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VA Study Identifies Factors In Veterans' Weight Changes
- Categorized in: Department of Veterans Affairs (VA), June 2012
Resolving Morbid Obesity to Control Sleep Apnea
A new study from the VA Western New York Healthcare System in Buffalo looks at the relationship of the increasing prevalence of morbid obesity to a greater incidence of sleep-disordered breathing in the general population.1
Noting that the “disproportionate structural characteristics of the pharyngeal airway and the diminished neural regulation of the pharyngeal dilating muscles during sleep predispose the obese patients to pharyngeal airway collapsibility,” the authors added that, “a subgroup of obese apneic patients is unable to compensate for the added load of obesity on the respiratory system, with resultant daytime hypercapnia.”
Poor sleep quality leads to excessive daytime sleepiness, a frequent complaint in this population, the study notes.
Obese patients are also more likely to suffer from narcolepsy, possibly related to the loss of neuropeptides co-localized in hypocretin neurons, according to the report.
The authors note several possible solutions, including monitoring patients for sleep-related eating disorder and night-eating syndrome. Both “are treatable and represent potentially reversible forms of obesity,” they note.
While weight loss from dietary modification and lifestyle changes is the safest approach to resolving obesity and related sleep apnea, it does not always work in the long term. Bariatric surgery is the most immediate way to alleviate sleep apnea, the authors add, but has to be balanced against the risks of the procedures.
1. Akinnusi ME, Saliba R, Porhomayon J, El-Solh AA. Sleep disorders in morbid obesity. Eur J Intern Med. 2012 Apr;23(3):219-26. Epub 2011 Nov 21. PubMed PMID: 22385877.Psychiatr Serv. 2012 Mar 1;63(3):230-6.
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Does VA have an appropriate number of specialty physicians to meet patient-care needs?
I recall during my deployment to Bosnia, the dining facilities were open 24/7, the food was high in calorie content, cans of soft drinks were always available, there was no portion control, and no evidence of a guiding hand by a dietician. I literally watched already overweight soldiers eat their way to a new (larger) uniforme size during a 6 month period.
The following risk factors for weight gain were apparent to me:
1. Uniform design that hides weight. The loose top that is not tucked into the belt hides a lot of fat. Out of sight, out of mind.
2. Generalized ignorance regarding calorie need, calorie content, and calorie consumption during sedentary activity, modest exercise, and strenuous work, in the face of high calorie rations provided to sustain the strenous work of carrying 100+ pounds of body armor and weapons systems during long mountain foot patrols (which not all service members perform).
3. Being in a "stop loss" status (involuntary retention on active duty), where in the rules that discharge overweight servicemembers from active duty are set aside.
4. Lack of portion control / ration adjustment depending on activity level. Active intervention by dieticians could do much to prevent undesired weight gain.