For the past several years, I have been taking care of a patient who was morbidly obese. Due to the obesity, the patient had severe sleep apnea, mostly due to a very short, thick neck. The patient’s body habitus made her obstructive sleep apnea and GERD very difficult to manage, despite aggressive medical management plus a proton pump inhibitor and H2 blocker.
Patient Overview
Over the past several years, the patient had had multiple admissions to the hospital for difficulties breathing. In most instances the patient would have pneumonias due to aspiration. Uncontrolled reflux, because of the patient’s obesity, was the risk factor.
In addition, the patient also had metabolic syndrome and her diabetes was worsening, despite an insulin pump. She also had recurrent chronic sinusitis and, despite IV I G therapy, the patient continuously had chronic sinus infections requiring intravenous antibiotics due to the organisms that were being identified in her sinus cavities by ENT.
Bariatric Surgery
Last year the patient decided to undergo bariatric surgery. Since that time the patient has lost nearly 100 pounds. Her obstructive sleep apnea has reversed itself and she no longer requires CPAP. She also no longer requires therapy for her diabetes and her last hemoglobin A-1 C was 5.6. She has not had any sinus infections for the past six months and repeat IgG and subclass levels are at the high end of normal, and the patient and I are considering stopping her IV I G therapy at this time.
There are many patients that are obese and they may not seem to have many medical problems. Unfortunately, many patients that are obese do have significant medical problems, and in most of these instances, the medical conditions associated with obesity are usually related to high blood pressure and cardiac issues. Also, obese patients do have difficulty with healing because of the poor blood flow that is associated with fatty tissue. Most infections that are associated with obesity usually involve skin structures, such as chronically infected ulcer of the lower extremities. In this patient we describe how obesity can directly contribute to respiratory tract infections, including both the sinuses and lungs.
The obesity epidemic that has been plaguing the United States for decades now is spreading to the rest of the world and it will contribute to many chronic medical problems in the future in other countries, such as the ones we are seeing here. The first line for treatment of obesity is diet and exercise. Unfortunately, for many, diet and exercise may not be enough to reverse obesity. For these individuals, bariatric surgery may not be only life- altering, but in reality life-saving.
