can yield impressive results.
Up to 70 percent of comorbid conditions like diabetes and high blood pressure will resolve themselves once the weight comes off, said LePort.
In some cases, patients simply are predisposed to these conditions regardless of their weight, LePort noted.
“The goal is to get them off medication completely, but if they have to stay on, then to have a very reduced amount,” he said.
Medicare will pay for weight loss surgery for people with severe obesity, said Bramblette, but the federal health program will not pay for surgery for people with a BMI under 35.
“It should be offered to patients sooner,” she told Healthline.
However, LePort cautions that surgery carries risks, sometimes fatal ones, that should be weighed against the benefits to a patient who may only need to lose 25 to 40 pounds to get down to a healthy weight.
“We should try to get them to diet and exercise first,” he said.