What defines
obesity?
Obesity is often
measured by a
parameter known
as the body mass
index (BMI),
which takes into
account an individual’s height and weight.
What are the adverse effects of obesity on
health?
Obesity can predispose a person to a variety of
illnesses
including high blood pressure, heart disease,
type II diabetes
mellitus and osteoarthritis. Specific to kidney
transplantation,
obesity is associated with increased:
1. length
of hospital stay,
2. rate of readmission to the
hospital,
3. wound
complications,
4. infections,
5. risk of development
of posttransplant
diabetes mellitus, and
6. risk of kidney transplant
failure.
Can I be ruled out as a transplant
candidate
because of obesity?
Kidney transplantation is associated with an increased
life
expectancy as well as an improved quality of life
compared to
dialysis. Unfortunately, due to the numerous complications
associated with obesity in the kidney transplant
patient,
an individual must have a BMI of less than or
equal to 35 to
qualify for a kidney transplant. Studies have
shown that fewer
than one out of 10 morbidly obese patients on
dialysis will be
able to lose sufficient weight by dieting and
exercising alone
to become eligible for a kidney transplant.
The formula to determine BMI = 703 x your weight
in pounds divided by your height in inches x your height
in inches.
What are my options for weight loss?
Patients at Saint Barnabas Medical Center or Newark Beth
Israel Medical Center who are turned down as a kidney
transplant candidate because of obesity (BMI greater than
35) have the option of participating in our study,
“Therapeutic Options for Obese Kidney Transplant
Candidates”. Study participants will work with a
multidisciplinary weight loss team that includes a dietician,
psychologist, behavioral therapist, exercise physiologist and
nephrologist. In addition, a highly experienced surgeon from
our Centers will explain the potential surgical options for
weight loss, known as bariatric surgery.
What is bariatric surgery?
Bariatric surgery consists of two surgical options for weight
loss: Laparoscopic Adjustable Gastric Banding and Gastric
Bypass procedure. Gastric banding involves the laparoscopic
(minimally invasive) placement of a silicone prosthetic
device around the top portion of stomach leading to a
sensation of early fullness and subsequent decrease in food
consumption. Gastric bypass results in the division of the
stomach into a small upper pouch and a lower, larger,“remnant” pouch, thus limiting the amount of food
consumption. The typical recovery time is 2 to 4 days after
gastric banding and 2 to 4 weeks after gastric bypass surgery.
The surgeon will discuss all the potential side effects of
bariatric surgery at the time of your consultation with the
surgeon.
How fast is the weight loss and when
will I be listed for a kidney transplant?
Individuals need to achieve a BMI of less than or equal to
35 to be actively listed for a kidney transplant. The rate of
weight loss is different among individuals and also depends
on following a good diet and exercise regimen after surgery.
On average, individuals are able to lose over 60 percent of
their excess weight by 9 to 12 months with Gastric Bypass,
allowing them to achieve a BMI of less than or equal to
35 to become eligible for a kidney transplant. For example,
if an individual is 5 feet and 9 inches tall and weighs 265
pounds, he would have a BMI of 39 and would not qualify
for a kidney transplant. After gastric bypass, that individual
would be expected to lose approximately 60 pounds at about
9 to 12 months. The subsequent BMI would be 31 and, as a result, he would qualify for a kidney transplant. On average,
individuals lose 20 percent of their weight with Gastric
Banding.
How do I get enrolled in the weight loss study?
The first step is to make an appointment for a kidney
transplant evaluation. The appointment can be made by
calling Saint Barnabas Medical Center at 973-322-5938
or Newark Beth Israel Medical Center at 973-926-7555.
During the transplant evaluation, the transplant coordinator
and transplant physician will calculate your body mass index
and give you a goal weight to achieve before you can be et a dietician and will
be given the information to make an appointment with the
bariatric surgeon.
Will I be able to gain time on the transplant
wait list as I am losing weight?
If you are otherwise deemed a good transplant candidate at
the transplant evaluation and your BMI is less than or equal
to 40, you can gain time on the transplant list if you are
motivated and willing to engage in an active weight loss
plan. Early listing on the transplant list is important since
the average waiting time for a kidney transplant is 3 to 5
years. You will not be called in for a kidney transplant until
your BMI is less than or equal to 35. In addition, you will
require a re-evaluation 6 months after your initial evaluation
to make sure that progress has been made in regards to
weight loss.
Aside from becoming a transplant candidate,
are there other benefits of weight loss?
Weight loss from bariatric surgery has been associated with:
1. remission of type II diabetes mellitus
2. improvement in control of type II diabetes
3. improvement in cholesterol levels
4. improvement in physical activity levels
5. decreased risk of heart disease
6. improvement in life expectancy
Download a copy of Therapeutic Options for Obese Kidney Transplant
Candidates  .
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