# I want an operation and have a raised BMI. Why is this important?

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1 Saint Mary s Hospital Gynaecology Service Warrell Unit I want an operation and have a raised BMI. Why is this important? Information for Patients

2 What is a BMI? Over the years, many different ways of calculating a healthy weight have been developed. Most health professionals use the Body Mass Index (BMI) formula to work out whether your weight is within a healthy range. Although this formula isn t perfect, it is a good estimation of the amount of body fat you have. It is the most useful tool available to help doctors calculate the risk of you experiencing health problems or complications from treatment as a result of your weight. To calculate your BMI, you will need to know your current height (measured in metres) and weight (measured in kilograms). BMI calculators and charts, including those using imperial measurements (feet and inches, stone and pounds) are widely available on the internet. BMI is your weight divided by your height squared (multiplied by itself). For example, a woman measuring 1.5 metres tall and weighing 50 kilograms would have a BMI of: = 22.2 Your BMI should be calculated at your first appointment in the Warrell Unit and again at any pre-operative assessment appointments. What is a healthy BMI? A healthy BMI measures between 18.5 to A BMI below 18.5 suggests you are underweight. A BMI of over 24.9 suggests you are overweight. Women with a BMI of over 30 have obesity. This means that their weight has reached a level where it is likely to have a negative effect on their health, increase their risk of some diseases and reduce their life expectancy. 2

3 Women with a BMI of 40 or more have morbid obesity. Women with a BMI of 35 or more who are experiencing an obesityrelated medical condition, such as diabetes or high blood pressure, also have morbid obesity. My BMI may be raised but I m happy with it and feel well. It is good that you feel well. However, having a raised BMI may be causing problems for your body that you are not yet aware of and may take time to show. Unfortunately, even if you feel healthy, a raised BMI is not good for you. What are the risks of having a BMI of 30 or more? The number of women with a BMI of 30 or more is increasing. Having a BMI of 30 or more affects all the parts of the body. Human beings are not designed to carry that much extra fat and it causes us harm. Obesity is now one of the leading causes of preventable death worldwide and is a major risk factor for heart disease, stroke and many cancers, including cancers of the breast and womb. On average, a BMI of 30 or more reduces life expectancy by about 6 years and a BMI of over 40 reduces life expectancy by about 10 years. The very good news is that reducing your weight also reduces these risks. Can a raised BMI affect bladder problems or a prolapse? Yes, it can. The pressure generated in your tummy (intra-abdominal pressure) is related to your weight, especially if you carry excess weight around your middle. This pressure places stress on your pelvic floor. 3

5 Keyhole (laparoscopic) surgery can be especially difficult and carry high risk of complication if your BMI is raised. Keyhole surgery causes a lot of stress on your breathing because of the high pressure in your abdomen during the operation and the carbon dioxide gas used. Having a thicker abdominal wall also restricts the movement of the laparoscopic instruments and the fat covers structures inside the abdomen making them difficult to see. As keyhole surgery has an increased risk of complications and may need to be abandoned, it is unlikely that your surgeon will offer you a keyhole operation if you have a raised BMI. What are the other risks of having an operation now? The risks include: Other medical problems: Women with raised BMI are more likely to have other medical problems such as diabetes, high blood pressure or heartburn which increase the risk of having an anaesthetic or getting a complication of an operation. DVT/PE: Deep vein thrombosis (DVT) is a clot in the deep veins of the leg. Sometimes parts of this clot break off and travel to the lungs where they get stuck and cause a serious medical problem known as a pulmonary embolus (PE). Women with a raised BMI are four times more likely to suffer a DVT after a daycase operation and 40 times more likely to suffer a DVT after an operation which keeps them in hospital. Infection: Women with raised BMI are 1½ times more likely to get a urinary tract infection and at least twice as likely to get a wound infection as women with normal BMI. When a wound infection occurs, it is more likely to be serious and more likely to need another operation to treat it. 5

6 Other wound problems: Women with a raised BMI are more likely to have other problems from their wound after an operation such as developing a hernia or having the wound come apart (dehiscence). Breathing problems: Women with raised BMI are more likely to have problems with their breathing after an operation. They are more likely to get pneumonia and more likely to need extra support with their breathing. The risk of respiratory failure, where the body is not able to get enough oxygen because of breathing problems, is doubled in women with raised BMI. Heart problems: Women with raised BMI are at higher risk of heart problems after an operation including abnormal heart rhythms. Women with raised BMI are 3 to 5 times more likely to suffer a heart attack after an operation. Nerve injury: Women with raised BMI are four times more likely to suffer a nerve injury during an operation. This can cause muscle weakness or an area of numbness. Most of the time these injuries heal but they can be permanent. Admission to intensive care: Women with a raised BMI are more likely to develop serious medical problems after an operation which means they need to be looked after on an intensive care unit. Death: No-one likes to think about the risk of dying and fortunately the risk of dying during or after an operation is very rare. However, for women with a raised BMI this small risk is doubled compared to women with a lower BMI. 6

8 Following a popular diet plan: Many diet plans are promoted to help weight loss and fall in and out of fashion over the years. Following a popular diet plan may or may not work for you. The Association of UK Dietetics has looked at the pros and cons of many of these and has published their advice on the NHS Choices website to help you decide. NHS Choices weight loss plan: This is a 12 week weight loss plan which can be followed free of charge on the NHS Choices website. It includes lots of help including a calorie calculator, support and a supportive discussion forum. Joining a commercial weight loss programme: Some women find joining a programme such as Weightwatchers or Slimming World helpful. Usually they allow you to attend supportive meetings to encourage you or you may choose to follow a programme on a phone app or on-line. These programmes will involve a subscription fee. Tablets or surgery: If you have a lot of weight to lose and suffer with morbid obesity, your GP may be able to offer you medical help to lose weight. These usually have side-effects, require you to stick to a diet and are not a quick fix. However, it may be worth discussing this with your GP, especially if you have any obesity related medical problems such as diabetes or high blood pressure. 8

9 Checklist of questions to ask your doctor before deciding on an operation for prolapse and/or bladder leakage. What is my BMI? Does my BMI mean I suffer from obesity or morbid obesity? How is my BMI affecting my prolapse or bladder leakage problem? What operation is recommended for my prolapse/bladder leakage? Would there be other options if my BMI was lower? Are there any alternatives to an operation? Will my BMI affect the chance of having a successful operation for my prolapse/bladder leakage? What are the risks of the operation and how does my BMI affect the risks? What can be done to reduce the risks if I decide to go ahead with an operation at my current BMI? What will happen to my symptoms if I delay an operation? 9

10 Other sources of information The NHS Choices website has lots of resources and information for anyone wishing to lose weight. It includes the 12 week weight loss plan, a BMI calculator and the popular diet reviews and can be found here: The Association of UK Dietitians has information about finding a dietician and information about weight loss including factsheets. They can be found here: The British Heart Foundation has a free BMI calculator and lots of information about healthy eating and weight loss. They can be found here: The Anaesthetists Association of Great Britain and Ireland (AAGBI) have a website where you can read all their publications including their advice for the perioperative management of patients with morbid obesity. Their website is found at: 10

12 TIG 142/14 Produced Sept 2014 Review Date Sept 2016 (SF Taylor CM15821)

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