December 1, 2013
By Jonathan Sackier
Weird Al Yankovic parodied two Michael Jackson songs; Beat It became Eat It, celebrating copious consumption, while Bad morphed into Fat, mirroring what is happening in America—our mutation into a fat nation.
Many obese people, while acknowledging their size, deny being unhealthy; this is delusional. Obesity among the young will ensure the next generation has a shorter lifespan than their parents for the first time ever. Carrying excess weight causes heart, lung, brain, joint, skin, and other diseases; predisposes to cancer and social isolation; and wastefully burns 100LL to ship unnecessary freight. Pounds pack on through poor eating and exercise behaviors. Periodic dieting does not work; without fundamental behavioral change, slimming down inevitably is followed by expanding waistlines—the “rhythm method of girth control.” With commitment to change, physician supervision, and certain medications, a svelte you can be attained by acknowledging the problem and a desire to address it.
As a surgeon, I am pleased to report that there are options, especially for those with morbid obesity. Obesity means there is so much of a person that his premature death is inevitable. One calculates body mass index (BMI) by dividing body mass (weight) in kilograms by height in meters squared. Ideal BMI is between 18 and 25; overweight is 25 to 30; obese 30 to 35; above 35 is severe obesity; and above 40 is morbid obesity. If one cannot lose weight with a physician-supervised program, most insurance companies cover surgical approaches when BMI is above 40 or when obesity-induced physical problems—co-morbidities—have developed.
If you are interested in pursuing a surgical solution, choose a surgeon experienced in bariatric discipline, like Dr. Shawn Garber who many moons ago was one of my trainees. He told me, “Our field is constantly evolving and has moved from major operations with large incisions down the center of the belly, to minimally invasive laparoscopic procedures ensuring swifter recovery. Now, through one tiny incision, we insert a video-equipped telescope providing a view of the inside of the belly, and three to four other little cuts allow us to insert grasping, cutting, stapling, and suturing instruments.” Talk to prior patients; many doctors either host or encourage support groups.
You would not add new avionics to your airplane without doing thorough research, so do not rearrange your insides until you know the skinny; operative choices abound and most can be performed under laparoscopic guidance, so get well-informed.
A relatively easy option is an adjustable, inflatable band placed around the top of the stomach, thereby promoting earlier satiety. This works for some people and is also used with lower-BMI patients to treat diabetes.Gastric stapling and Roux-en-Y bypass, a widely-practiced operation, partitions the stomach into a small pouch and bypasses some small bowel. In good hands, weight loss can be dramatic, but postoperative complications merit consideration. Sleeve gastrectomy limits how much one can eat and carries good results.
Other operations are occasionally offered and two fairly recent developments merit mention. Single-incision laparoscopic surgery (SILS) is becoming more widespread; through one small cut inside the umbilicus, doctors place telescope and surgical devices into the abdomen, reducing pain, improving cosmesis, and delighting patients and surgeons alike. Some surgeons use robotic assistance to perform these operations, allowing for very precise procedures with three-dimensional vision. Another new approach undergoing clinical trial evaluation places an inflatable balloon inside the stomach to limit the desire to eat. Although this was tried long ago with limited success, time will tell if the new generation of balloons is better. Additionally, a number of impermeable liners have been developed—placed via the mouth with a flexible endoscope, they allow food to pass but prevent absorption. Early results promise weight loss and reduced severity of diabetes, which frequently accompanies obesity.
New technology also allows specialists like Dr. Garber to revise prior operations by adjusting the re-arranged anatomy via flexible endoscopes. So many new inventions reflect the impact that obesity is having on our country—companies are investing in finding solutions because so many people are so heavy.
I am reminded of Paul Simon’s iconic song Fifty Ways to Leave Your Lover. If you are unhappy with your body mass, do some research and talk to your doctor—because there really are fifty weighs to lose your blubber.
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