Struggling With the Epidemic
The CDC calculates that in 2000, the United States spent $117 billion on obesity. Furthermore, it was linked with more than 300,000 premature deaths. People with BMIs of 25 and higher are at increased risk for myriad diseases and conditions: hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, angina pectoris, congestive heart failure, stroke, gallstones, gout, osteoarthritis, obstructive sleep apnea and other respiratory problems, cancer, complicated pregnancies, bladder control problems, kidney stones, depression, eating disorders, and low self- esteem.5 Emergence of one or more of these problems associated with excess weight leads to lower quality of life, reduced productivity, increased healthcare spending, and a further taxation of healthcare delivery.
The recent estimates say that the United States spent $33 billion on treating weight loss.2 Apart from too-good-to-be-true over-the-counter supplements promising to shed pounds during sleep, other methods have been employed to promote a reduction in weight. They include bariatric surgery, jaw wiring, stomach balloons (which are no longer used), commercial support groups such as Weight Watchers and Jenny Craig, exercise, behavior modification and psychotherapy, hypnosis, fad diets, medical nutrition therapy by registered dietitians, meal replacements (eg, Slim Fast products), and pharmaceutical agents.
Surgical intervention has taken center stage these days. Tufts University’s Health and Nutrition Letter reports, “More than 63,000 [bariatric] operations were performed in 2002, up from 16,000 10 years earlier.”6 There are numerous procedures—of which extensive coverage is beyond the scope of this paper—but the most popular are gastric bypass (new stomach connected to jejunum) and vertical banded gastroplasty (food trickles into the stomach).
Overall, these procedures are considered an absolute last resort for extremely obese patients who have been unsuccessful on every weight-loss diet, tried prescription medication, group support, and basically anything else under the sun purported to promote weight loss. In these cases, the risks of the surgery are considered less than obesity itself.6,7 Also, patients must undergo evaluation from a nutrition professional and a psychologist before being approved for the surgery. First-rate surgical programs require patients to attend nutrition classes and stop smoking.6 Body image and emotional status are both closely linked with weight and size. Patients must be mentally prepared to undergo surgery, deal with painful and difficult postoperation side effects (eg, diarrhea, vomiting, faintness, and gastric discomfort), and receive education on the proper diet to meet protein, vitamin, and mineral requirements.
Generally, a person with 200 pounds of extra body fat can lose 120 pounds during the first two years after surgery.6 On the flip side, patients can gain all the weight back and more because the stomach can stretch and patients may try to cheat by consuming high-calorie, high-fat foods such as premium ice creams and cream sauces. Liquid items go down easier and are better tolerated, plus they are very satisfying to the taste buds; however, calorically dense foods go against the nutrition recommendations and meal plans patients are expected to follow.
In response to the booming overfatness in American society, hospitals are recruiting surgeons with laparascopic expertise and outfitting surgical suites with state-of-the art video equipment to perform the procedures. Marketing efforts have been stepped up as well. Droves of patients are requesting the procedure. Insurance companies reimburse for some of the $25,000 average cost and recipients pay for the remainder. In looking at the bigger picture, antiobesity surgery can cure and improve a host of the problems mentioned earlier—hypertension, diabetes, dyslipidemia, asthma, heart failure, and sleep apnea—further reducing the demand on our healthcare system.7
The recent estimates say that the United States spent $33 billion on treating weight loss.2 Apart from too-good-to-be-true over-the-counter supplements promising to shed pounds during sleep, other methods have been employed to promote a reduction in weight. They include bariatric surgery, jaw wiring, stomach balloons (which are no longer used), commercial support groups such as Weight Watchers and Jenny Craig, exercise, behavior modification and psychotherapy, hypnosis, fad diets, medical nutrition therapy by registered dietitians, meal replacements (eg, Slim Fast products), and pharmaceutical agents.
Surgical intervention has taken center stage these days. Tufts University’s Health and Nutrition Letter reports, “More than 63,000 [bariatric] operations were performed in 2002, up from 16,000 10 years earlier.”6 There are numerous procedures—of which extensive coverage is beyond the scope of this paper—but the most popular are gastric bypass (new stomach connected to jejunum) and vertical banded gastroplasty (food trickles into the stomach).
Overall, these procedures are considered an absolute last resort for extremely obese patients who have been unsuccessful on every weight-loss diet, tried prescription medication, group support, and basically anything else under the sun purported to promote weight loss. In these cases, the risks of the surgery are considered less than obesity itself.6,7 Also, patients must undergo evaluation from a nutrition professional and a psychologist before being approved for the surgery. First-rate surgical programs require patients to attend nutrition classes and stop smoking.6 Body image and emotional status are both closely linked with weight and size. Patients must be mentally prepared to undergo surgery, deal with painful and difficult postoperation side effects (eg, diarrhea, vomiting, faintness, and gastric discomfort), and receive education on the proper diet to meet protein, vitamin, and mineral requirements.
Generally, a person with 200 pounds of extra body fat can lose 120 pounds during the first two years after surgery.6 On the flip side, patients can gain all the weight back and more because the stomach can stretch and patients may try to cheat by consuming high-calorie, high-fat foods such as premium ice creams and cream sauces. Liquid items go down easier and are better tolerated, plus they are very satisfying to the taste buds; however, calorically dense foods go against the nutrition recommendations and meal plans patients are expected to follow.
In response to the booming overfatness in American society, hospitals are recruiting surgeons with laparascopic expertise and outfitting surgical suites with state-of-the art video equipment to perform the procedures. Marketing efforts have been stepped up as well. Droves of patients are requesting the procedure. Insurance companies reimburse for some of the $25,000 average cost and recipients pay for the remainder. In looking at the bigger picture, antiobesity surgery can cure and improve a host of the problems mentioned earlier—hypertension, diabetes, dyslipidemia, asthma, heart failure, and sleep apnea—further reducing the demand on our healthcare system.7
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