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Understanding Obesity

Don’t Let Obesity Control You

Morbid obesity is a serious issue that can have major effects on your health. If you feel you can’t lose the weight, and that it’s affecting your daily life, the surgeons at Alabama Surgical Associates in Huntsville, AL are here to help.

Dr. Doucette and Dr. Foreman specialize in bariatric weight loss surgery. They offer several surgical weight loss solutions for to fit your specific needs. If you are interested in confronting morbid obesity with weight loss surgery, call our Huntsville, AL office at (256) 880-1977.

What is Morbid Obesity?

Morbid obesity, also called clinically severe obesity, occurs when an individual’s risk significantly increases for one or more obesity-related health conditions or serious diseases (also known as co-morbidities) that result either in significant physical disability or even death. Most bariatric surgeons define morbid obesity as being 100 lbs. or more over ideal body weight or having a Body Mass Index (BMI) of 40 or higher. Individuals with severe weight-related medical conditions and a BMI over 35 are also in this category. According to the National Institutes of Health Consensus Report, morbid obesity is a serious disease, and both doctors and patients should treat it as such. It is a chronic disease, meaning that its symptoms build slowly over an extended period.

What Causes Obesity and Morbid Obesity?

The reasons for obesity are multiple and complex, and the underlying causes of severe obesity are not known. Despite conventional wisdom, obesity is not simply a result of overeating. Research has shown that many factors contribute to the development of obesity including:


  • Genetics Numerous scientific studies, including studies of adopted children and twins, have established that your genes play a major role in your tendency to gain excess weight. Just as some genes determine eye color or height, we have others that affect our appetite, our ability to feel full, our metabolism, our fat-storing ability, and even our natural activity levels.


  • Environment Fast food, long days sitting at a desk, and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage. For those suffering from morbid obesity, anything less than a total change in environment usually results in failure to reach and maintain a healthy body weight.


  • Metabolism Obesity researchers now talk about a theory called the “set point,” a sort of thermostat in the brain that makes people resistant to either weight gain or loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you lost.


  • Eating Disorders and Medical Conditions Weight loss surgery is not a cure for eating disorders. And there are medical conditions, such as hypothyroidism, that can also cause weight gain. That’s why it’s important that you work with your doctor to make sure you do not have a condition that requires medication or counseling.


Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief. Science continues to search for answers, but until the disease is better understood, the control of excess weight is something patients must work at for their entire lives. That is why it is critical to understand that all current medical interventions, including weight loss surgery, should not be considered medical cures. Rather they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease.

Am I Morbidly Obese?

As defined by the American Society for Bariatric Surgery (ASBS), overweight individuals are classified by BMI as follows:

  • Overweight: 25 to 29
  • Obesity: 30 to 35
  • Super Obesity: 35 to 39
  • Morbid Obesity: 40 to 49
  • Super Morbid Obesity: 50 or higher

Take a look at our BMI Calculator to determine your BMI number.

In addition to the BMI classification, many bariatric surgeons also define morbid obesity as weighing 100 pounds or more above ideal body weight.

What are the Health Threats of Obesity?¹

Obesity may be harmful in many ways. Many people with morbid obesity have one or more comorbidities (diseases caused by obesity). One fifth of adults with diabetes have morbid obesity, with many other people with morbid obesity having impaired glucose tolerance (IGT). Mortality (early death) could increase when diabetes is associated with morbid obesity. Obesity also increases risk of mortality, with the life expectancy of an obese person shortened by 2 to 5 years and the life expectancy for a morbidly obese man possibly shortened by 13 years.1 People who are have morbid obesity are likely at greater risk of death from diabetes or heart attack.

Hypertension (high blood pressure)

Hypertension is one of the most common co-morbidities in the morbidly obese patient. It is a significant factor in the increased incidence of cardiovascular disease. Hyperlipidemia and hypercholesterolemia further increase this risk.

Obstructive sleep apnea syndrome

Obstructive apnea episodes occur while sleeping. These incidents cause low blood oxygen saturation levels. If left untreated, this could lead to significant lung and heart problems such as pulmonary insufficiency, pulmonary artery hypertension, and right heart failure.

Joint and back problems

Joint issues are a prevalent and painful comorbidity. These problems have been shown to significantly increase the potential for disability.

Other comorbid conditions involve the cardiovascular, endocrine, gastrointestinal, genitourinary, integument (skin), musculoskeletal, neurological, psychiatric, and respiratory systems. Obesity also increases the risk of several cancers as well. Social, psychological and economic effects of morbid obesity, however unfair, are real and can be especially devastating.2

Preparation for Weight Loss Surgery

Preparation for weight loss surgery begins with an informative bariatric symposium or private consultation. The average time from the initial consultation to surgery is 4-6 months. During this period you will have several more consultations and undergo several tests, including:

    • Complete Blood Count (CBC)

Identifies anemia, infections, and other related problems.

    • Complete Metabolic Profile (CMP)

Gives a readout of about 20 blood chemistry values.

    • Electrocardiogram


Other tests will be required depending on underlying medical conditions and age. An accurate health assessment is necessary to determine the risks of surgery. The best way to avoid complications is never to have them in the first place.

If you want to speed up your weight loss surgery preparations, here are a few things you can do:

  • Select a primary care physician – if you don’t already have one, and establish a relationship with him or her. Ensure that your routine health maintenance testing is current.
  • Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
  • Bring any pertinent medical data to your appointment with the surgeon – this would include reports of appropriate tests (echocardiogram, sleep study, etc.), operative notes, and/or hospital discharge summary if you have been in the hospital.
  • Bring a list of your medications with dose and schedule.
  • Patients are required to stop all nicotine use. Surgical patients who use tobacco products are at a higher surgical risk. Patients are required to quit smoking at least eight weeks before surgery.
  • If you have a third party payer, contact your insurance provider to inquire about the status of approval, rather than our office. Insurers will not give us the information they will only mail a response. Therefore, it is typically better for you to monitor the insurance approval process by contacting the insurance provider yourself.

If you have further questions on test or preparation, visit our weight loss surgery FAQ.

How is the Surgery Performed?

At Alabama Surgical Associates, we believe that laparoscopic surgery is the best approach to weight loss surgery. Laparoscopic surgery is a surgical procedure that uses a camera and several small instruments to conduct the surgery with minimal invasiveness. This procedure has several benefits, including:

  • shortened recovery time
  • earlier return to work
  • shorter hospital stay
  • shorter operative time
  • decreased pain and discomfort
  • reduced risk of most postoperative complications, like infections or hernias
  • earlier ambulation
  • reduced scarring*

*individual results may vary

Your surgeon will discuss the details of the procedure during your preoperative consultations. If you have had prior abdominal surgery, the laparoscopic approach is much more challenging. If you have had a vertical banded gastroplasty or other gastric bypass procedure, you may not be a candidate for laparoscopy.

You will likely not require a drain, nor should you need a blood transfusion.

If you have further questions on the surgical procedure, visit our weight loss surgery FAQ.

Recovering from Surgery

When you wake up from your surgery, nurses will be present to provide you with comfort measures, including pain and nausea management medications. You will be wearing Sequential Compression Devices (SCDs) on your legs and may have an oxygen mask over your mouth.

For an uncomplicated laparoscopic gastric bypass or vertical sleeve gastrectomy, we will hold you in the hospital overnight. 99% of patients go home the following day. Once released, you can follow the post-operative dietary guidelines provided by your doctor before your surgery.

  • Vitamin, mineral and protein supplements need to be started on post-op day 8.
  • Protein in the form of lean meats (chicken, turkey, fish) and other low-fat sources should always be eaten first.
  • Avoid junk foods and any other foods which are composed of processed sugars and can cause dumping syndrome.
  • Do not drink carbonated and/or sweetened beverages.
  • Drink 64 ounces or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.

Food and Medications

We recommend a period of six weeks or more without solid foods after surgery. A liquid diet, followed by semi-solid foods or pureed foods, is recommended for a period until adequate healing has occurred.

Initially, medications must be taken in liquid form or crushed. Most pills or capsules are small enough to pass through the new stomach pouch after healing has occurred (8 weeks). It is important to crush pills after the procedure.


Exercise is an essential component of success after surgery, and it begins the afternoon of surgery – the patient must be out of bed and walk. The goal is to walk further on every day progressively. After about two weeks patients are often released from medical restrictions and encouraged to exercise five days per week for at least 30 minutes per day.

Sexual Activity

Patients can return to regular sexual intimacy when wound healing and discomfort permit. This is typically 7-14 days. However, birth control measures are recommended for 18 months.


For your safety, you should not drive until you have stopped taking narcotic medications and your pain has resolved completely. You must be able to move quickly and alertly to stop your car, especially in an emergency. Usually, this takes about one week.

If you have further questions on recovery, visit our weight loss surgery FAQ.

How can I get insurance to cover the procedure?

Each insurance company has different processes for approval. To accelerate your approval process, gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide “necessary” information. Letters from your personal physician and consultants attesting to the “medical necessity” of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.

After your initial consultation is completed, it usually takes your doctor 1-2 days to send a letter to your insurance carrier to start the approval process. The time it takes to get an answer can vary from about 2-4 weeks or longer if you are not persistent in your follow-up. It may be helpful for you to call the claims service of your insurance company about a week after your letter is submitted and ask about the status of your request.

If your insurance company does not provide coverage for weight loss surgery, you may finance your operation through a variety of third-party services.

If you have further questions on insurance or financing, visit our weight loss surgery FAQ.

To learn more about Morbid Obesity, please contact our office, call us at (256) 880-1977.

1 NIDDK Weight-control Information Center: U.S. Department of Health and Human Services, National Institutes of Health; 2003. Statistics Related to Overweight and Obesity. NIH Publication No. 03-4158.