4 Health Effects of Obesity in Special

 

  Transplant Recipients

Considering that obesity is a risk factor for end stage renal disease (ESRD), heart failure, and cirrhosis, it is not surprising that many transplant recipients have an elevated BMI. Unfortunately, obesity that has contributed to the end organ damage in these patients, also leads to worse post-transplant outcomes. The relationship between obesity and transplant has probably been most studied in the renal transplant field in which obesity has been associated with delayed graft function, graft failure, urine protein and acute rejection, independent of diabetes. In lung transplant recipients, obesity affects short- and long-term survival above BMI >30 kg im?, whereas in liver transplant recipients it does not seem to confer added risk until much higher BMIs [30]. Obesity in heart transplant patients is associated with multiple complications related to the heart transplant, left ventricular assist devices, and cardiothoracic surgery more generally. These complications include infection, wound dehiscence, mediastinitis, prolonged mechanical ventilation and intensive care unit stays, thrombosis, premature device failure, cardiac arrythmias, and early and late mortality

Due to the adverse effect of obesity on transplant outcomes, many transplant centers have implemented BMI thresholds resulting in an increased demand for more effective weight loss options in this population .

 Orthopedic Surgery Patients

Obesity is a risk factor for multiple musculoskeletal issues including knee osteoarthritis. There has been an increase in total knee arthroplasties in patients with elevated BMI. In these patients. obesity is associated with a functional recovery similar to those without obesity. However, there is a significant increase in mid- to long-term revision rates in those with severe obesity.

Obesity also poses a higher risk of post-operative superficial wound infections and thromboembolism. Many orthopedic surgeons recommend a BMI cut-off for knee replacements. As is the case in transplant medicine, the BMI cut-offs lead to increased demands for effective weight loss options in this population.

     Pregnancy

Obesity impacts both maternal and neonatal health. Rates of miscarriage are higher in women with obesity irrespective of spontaneous conception or in vitro fertilization. The rate of gestational diabetes doubles for BMI >30 kg/m? and triples for BMI >40 kg/m. Risk of pre-eclampsia doubles with overweight and triples with obesity. There is also a more than 30% chance of pre-term delivery (before 37 weeks) in women with obesity. The peripartum risks include a prolonged first stage of Labor, less success with vaginal birth after cesarean (VBAC), and increased rates of cesarean section delivery. Other obstetrical risks include increased fetal distress, instrumental deliveries, and shoulder dystocia. Wound infection and dehiscence, perinatal hemorrhage, and deep venous thrombosis are also more common in pregnant women with obesity. Neonatal effects of obesity include macrosomia and congenital anomalies, such as neural tube defects. oral clefts, hydrocephaly. anorectalatresia, limb reductionand cardiovascular anomalies.

         Children and Adolescents

Much of the health effects of obesity in children and adolescents parallel those in adults. The increasing prevalence of obesity in children is therefore accompanied by an increase in type 2 diabetes, dyslipidemia, hypertension, non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH). And OSA. There are, however, additional musculoskeletal and psychological considerations. Obesity during periods of growth can exert biomechanical forces leading to flatfoot, Blount’s disease, and slipped capital femoral epiphysis. Children with obesity also experience significant psychosocial distress thought to be related to lower self-esteem. social isolation, depressive symptoms, and body dissatisfaction.

      Conclusion

Excess adiposity has widespread effects on health and well-being leading to significant morbidity and mortality. Obesity is not only a risk factor for numerous diseases, but it can also exacerbate underlying conditions leading to more severe symptoms. More rapid progression. and worse treatment prognosis. In some cases, obesity is even the primary cause of specific conditions such as obesity cardiomyopathy, NAFLD/NASH, and obesity-related glomerulopathy. The extensive endocrine and physical effects of excess and ectopic fat depots warrant a thoughtful and comprehensive assessment of the patient with obesity in clinical practice. The degree to which a therapy improves upon the many negative health effects of obesity also warrants evaluation, so the full risk-benefit of treatment is understood.