Obstructive sleep apnea (OSA)

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Obstructive Sleep Apnea is the most common sleep related breathing disorder. In males, studies have shown a prevalence of 20-30% of the adult population and 10-15% in adult women. In people with a body mass index of greater than 30 (classically defined obesity), one study showed an incidence of 63% of OSA in this group.

Consequences of OSA include:

  • Daytime cognitive impairment
  • Motor vehicle accidents
  • Poor work performance
  • Hypertension (high blood pressure)
  • Coronary artery disease
  • Pulmonary artery hypertension
  • Cardiac arrhythmias
  • Heart failure
  • Stroke and Heart Attack.

The first line of therapy for OSA is weight loss. We will see significant improvement in Obstructive Sleep Apnea, snoring and sleep performance with weight loss. Most of our OSA patients who lose weight find that they will be able to use lower CPAP pressures, may be weaned off of the device, and/or have improved daytime performance.

Low Testosterone

A recent study showed that men with abdominal measurements that exceed their chest circumference have a high likelihood of having low testosterone. In addition it is well known that obesity is associated with low testosterone levels. We find that in men who have low testosterone and are participating in our comprehensive Obesity Medicine Program for the purposes of improving health, testosterone replacement helps in maintaining and improving lean muscle mass, improves insulin sensitivity in diabetics, improves motivation and concentration. If you are concerned about low testosterone and you would like to discuss the risks and benefits of this therapy, we would like to help you with this.

Migraine Headaches

Migraine Headaches are commonly found in women and occasionally in men in our Obesity Medicine population. Several treatments for migraines have also been shown to help in weight loss. In the majority of our migraineurs who lose weight, we will see a significant lessening of symptoms both in frequency and in intensity. Many of our successful migraineurs who lose weight will have a remission of their migraines when they reach a certain weight. We look forward to helping you with this often challenging issue.


Hernias come in a variety of forms. The most common forms that we see here is the Ventral Hernia and the Inguinal Hernia. Ventral Hernia is commonly caused by excessive abdominal obesity that leads to thinning of the abdominal wall musculature. Typically an insult such as surgery or heavy lifting will exacerbate this. Surgical treatment is difficult for this and long term success of the surgery is made more difficult by Obesity. We often receive requests from Surgeons for the Obese individual to lose weight preoperatively in order to improve the long term success of the surgery. Recurrent Inguinal Hernias that are exacerbated by Obesity can also show improved long term success on subsequent operations with weight loss. We look forward to helping you with this often difficult problem.


Hypoglycemia or low blood sugar is a common complaint in an Obese population but one that often stymies their Primary Care Doctor in Management. We find that this is typically caused by a poor diet. Once we have corrected your diet, you will find that this problem will largely resolve.

Obesity Related Psychiatric Disorders

These are numerous and are common reasons for weight gain, failure to lose weight, and weight gain following plateau in post bariatric surgery patients. Additionally, it has been noted that there is a slight increase in attempted and completed suicides in bariatric surgery patients. It is felt that this is due to poorly identified and treated psychiatric conditions and removal of the individual’s chosen treatment option for their psychiatric problem: refined carbohydrates. A brief summary of the common Obesity Related Psychiatric Disorders are listed here. Each of these disorders is regularly seen and treated in our clinic and tends to respond very well to medical therapy.

  • Major Depression: We often find that untreated depression will lead to carbohydrate cravings and self treatment of depression through excess carbohydrate ingestion.
  • Generalized Anxiety Disorder: There is often a cycle wherein the anxious patient will eat because they are anxious, then they gain weight which makes them more anxious.
  • Bipolar Spectrum Disease: Probably the most common untreated/unidentified problem in bariatric surgery patients.
  • Night Eating Syndrome: Regular craving for sweets or starches before bedtime.
  • Sleep Related Eating Disorder: Getting up in the middle of the night, preparing a meal and eating it with varying levels of self awareness of the eating behavior.
  • Binge Eating Disorder: Eating large quantities of food impulsively often until uncomfortably full and then often having feelings of regret for this.
  • Bulimia: This is very similar to Binge Eating Disorder but there is a purging behavior associated with it such as vomiting, laxative abuse, or excessive exercise.
  • Anorexia Nervosa: Intense fear and anxiety of getting fat accompanied by a distorted perception of body image. We generally do not treat this disorder but it is included in this list for the sake of completion.