How Obesity Can Result in Pregnancy Complications

There is a strong link between obesity and pregnancy complications which can lead to long term health concerns for both the mother and the baby. Women who are overweight and looking to become pregnant may be at risk of pregnancy and delivery complications. These complications come when a mother is considered overweight before becoming pregnant. If your pre-pregnancy BMI falls between 25 to 30, you are considered overweight, and if your BMI is greater than 30, you are considered obese. 

Nearly 75% of women in their child-bearing years are considered overweight, with 40% categorized as being obese. Not only will becoming pregnant be more difficult if you are carrying around excess weight but there is an increased risk of carrying the baby at a higher weight and BMI.

the risk of obesity and pregnancy complcations in womenHow Obesity Impacts Fertility

Obesity is linked to infertility in women. According to the American Society of Reproductive Medicine (ASRM), nearly 6% of women who reported difficulties getting pregnant were considered obese based on the BMI criteria. 

When an individual is obese, the female body will react differently to the sex hormones by converting androstenedione (a male hormone, which all women have a small amount of) into estrone (the female hormone). Higher amounts of estrone in the body affect the metabolism and part of the brain that regulates reproductive function. 

Similarly, overweight women are also more likely to develop polycystic ovarian syndrome (PCOS). PCOS is an endocrine condition in which the female reproductive hormones are off-balance, resulting in infertility in women of child-bearing age. Women with PCOS are not ovulating and releasing an egg to be fertilized by the sperm, thus resulting in infertility. 

Obesity can also lead to irregular periods, making it harder to track the ovulation cycle. If you seek fertility treatments, your weight could also hinder the success of these treatments, such as in-vitro fertilization (IVF). Studies have found that women at a higher weight have a lower rate of getting pregnant through IVF and other infertility treatments. 

Pregnancy Complications as a Result of Obesity

If you are able to successfully become pregnant, the stress and worry do not end there. Like all pregnancies, greater precautions and a closer look at your health needs to occur. However, being overweight or obese may result in your gynecologist and primary care physician keeping an extra close eye on your health during the duration of your pregnancy. Complications that could occur during pregnancy if you are overweight or obese prior to becoming pregnant include: 

1. Preeclampsia

Preeclampsia is a medical condition that affects up to 8% of women and is characterized by high blood pressure and higher than normal protein levels in the urine (proteinuria). Preeclampsia usually occurs after the 20th-week of pregnancy and can become extremely worrisome for both the mother and baby. 

2. Complications from High Blood Pressure 

When you carry around excess weight, your heart will have to work harder to pump blood throughout the body, putting strains on the arteries. This can result in your arteries resisting the flow of blood, causing blood pressure to increase. This is exacerbated once a woman becomes pregnant. Studies show that women with high blood pressure during pregnancy may increase their child’s risk of developing childhood obesity. 

3. Gestational Diabetes 

Gestational diabetes develops once a woman becomes pregnant. Although some cases of gestational diabetes will go away after delivery, most obese mothers will be at a higher risk of gestational diabetes turning into type 2 diabetes after the baby is born. 

4. Miscarriage 

Miscarriage occurs when a woman loses the baby before 20 weeks. The rate of miscarriages increases in women who are considered obese due to the health complications the mother may develop (or already have) during pregnancy. 

Other complications that may arise during pregnancy include: 

  1. Infections, like a urinary tract infection (UTI)
  2. Obstructive sleep apnea
  3. Blood clotting
  4. Induced labor 
  5. Problems breastfeeding and producing milk 
  6. Blocked passage of the baby through the pelvis, resulting in a cesarean birth (c-section)

Complications for the baby if you are obese

Along with the complications a mother may experience due to her weight, there are also serious complications that might impact the baby as well. These include: 

  1. Premature birth 
  2. Birth defects that affect the brain, spine, and heart
  3. Macrosomia, or a baby who weighs more than 8 lbs 13 oz at birth (which is considered large for gestational age)
  4. Childhood asthma or obesity if you had gestational diabetes or high blood pressure while pregnant

How to Seek Treatment for Pregnancy Complications

If you are currently pregnant or looking to become pregnant and considered overweight or obese, we recommend you consult with your gynecologist. Be sure to get early and frequent prenatal care to ensure you and the baby are as healthy as can be. 

The best form of treatment to increase your risk of becoming pregnant and minimize your risk during pregnancy is to lose weight. We recommend looking into lifestyle changes that could help you live a healthier life. In fact, bariatric surgery is a very beneficial method in helping patients at a higher BMI lose weight and keep it off long term. Bariatric surgery is also an excellent treatment option for fertility; however, we recommend you wait at least 18 months post-op to become pregnant.

Researchers have found that “bariatric surgery was associated with a lower risk for adverse outcomes, including gestational diabetes,  preeclampsia, cesarean delivery, macrosomia, and neonatal intensive care unit admission.” – HealthDay News 

How Staying Up Late Affects Your Weight

Getting enough sleep each night is critical to your overall health and impacts many of your bodily functions—including your mood, mental clarity, immune system, and disease risk factor. Furthermore, sleep also plays a vital role in managing your weight as it influences your hormones and metabolism. 

Yet, not only can a lack of sleep lead to weight gain, but carrying around excess weight can cause sleep troubles – such as sleep apnea. Therefore, individuals who are not getting enough sleep are at risk of becoming obese, and once obese, those individuals will have a more difficult time getting quality sleep. 

Individuals who suffer from sleep deprivation can experience adverse side effects related to their health over time. When we talk about being sleep deprived, we refer to not going through enough REM and non-REM sleep cycles, which ultimately affects your ability to function at your optimal point throughout the day.

When you do not get enough sleep each night, your risk of developing diabetes, heart disease, high blood pressure, cancer, arthritis, an overactive thyroid, and obesity increases significantly. Many studies have shown sleep deprivation increases the risk of heart disease by nearly 50% and triples the risk of type 2 diabetes.

However, it is not just sleep deprivation that can lead to excess weight gain but also staying up late. Research studies have found that individuals who stayed up late were more likely to eat large dinners and use tobacco or alcohol products, ultimately putting them at a higher risk of developing health problems down the road. 

In individuals who stayed up late, the risk of developing heart disease increased by 58%, and the risk of developing diabetes increased by 121% compared to people who went to bed at a decent hour and woke up early.

The disruption to the body’s natural circadian rhythm affects its ability to heal and restore itself during sleep hours. Your circadian rhythm is the 24-hour sleep-wake cycle the body goes through to balance and carry out essential functions. The brain was developed to follow the circadian rhythm, otherwise known as the sleep-wake cycle, based on light, which is why the circadian rhythm is tied to night and day. 

When your sleep-wake cycle is regulated, the body will be able to cycle through the appropriate stages of REM and non-REM and thus restore your body and brain during sleep. On the contrary, when your circadian rhythm is thrown off by staying up late, your body is not able to heal and be restored at the most optimal level.

Our bodies are centered around this “master clock,” which during hours of light (day time) signals the body to feel alert to keep us active. Whereas at night, the master clock signals the body to produce melatonin, a hormone that promotes sleep, and keeps producing melatonin to help us stay asleep throughout the night. 

Individuals who frequently disrupt their circadian rhythm due to staying up late are at an increased risk of developing sleep problems, such as insomnia or wakefulness throughout the night, as well as sleep apnea—which we know is exacerbated by obesity. 

If you suffer from obesity, it would be beneficial to develop better sleep-wake habits to promote a healthier lifestyle. Similarly, it is important for all individuals to stick to a consistent sleep-wake cycle regulated by day and night to improve their overall health. Although we understand that some individuals cannot adhere to the “normal” sleep-wake cycles regulated by light due to their job or travel, we encourage you to still set and follow a consistent sleep schedule to help regulate the body and promote restoration during sleep. 

The Link Between Non-Alcoholic Fatty Liver Disease and Obesity

Non-alcoholic fatty liver disease and obesity are strongly correlated. Non-alcoholic fatty liver disease (NAFLD) is a condition in which an individual has excess fat stored in the liver cells. As the name suggests, this type of fatty liver disease is not caused by excessive alcohol consumption but instead is a result of excess weight. Non-alcoholic fatty liver disease is quickly becoming the most common form of liver disease. It coincides with other metabolic disorders such as obesity, insulin resistance, diabetes, hypertension, and cardiovascular disease.

The Link Between Non-Alcoholic Fatty Liver Disease and Obesity

Obesity is a solid contributor to NAFLD due to the inflammation caused by being overweight and excess insulin production in diabetic patients. Excess fat contributes to insulin resistance that forces the pancreas to produce more insulin to manage glucose levels, which is why diabetes is common in overweight individuals.

The increased production of insulin causes excessive glycogen storage in the liver, ultimately increasing the presence of fat in the liver cells. Combined with the behavior of adipose tissue in overweight and obese individuals, where often the metabolism and rate of caloric burn has decreased due to fad dieting, the correlation between non-alcoholic fatty liver disease and obesity is significant.

The Risk of Non-Alcoholic Fatty Liver Disease

In most instances, non-alcoholic fatty liver disease does not cause any symptoms until it results in end-stage liver disease, leading to cirrhosis. If NALFD has not been discovered, monitored, and treated, it leads to non-alcoholic steatohepatitis (NASH), an aggressive form of fatty liver disease. NASH is defined as inflammation in the liver, and if left untreated, could progress to cirrhosis. 

It is estimated that most obese individuals will ultimately develop some degree of liver damage. Whether or not this will progress to cirrhosis is not clear; however, it is estimated that the progression of NAFLD and NASH leading to cirrhosis will become the leading cause for liver transplantation over the next decade. About 5 to 12% of individuals who develop NASH will suffer severe complications from cirrhosis.

Cirrhosis is a condition where some form of toxin or insult has damaged the liver cells that ultimately causes scarring in the liver, reducing the liver’s ability to perform its normal function. You may already be familiar with some of the more common causes of cirrhosis, such as excessive alcohol consumption or hepatitis. Yet, what you may not already know is that obesity also can cause damage to the liver resulting in the same end-stage liver failure. As obesity rates are rising in our society, so is the incidence of NAFLD.  

Non-alcoholic fatty liver disease is often silent and without symptoms; however, physicians should assume that all obese patients have some degree of fatty liver disease. Often the first direct evidence that someone has a fatty liver is when it is discovered incidentally when the patient might have a CT scan or ultrasound of the liver for other medical reasons. 

There are radiographic findings that are typically seen when the liver is imaged by these modalities. As the fatty liver disease progresses, the liver enzymes may become elevated. The liver enzymes can be measured with a simple blood test. Usually, when the liver enzymes are elevated, this is a serious sign that ongoing damage to the liver cells is occurring and should be closely monitored and addressed. However, ultimately the best way to diagnose the extent of NAFLD or NASH is through a liver biopsy.  

How to Manage Non-Alcoholic Fatty Liver Disease and Obesity

Currently, there are no approved medications on the market used to treat non-alcoholic fatty liver disease. However, a significant shift in lifestyle habits to include diet, exercise, and overall weight loss, can improve and reverse non-alcoholic fatty liver disease and obesity.

Studies have found that even a moderate decrease in weight by about 5 to 10% will significantly improve the risks associated with non-alcoholic fatty liver disease. Weight loss will reduce inflammation in the body (and liver), shrink the fat within the liver cells, and improve the way the body responds to insulin, ultimately helping the liver function properly.  

Bariatric surgery is an excellent treatment option for individuals who have difficulty losing weight or need to lose a significant amount of weight. Before weight loss surgery, surgeons will often recommend that their patients only consume protein shakes for a week to two before their surgery. This will significantly decrease the amount of fat in the liver and shrink its size. 

Additionally, bariatric surgery will create a metabolic shift in your body to help you better manage your weight and improve the functionality of your organs. Surgeons and researchers have thoroughly studied this phenomenon and how bariatric surgery creates a physiologic shift in fat storage and insulin productivity. Weight loss surgery can improve non-alcoholic fatty liver disease and obesity conditions, ultimately improving your health and overall life.

Obesity and Cancer: What’s the Connection?

There is a significant link between obesity and cancer that many people do not appreciate. Diabetes and heart disease have links to obesity that many people understand. But cancer, a word no one wants to hear, is rarely discussed as a complication of obesity. Did you know, obesity increases your risk of 13 different cancers?  

Obesity and Cancer Link

These cancers make up 40% of all cancer cases diagnosed in the United States each year. The American Cancer Society reports excess body weight is responsible for about 11% of cancers in women and 5% of cancers in men in the United States, and about 7% of all cancer deaths.  

What if I told you, you could help reduce your risk of getting cancer? 

That’s right, keeping a healthy weight is one of the most important steps you can take to lower your risk of getting cancer. It is staggering to learn that in the United States, from 2005 to 2014, the rate of obesity-related cancers increased 7%, while the rate of cancers not associated with obesity decreased by 13%. The link between obesity and cancer risk is clear. 

Understanding the Link Between Obesity and Cancer

Experts believe excess weight changes increase a patient’s cancer risk primarily due to inflammation caused by visceral fat, the fat that surrounds our organs. The problem with excessive visceral fat is that it affects specific processes in your body. Fat cells produce hormones that promote cell growth; the more often these cells divide, the more chances for cancer to develop. Fat tissue can also produce proteins that cause conditions like chronic inflammation and insulin resistance, which can promote cell growth. 

Actions to Take to Lower Your Risk of Obesity and Cancer

  1. Make healthy lifestyle choices. You can lower your risk of both obesity and cancer by exercising regularly and eating a healthy balanced diet. Many observational studies have shown people who have lower weight gain during adulthood have lower cancer risk. Studies have also found, with weight loss comes decreased risk of endometrial, colon, prostate, and breast cancer. Being obese or overweight hurts your body’s ability to function correctly. Maintaining a healthy weight is essential for reducing your risk for cancer. 
  2. Consider having Bariatric (weight loss) surgery. Sometimes, we need an extra tool in our tool belt to help us lose weight. Bariatric surgery might be the tool you need. This procedure reduces food consumption and aids weight loss by removing a part of the stomach, thereby reducing its size.

Patients who have had Bariatric surgery appear to have lower obesity-related cancer risk than those who have not. Though bariatric surgery is a more aggressive approach than lifestyle modifications, surgery may provide additional benefits, such as improved quality of life and decreased long-term health care costs.  

How Do Medical Professionals Help Patients Lower their Risk of Obesity and Cancers

Achieving or maintaining a healthy weight can be challenging. Sometimes you might need professional advice, so don’t be afraid to ask health professionals for assistance. Health care providers can help patients keep a healthy weight by doing the following: 

  1. Measure and define the data
  2. Educate on risks and opportunities of obesity and cancer
  3. Help build a support network
  4. Agree on a comprehensive action plan
  5. Hold patients accountable

Have you decided to take a positive step toward reclaiming your health? Many of us have struggled to lose weight and keep it off most of our life. We are not just starting the journey. It is a journey we have been on for years. It is time to finally achieve your goal. Maybe you’ve already researched on your own or talked with your Primary Care Physician. 

Treating Diabetes Through Weight Loss Surgery

Diabetes affects nearly 463 million people worldwide. In America, where the standard American diet consists of high carbohydrate foods, diabetes affects about 10% of the population, with 90% of all cases being type 2 diabetes. 

Given the rising trend in the rates of obesity, it appears the incidence of diabetes will continue to rise. Bariatric surgery is currently the most effective and long-term treatment for obesity. Weight loss surgery procedures are meant for patients to achieve a significant degree of weight loss. With patients attaining successful weight loss results, bariatric surgery is a viable solution for diabetic patients.  

How Excess Weight Causes Diabetes

The exact mechanism of how obesity leads to insulin resistance is still not fully known. Recent research proposes that overeating and obesity places stress on a particular cellular organ (organelle) called the endoplasmic reticulum. This organelle is responsible for the processing of nutrients within the cell.

When nutrients are too plentiful, as might be the case in obese patients, the cell sends out signals to the cellular surface to shut down the glucose transport system, thereby inhibiting the action of insulin on the surface of the cell. This ultimately prevents glucose entry into the cell, leading to persistently higher glucose levels in the blood.

Other theories suggest that obesity causes increased levels of fatty acids in the blood, resulting in chronic inflammation. This might result in a response in the immune cells located in adipose tissue to produce toxic chemicals. This somehow inhibits the action of insulin at the level of the cellular insulin receptor or prevents the pancreas from producing enough insulin. Either way, the result is a blood glucose level that is too high. 

How Weight Loss Surgery Improves Diabetes in Obese Patients

If the inflammation theory mentioned above is the leading cause for insulin resistance, then it would seem logical that losing weight would decrease the state of chronic inflammation, thereby improving the action of insulin at the cellular level and lowering blood glucose levels.  

When considering the endoplasmic reticulum theory, a patient is consistently eating less, resulting in fewer nutrients available for the cells. 

This should then result in a lower stimulus for the cell to prevent the entry of glucose, thereby improving the action of insulin at the level of the cell, lowering blood glucose level, decreasing overall improved glycemic control.  

Aside from losing weight and eating less, it also appears that preventing food from coming into contact with the first part of the intestine (duodenum) seems to result in hormonal changes that improve insulin sensitivity. This effect appears to be independent of the weight loss. 

The prevention of food from coming into contact with the duodenum occurs in the gastric bypass and duodenal switch due to the anatomic changes that divert food away from the duodenum. In most type 2 diabetics, glycemic control is improved if not normal within days of surgery, even before any degree of significant weight loss.

A June 2014, an article published in The International Journal of Clinical Practice reported that surgery — compared to conventional treatment — results in better blood sugar control. Many patients even go into remission within days of their bariatric procedure.

Read the entire ASMBS Fact Sheet on type 2 diabetes and bariatric Surgery

Nearly all individuals who have bariatric surgery show improvement in their diabetic state. Bariatric surgeries have shown the following statistical results as it relates to type 2 diabetes: 

  • Surgery improves type 2 diabetes in nearly 90 percent of patients
  • Surgery causes type 2 diabetes to go into remission in 78 percent of individuals
  • Improved health and increased longevity last for years, if not a lifetime.

Treating Diabetes Through Medication Therapy

The primary goal of diabetes treatment and management is to keep the blood sugar/glucose levels as close to a normal range as possible (around 100 mg/dl) while avoiding drops in the glucose level to the degree that the patient develops symptomatic hypoglycemia. The techniques to accomplish this center around lifestyle changes (diet, exercise, weight loss, close medical follow-up/monitoring), the use of medications, and bariatric surgery. 

Learning about the disease and being an active participant in the management process is critical to long-term glycemic control. The goal of treatment is to keep the HbA1C level no more than 7-8% and preferably less than 7.  You should pay attention to those medical conditions that will accelerate the long-term consequence of the disease, such as hypertension (high blood pressure), elevated cholesterol (heart disease), and excess weight. 


The goal of medicine that treats diabetes is to lower the blood glucose levels by either replacing the insulin that is lacking, improving the body’s production of insulin, or improving the absorption of glucose from the blood into the cells of our body. There are several different classes of drugs that we will below. 


Insulin is the most common type of medication used in type 1 diabetes treatment. The goal is to replace the insulin that the body fails to produce. Several types of insulin are classified as short and long-acting. 

A diabetic patient will take insulin by frequent, intermittent injections or a continuous infusion through various pumps. Ultimately, the amount of insulin required is dependant on the patient’s blood sugar levels, how much natural insulin they might make (if any), and how sensitive their body is to the insulin. 

Some of the common drug names for insulin are:

  1. Short-Acting Insulin:  Regular Insulin (Humulin and Novolin), Insulin Aspart (NovoLog, FlexPen), Insulin Isophane (Humulin N, Novolin N)
  2. Long-acting insulin: Insulin Degludec (Tresiba), Insulin Detemir (Levemir), Insulin Glargine (Lantus), Insulin Glargine (Toujeo)
  3. Combination Insulins (short and long-acting): NovoLog Mix 70/30 (Insulin Aspart Protamine-Insulin Aspart), and many other combinations


Amylinomimetic drugs are injectable medications used before meals. They are meant to delay emptying the stomach, thereby delaying the digestion and absorption of the meal. This results in a slower, more controlled rise in glucose levels, which will sometimes prevent the rapid spikes in glucose levels when a diabetic eats. The medication also seems to reduce appetite. Pramlintide (SymlinPen 120, SymlinPen 60) is one of these medications.

For type 2 diabetics, the body makes insulin, however, the cells no longer respond well to the insulin the body makes. The goal of treatment with the following medications is to help the cells respond to insulin better to improve glucose absorption.  

Common Medications to Manage Diabetes 

1.   Alpha-glucosidase inhibitors, medications that help your body break down starchy foods and simple sugars more efficiently. Some of the common names are Acarbose (Precose) and Miglitol (Glyset)

2.   Biguanide class of medication decrease how much glucose the liver produces. The most common biguanide is Metformin (Glucophage, Metformin Hydrochloride ER, Glumetza, Riomet, Fortamet). Metformin can also be combined with other drugs to have a synergistic effect.  

3.   Dipeptidyl Peptidase-4 (DPP-4) Inhibitors help the body continue to make insulin by stimulating increased production from the pancreas. Some of the more common drugs in this class include Linagliptin (Tradjenta), Saxagliptin (Onglyza), and Sitagliptin (Januvia). 

4.   Glucagon-like Peptide-1 Receptor Agonists (GLP-1 receptor agonists) are similar to the natural hormone called incretin. These medications stimulate the growth of the cells in the pancreas that make insulin. In some patients, these medications decrease appetite and delay gastric emptying, which may positively benefit weight. These medications include Dulaglutide (Trulicity), Exenatide (Byetta), Liraglutide (Victoza), and Semaglutide (Ozempic)

5.   The Meglitinide class of medications helps your body release insulin. However, in some cases, they may lower your blood sugar too much, resulting in hypoglycemia. Some of the common brands include Nateglinide (Starlix), Repaglinide (Prandin) and Repaglinide-Metformin (Prandimet)

6.   Sodium-glucose transporter (SGLT) 2 Inhibitor works by decreasing glucose absorption in the kidney. As a result, excess glucose is lost through the urine. Some of the common medications in this class include Dapagliflozin (Farxiga), Dapagliflozin-Metformin (Xigduo XR), Canagliflozin (Invokana), and Empagliflozin (Jardiance).

7.   Sulfonylureas are among the oldest diabetes drugs still used today. They work by stimulating the pancreas to make insulin. These drugs include Glimepiride (Amaryl), Glipizide (Glucotrol), and Glyburide (DiaBeta, Glynase, Micronase). These medications are often combined with other medications such as metformin to achieve a synergistic effect (Glyburide-Metformin, known as Glucovance).

8.   Thiazolidinediones are an additional class of medications that work by decreasing glucose in your liver. They may also improve insulin sensitivity at the level of the fat cell, thereby improving glucose absorption and utilization. Options include Rosiglitazone (Avandia) and Pioglitazone (Actos). 

Medications to lower blood glucose levels are often used in conjunction with other medicines to reduce the long-term damage diabetes tends to have on our organs. These include anti-hypertensive medications used to lower blood pressure and protect the kidney from the damaging effect of frequent high glucose levels. Other medications that protect the organs are medications to lower cholesterol levels. These medications reduce the development of atherosclerosis/heart disease that is more likely to be accelerated in diabetic patients. 

Diabetes Diagnosis and Treatment

Diabetes is a hormonal condition in which an individual experiences consistently high blood sugar levels. When the glucose levels in the blood are persistently too high, this can ultimately impact the body’s organs and tissues, resulting in long-term damage. 

Understanding Insulin

Diabetes is due to either the pancreas not producing enough insulin or the body’s cells not responding properly to the insulin produced. 

Insulin is a hormone made by the Beta-cells in the pancreas. It is the primary hormone that stimulates glucose uptake from the blood into most cells of the body by interacting with an uptake receptor on the surface of the cells. When the body is deficient in insulin (Type 1 DM) or the body is insensitive to insulin’s actions due to a problem with the insulin receptors on the cells surface, then the blood glucose levels can remain too high. 

Ultimately one or both of these problems is the leading cause for all forms of diabetes mellitus.[69] Glucose is vital to normal cellular function and life. It’s the primary source of “fuel” for the cells in our body; however, too much of a good thing can become harmful.  

The glucose level in our blood comes from several sources:

  1. The intestinal absorption of food (carbohydrates)
  2. The breakdown of glycogen in the liver and muscle (the quick storage form of glucose) and gluconeogenesis
  3. The generation of glucose from non-carbohydrate substrates in the body (primary from protein and ketone bodies).  

Insulin works by inhibiting the breakdown of glycogen or the process of gluconeogenesis. It also interacts with particular receptors on the surface of most of the cells in our body to stimulate glucose transport into fat and muscle cells. Insulin stimulates glucose storage in the form of glycogen in the liver and muscle for future use when we have not recently eaten. 

Insulin is released into the blood by beta cells (β-cells), found in the pancreas, when these cells sense rising blood glucose levels, typically after eating. 

If the amount of insulin available is insufficient (Type 1 DM), or if cells respond poorly to the effects of insulin (Type 2 DM), then glucose is not absorbed by the body’s cells. The net effect is persistently high blood glucose levels leading to the long-term complications discussed in this article. 

Diabetes Treatments

Insulin Injections

Patients with type 1 diabetes who fail to make enough insulin can treat their diabetes with insulin injections. The patient must monitor their glucose levels frequently and supplement the body with various insulin doses to keep the glucose level in a “close to normal range.” Additionally, the patient needs to eat a low carbohydrate diet to prevent the glucose levels from spiking too high. 

Prevention and treatment of type 2 diabetes generally involves lifestyle changes such as losing weight, eating a low carbohydrate diet, and regular physical exercise. Type 2 diabetes may be treated with various oral medications that help the body’s cells to utilize glucose more effectively. Occasionally type 2 diabetics may also need insulin injections when the oral medications fail to keep the glucose levels low enough.   

Weight Loss

The third and probably most crucial lifestyle change a patient with diabetes should make is to lose weight. Weight loss can prevent progression from pre-diabetes to full-blown type 2 diabetes. Losing weight will also decrease the risk of developing hypertension and elevated cholesterol. In many cases, even a modest degree of weight loss can result in partial remission of the disease.   

Bariatric Surgery

Weight loss surgery can be an extremely effective treatment for obese patients with type 2 diabetes. Most patients after surgery can maintain normal blood sugar levels with little or no medications, and long-term complications and death associated with diabetes are decreased.  

The body mass index cutoffs for surgery are in debate. However, most physicians agree that anyone with a body mass index over 35 should be considered a candidate for bariatric surgery. There is some evidence that patients with a BMI between 30 and 35 should be considered when medications and lifestyle changes fail to lead to reasonable glucose control.

In 2018, The American Society for Metabolic and Bariatric Surgery (ASMBS) issued a position statement on the role weight loss surgery plays in treating class 1 obesity (BMI 30.0–34.9 kg/m2). It states, “Particularly given the presence of high-quality data in patients with type 2 diabetes, bariatric and metabolic surgery should be strongly considered for patients with BMI 30 to 35 kg/m2 and type 2 diabetes.” This position is supported by the American Diabetes Association (ADA); however, most insurance companies still do not cover these procedures until the body mass index is over 35.

How to Diagnose Diabetes

Normal glucose levels are typically less than 110. Diabetes mellitus is diagnosed by demonstrating any one of the following:[65]

  • Fasting plasma glucose level ≥ 126 mg/dl. For this test, blood is drawn after a period of fasting, most commonly in the morning before the first meal
  • Plasma glucose ≥ 200 mg/dL two hours after a 75-gram oral glucose load. This test is referred to as the oral glucose tolerance test.  
  • Symptoms of high blood sugar and plasma glucose ≥ 200 mg/dL either while fasting or not fasting
  • Glycated hemoglobin (HbA1C) ≥ 6.5.

A positive result on any of the tests should be confirmed by repeating the method on a different day. The fasting AM test is preferable because of the ease of measurement and the time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.

Most endocrinologists consider two fasting glucose measurements above 126 mg/dL a considered diagnosis for diabetes mellitus. An individual is considered to be pre-diabetic when the fasting glucose levels are 110 to 125 mg/dL, or when the plasma glucose is between 140 to 200 mg/dL, two hours after the glucose tolerance test.

Diabetes 101: A Breakdown of Diabetes for the Bariatric Patient

Diabetes mellitus (DM) is an endocrine (hormonal) disorder characterized by frequently high blood sugar levels over a prolonged period of time. Our glucose (sugar) levels in our blood are tightly regulated by insulin (a hormone made by the pancreas), which is designed to keep our blood sugar level in a reasonably narrow range. When the glucose levels in the blood are persistently too high, this will ultimately impact the body’s organs and tissues, resulting in long-term damage and possibly death. The name “diabetes” comes from the Latin meaning of “pass-through,” referring to increased urination and Mellitus, aka sweetened. In the past, diabetes mellitus was referred to as sweet urine.

Symptoms of Diabetes

The most common initial symptoms of diabetes are frequent urination, thirst, and increased hunger. The persistently high glucose levels in the blood cause kidneys to excrete glucose into the urine (sweet urine). Before measuring the glucose levels in the blood, physicians would suspect the diagnosis of diabetes when the patient’s urine tasted sweet. The increased glucose in the urine results in decreased water absorption by the kidneys, leading to increased urine production and fluid losses that ultimately cause dehydration and increased thirst.

Furthermore, the lower levels of glucose in the body’s cells stimulate increased appetite and hunger. If the glucose level gets too high, then many acute complications can arise, such as diabetic ketoacidosis, hyperosmolar hyperglycemic state, diabetic coma, and even death. Other less specific signs of diabetes are blurred vision, headaches, fatigue, mental fog, and poor wound healing.

Complications of Diabetes

Long term, persistently elevated glucose levels will ultimately lead to damage to small blood vessels limiting blood flow to the regions of the body that these vessels serve. The most common long-term complications from this damage are seen in the vital organs such as the heart (cardiovascular disease leading to heart attacks), brain (leading to strokes), and the kidney (leading to kidney failure and ultimately dialysis).

Additionally, damage to the body’s smaller blood vessels often leads to poor blood flow to the feet, which can cause foot ulcers, damage to the nerves causing neuropathy (numbness, tingling, and burning pain), and damage to the small blood vessels in the eyes leading to visual impairment and even blindness.

Types of Diabetes:

Diabetes is due to either the pancreas not producing enough insulin or the body’s cells not responding properly to the insulin produced. There are three main types of diabetes mellitus:[2]

  • Type 1 diabetes, commonly referred to as Juvenile diabetes, results from the failure of the pancreas to produce enough insulin due to the loss of cells in the pancreas that make insulin. Typically type 1 DM occurs in childhood or adolescence. Although, some individuals may have a slow loss in the insulin-producing cells, leading to a form of Type 1 DM that presents later in life.  It is believed that the loss of these insulin-producing cells is caused by an autoimmune disorder that leads to the death of these cells in the pancreas. The cause of this autoimmune response is unknown.
  • Type 2 diabetes, known as insulin resistance, is when the body’s cells fail to respond to insulin properly. This form of diabetes is often referred to as “non-insulin-dependent diabetes mellitus” (NIDDM) or “adult-onset diabetes .”The cause of this type of diabetes is not clearly known; however it is most commonly associated with a combination of excessive body weight and insufficient exercise.
  • Gestational diabetes is the third main form of diabetes and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels. Typically, the glucose levels normalize after delivery, making this form of diabetes a less serious condition.

Diabetes Statistics

Diabetes is the 7th leading cause of death worldwide and is the most expensive long-term disease to treat. As of 2019, an estimated 463 million people had diabetes worldwide, accounting for about 8% of the world’s population. In the US, where the diet of most individuals is higher in carbohydrates and obesity is more prevalent, the rates approach 10% of the population.

Type 2 diabetes accounts for about 90% of all cases. Given the rising trend in the rates of obesity, it appears the incidence of diabetes will continue to rise. Additionally, due to the long-term health consequences of diabetes, the risk of early death has nearly doubled, resulting in almost 4 million deaths a year.  As such, it is not surprising that the cost of diabetes treatment in the United States is over $300 billion, with the average medical expenditures for patients with diabetes being twice that of non-diabetics.

Options to Pay for Weight Surgery Without Bariatric Insurance Coverage

If your insurance does not pay for weight loss surgery, the costs can become worrisome for you and your family. Medical bills are the third largest cause of debt in the United States, aside from divorce lawyer fees and job loss. 

With weight loss surgery being an elective procedure, it is easy to decide not to have the surgery if you do not have bariatric coverage on your insurance plan. Unlike being diagnosed with cancer or having a heart attack, your weight is not going to kill you…yet

Many overweight and obese individuals fail to recognize the danger of living with obesity and its impact on their overall health and quality of life. Similarly, over time, carrying around excess weight will lead to health complications that must be treated, ultimately forcing you to rack up those medical bills. 

Would you rather pay a larger lump sum now to treat your obesity or continue to pay medical bills over the years to treat your health complications?  

We recognize that finding ways to pay for weight loss surgery can be difficult, and not everyone will have the same options. But before you settle with the choice to continue living with obesity, take a deeper look into your payment options. 

1. Take out a personal loan

Look into taking out a personal loan from the bank. Although you will have to pay interest on this loan, the total interest paid may be insignificant in relation to the amount you would have had to pay in late payment penalty fees. 

2. Use a personal line of credit

A personal line of credit will allow you to make withdrawals up to a certain amount. The benefit of a personal line of credit compared to a personal loan is you only pay interest on the amount that you withdraw instead of the entire lump sum.

3. Borrow against your home equity

If you have around 15 to 30% equity in your home, you may be able to take out a loan while securing your property as collateral. The downside to this option, though, is that if you can not afford the loan payments, you risk losing your home. 

4. Partner with a healthcare financing company

Apply for a healthcare credit card, such as CareCredit, to help you pay for your medical expenses. This option, if you qualify, is an excellent choice because most healthcare financing companies offer shorter financing options with little-to-no interest payments. However, make sure that your provider accepts CareCredit or other healthcare financing services before applying.

5. Withdraw funds from your retirement plan

If you have a 401K with your employer, you may be able to withdraw funds from this retirement savings. It is important to note, though, that the IRS will limit how much you can take out to either $10,000 or 50% of the vested amount. Similarly, you may be faced with a large tax bill at the end of the year due to the early withdrawal from your 401K.

6. Ask your family or friends to be lenders

Although there may be a lot of shame surrounding this option, it never hurts to ask for help. Explain to your family and friends the importance of bariatric surgery for your health and your quality of life. Even if they can’t afford to pay for it all, some help is better than no help. 

7. Tap into your savings

If you have the financial means, we always recommend this option to pay for weight loss surgery. By using your savings, you won’t have to pay interest, risk losing your assets, or be penalized due to an early withdrawal.

We encourage you to think about just how much your life is worth before you settle with continuing to live with the extra weight. Not only is your weight likely inhibiting your ability to enjoy life, but over time, it could lead to serious health complications, or worse, death.

Small Steps to Tackle Obesity and Live Healthy

The national obesity problem affects all generations—20 percent of adolescents and 40 percent of adult Americans are obese. In most cases, obesity starts with genetics and is exacerbated by poor diet, little or no exercise, and poor sleep habits. Beating obesity can happen, though it won’t happen overnight.

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Polycystic Ovarian Syndrome and the Link to Obesity

Polycystic ovarian syndrome, PCOS for short, is an endocrine condition in which the female reproductive hormones are off-balance and result in infertility in women of childbearing age. Women who experience PCOS may have irregular periods, high androgen levels, and the frequent development of ovarian cysts (small fluid-filled sacs within or on the ovaries) and presents itself as a higher risk in obese or overweight women. 

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The Link Between a Hiatal Hernia and Obesity

If you have ever researched bariatric surgery, you have probably heard the term “hiatal hernia.” A hiatal hernia occurs when part of the stomach slides into the chest through a hole in the diaphragm called the hiatus. When this happens, it places the stomach in an unnatural position, causing a range of problems from reflux (heartburn), to chest pain and vomiting.

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How Hormonal Imbalances are Contributing to Obesity

Within the last decade, we have learned a lot about hormones and their impact on our weight. Hormones are chemical messengers made by endocrine glands (glandular organs) in our body that regulate various processes from how we sleep, grow, reproduce, and metabolize food, to name a few. The most commonly known glandular organs are the adrenal glands, pancreas, pituitary, and thyroid gland.

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The Dangers of the Coronavirus for Obese Individuals

The coronavirus, officially known as COVID-19, is a virus that has gotten international attention in the last few months. Since the initial outbreak in Wuhan, China, this virus has spread rapidly across countries, inciting fear in many individuals. But among all the media and news reports, what sources can you trust? And what does this virus mean for individuals suffering from obesity?

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Methods to Lowering Your Blood Sugar Levels and Controlling Diabetes

Dietary modifications may be the most direct and obvious way to keep your weight within healthy levels and help control your blood sugar. Yet, there are other techniques to supplement your journey along the way as well.

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Understanding My Body Mass Index

Body mass index (BMI) is a measurement of a person’s weight relative to their height. It is what our practice, and insurance companies, use to qualify a patient for weight loss surgery. So today we are going to breakdown the BMI calculation and let you in on what it really measures.

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World Obesity Day: A Fight to End The Weight Stigma

Every year, October 11th marks World Obesity Day—a day to raise awareness for the treatment options and action plans for individuals struggling with obesity. As stated before in previous blogs, obesity is a disease that is quickly becoming the largest health epidemic in the world. With more than 28% of the world population estimated to be obese, it is critical we start educating the public and other physicians about this disease of obesity. This year, World Obesity Day is focused on weight stigma

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Video Blog: Family Dynamics and Your Weight


The Talking it Up Show with Arlean Edwards is a local production that interviews keynote speakers within the CSRA. I, Dr. Jacome, was invited to join Arlean on set in a series of videos where I talk about what it takes to live healthy. This is the third video we are sharing from this series. You can find the first two videos on Calories and Dieting on our blog. Be sure to stay tuned to see what other exciting topics I cover in the coming months!

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The Effects of Obesity: Overview

As a medical weight loss physician, I see many patients who complain about a lower quality of life due to their excess weight. However, weight gain and the disease of obesity does not just affect your self-esteem and the activities you are capable of participating in. If left untreated, obesity can contribute to many debilitating or deadly diseases.

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The Effects of Obesity: Hypertension

It may be the day after Valentine’s Day, but lets continue this theme of hearts. Your heart is the most important organ in the body as it pumps blood throughout the veins, providing the body with oxygen and nutrients needed for survival. But what happens when the amount of blood that flows through your veins becomes too dense? It will begin to apply pressure to the inner walls of the arteries, thus leading to high blood pressure, more formally referred to as hypertension.

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The New “F” Word: Fat-Shaming

If ever there were a combined pair of words that had the bariatric world buzzing, it’s these two: fat-shaming. These two words can evoke intense emotions for those who have, or who are, suffering from the disease of obesity. Similarly, the family members and loved ones of those who suffer from the disease of obesity are highly sensitive to the numerous varieties of “fat-shaming” that takes places in our society.

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The Effects of Obesity: Arthritis

At their first monthly follow-up visit with me, patients often remark on how much better their knees feel. Even though some of these folks lost 10 or more pounds in this first month, their reports of “less pain when I climb the stairs,” or “I can walk the block again without my cane,” seemed like optimistic exaggerations when I started out practicing bariatric (weight loss) medicine. However, based on work done by the Arthritis Foundation, it makes perfect sense. Regardless of how much you weigh, you too can relieve joint pains with small amounts of weight loss.

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The Effects of Obesity: Sleep Apnea

Has anyone ever complained about your snoring?  Maybe someone you love is snoring so loudly that it seems as though wild animals are attacking you in the night. Everyone in the house is tired from sleepless nights either from your snoring or your relative’s snoring. Snoring can be a serious concern if it can be linked to obstructive sleep apnea.

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The Effects of Obesity: Diabetes

Diabetes has come to be a household term. With the obesity epidemic on the rise, diabetes can be one of the first signs of an unhealthy lifestyle. Diabetes is a disease that is characterized by higher than normal levels of sugar in the blood and not enough insulin to manage these levels

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Don’t Wait to Lose Weight

As a bariatric surgeon, I have found that patients are more likely to have greater success with their weight loss following bariatric surgery when it is performed at a lower, obese weight.  A recent data study conducted by researchers at the University of Michigan, Wayne State University and Henry Ford Health System supports this idea.

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Am I Considered Obese?

Obesity is quickly becoming the largest health epidemic in the United States. With the increasing portions of food at restaurants and the continued need for fast, cheap food, America has taken the lead for the most obese country in the world. Physicians are now beginning to recognize this problem as a disease. Therefore, it is critical to understand where you fall in regards to your weight and to know all of the options you have to get back onto a healthy lifestyle track.

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