THE WEIGHT EQUATION

What exactly is weight? Physics defines weight as a force measured in Newtons. Force is calculated by multiplying the mass of an object in kilograms by acceleration in meters per second squared (m/sec2). For our purposes on earth, acceleration is the effect of gravity, or 9.8 m/s2.
Weight or Force (Newtons) = mass (kg) x acceleration (m/sec2).
The mass of an object is more difficult to define but in general terms it is a fundamental measure of the “amount of matter” present in an object. In lay language, we tend to use weight and mass interchangeably but in physics they are distinctly different entities. If we lived on the moon or in outer space where gravitational forces are lower, then theoretically our weight would be lower (but our mass would remain constant). I guess one way to lose weight quickly would be to orbit the earth in space for a few days where gravity (acceleration) is low, but you would gain it back just as quickly when you return. Short of toying with gravitational acceleration, we have to be content with decreasing our body mass in order to lose “weight”.
In regular verbiage, we tend to say that we have “gained or lost weight” to mean that we have “gained or lost mass.” Therefore short of traveling through space, the fundamental question then becomes why do we gain or lose weight over time. The best way of looking at weight gain or loss is to relate it to the amount of energy taken in or put out of our body over time. One of the fundamental laws of physics is that energy is not destroyed; it just changes form over time. For example, when we turn on the gas oven to cook food, we are converting chemical energy (natural gas) mostly into heat energy (to cook), and light energy (the blue flame we see). Similarly, long term fluctuation in body weight is a reflection of the input of energy into the body versus the output of energy from the body over time. I’m not talking about the one or twp pounds you “gain or lose” over a few days. Rather concerned with the steady weight gain that occurs over months and years that sticks with you.
If energy input exceeds energy output over a period of time, weight gain occurs. If the reverse is true and energy output exceeds energy input, then weight loss occurs. If energy input and energy output are equal, then weight does not change. These relationships are summarized below.
ENERGY INPUT > ENERGY OUTPUT INCREASE IN WEIGHT
ENERGY INPUT< ENERGY OUTPUT DECREASE IN WEIGHT
ENERGY INPUT = ENERGY OUTPUT NO CHANGES IN WEIGHT
Sounds simple? It would be if energy input and energy output factors did not change over one’s lifetime. When we talk about energy input and energy output in terms of the body, we are essentially talking about calorie input and output. Human input and output of calories is highly dependent on the interaction of numerous societal, psychological, physiological and time dependent factors. But before we get further into the reason why weight gain occurs, we have to define some of the terms that we use frequently when we talk about weight gain or loss, diets, and energy.

CHILDREN AND OBESITY

There is real cause for concern with the current rise in obesity rates of children. According to recent statistics, the rate of childhood obesity has tripled for children and adolescents between the age of 6 and 19. In addition, it is estimated that a third of all children and adolescents in the United States are either already obese or at increased risk for becoming obese. Childhood obesity rates have increased substantially because of dietary and social factors. According to a 10-year study by the National Health and Nutrition Examination Survey (NHANES), overweight teens in the United States consume anywhere between 700-1000 calories more than the required daily allowance. This excessive intake of calories has resulted in an average weight gain of 58 extra pounds for teenagers. Even children and teens who are not overweight consumed 110-165 calories more than was required, leading to an average weight gain of 10 pounds of extra body weight over the study period. There have been numerous recommendations made as consequence of this study in order to try and reduce teen obesity rates. These recommendations include reducing consumption of sodas, which could save 150 calories per can. Increasing healthy food consumption in place of snacking as well as eating at home will tend to decrease overall calorie intake. In terms of activity levels, it has been recommended that teens spend less time watching television and more time exercising and playing. Regular physical education classes are advised in order to help kids burn the extra calories.
Childhood obesity has resulted in a significant increase in Type 2 diabetes in kids. We used to call Type 2 diabetes “adult onset diabetes” because it occurred mostly in adults. However, pediatricians are now finding that many of their diabetic kids are type 2 diabetics as a result of being overweight, rather than the typical type 1 (juvenile onset) diabetics that they used to encounter years ago. Part of the problem with overweight kids is poor choices in diet from an early age. The American Academy of Pediatrics recommends that kids between the ages of 6 months to 6 years drink less than 6 ounces of fruit juice daily. In addition, kids between the ages of 6 to 12 years should limit their intake of sweetened liquids such as sports drinks and sodas to less than 12 ounces a day.
The epidemic of childhood obesity is confounded by the fact that most parents don’t recognize that their own kids are overweight or obese. In a recent study on overweight or obese children between the ages of 6 to 11, 43% of parents thought that their kids were “about the right weight.” Another 37% of parents thought their child was “slightly overweight”, while only 13% recognized their child as being “very overweight.” For obese children in the 12-17 age group, 11% of parents thought their child was “about the right weight”, while 56% voted for “slightly overweight”, and 31% voted for “very overweight.” A small percentage of parents of these obese children thought that their kids were “slightly underweight!” These were kids who were all documented by clinical criteria to be obese! Now this result means that either parents have a distorted body image, or they don’t want to face the obvious fact that their children are overweight or obese.

WHAT’S WRONG WITH BEING OVERWEIGHT?

So why are we so concerned about weight gain, apart from the aesthetic value? What are the potential health problems associated with weight gain? An estimated 300,000 adults in the United States die annually of obesity-related diseases. It has been well documented that being overweight with a BMI greater than 25 kg/m2 is associated with early death. With each incremental increase in BMI over 25 kg/m2, there is a commensurate increase in the risk for early death. The risk becomes particularly high when BMI exceeds 30 kg/m2. It has also been estimated that obese male patients have a life expectancy 3 to 7 years less than their non-obese counterparts. Obese women have a life expectancy 3.3 years less than their non-obese counterparts. Even a moderate increase in weight of approximately 20 pounds over the ideal body weight increases the risk of death, particularly for adults between the age of 30 and 64. A complete list of complications associated with obesity is shown below.
Cardiovascular
High Blood Pressure
Congestive Heart Failure
Right Heart Failure
Varicose Veins
Pulmonary Embolism
Coronary Artery Disease
Endocrine
Metabolic Syndrome
Type 2 Diabetes
Elevated Cholesterol and Triglycerides
Polycystic Ovarian Syndrome
Menstrual Cycle Disorders (female)
Gastointestinal
Gastroesophageal reflux disease (GERD)
Non-alcoholic fatty liver disease (NAFLD)
Cholelithiasis
Hernias
Colon cancer
Genitourinary
Urinary Stress incontinence
Obesity-related glomerulopathy
Hypogonadism (male)
Breast and uterine cancer (female)
Pregnancy complications
Integument
Striae distensae (stretch marks)
Status pigmentation of legs
Lymphedema
Cellulitis
Intertrigo, carbuncles
Acanthosis nigricans/skin tags
Musculoskeletal
Hyperuricemia and gout
Immobility Osteoarthritis (knees, hips)
Low back pain
Psychological
Depression/low self esteem
Body image disturbance
Social stigmatization
Neurologic
Stroke
Idiopathic intracranial hypertension
Meralgia paresthetica
Respiratory
Dyspnia
Obstructive sleep apnea
Hypoventilation syndrome
Pickwickian syndrome
Asthma

Let’s consider some of the co-morbidities associated with obesity and being overweight individually, since they are particularly important for cardiovascular disease and other frequent illnesses. Please excuse the density of the information, because there is lots of data and talk of risk factors. I want to impress on you the importance of taking control of your situation, because it is easier to prevent problems rather than treating them after they occur.
1. Hypertension: The recommended target blood pressure is less than 140 mmHg systolic (top number) and less than 90 mmHg diastolic (bottom number). A BMI greater than 30 kg/m2 is associated with a higher risk for hypertension. For example, approximately 30% of men and 32% of women with a BMI greater than 30 kg/m2 are hypertensive, as compared to 18% of men and 16% of women with a BMI less than 25 kg/m2. Why is this factor an important issue? Chronically elevated blood pressure, especially if poorly controlled, increases one’s risk for heart artery blockages and heart attacks, neck artery blockages and strokes, leg artery blockages and difficulty walking as well as possible loss of limb, kidney failure, congestive heart failure, and many other problems. Unfortunately, we have done a poor job in controlling hypertension, even in the general population. It has been documented that 32% of Americans with hypertension don’t even know they have high blood pressure. Another 15% of Americans with hypertension know they have high blood pressure, but are not being treated. Of the 53% of patients with hypertension who are being treated, only one half of them have adequate control of their blood pressure. Summarizing these statistics we find that only 27% of Americans with hypertension have adequate control of their blood pressure.
2. High cholesterol: A BMI level greater than 25 kg/m2 increases ones risk for high cholesterol levels. The ideal cholesterol level is less than 200 mg/dL. Cholesterol level is subcategorized into HDL (good cholesterol), and LDL (bad cholesterol). HDL levels in men greater than 40 mg/dL and in women greater than 50 mg/dL are protective against heart disease. HDL levels are elevated through regular physical activity such as walking 4-5 times a week for 30 minutes a day at a moderate pace. LDL cholesterol levels should ideally be less than 100 mg/dL. LDL cholesterol levels can be decreased by adopting a low cholesterol diet and taking medication. A cholesterol level greater than 240 mg/dL increases the risk for heart disease by 200%. Normal serum triglycerides should be less than 150 mg/dL. A high serum triglyceride level increases the risk for heart attacks, strokes, and other circulation problems. Triglycerides can be controlled through diet, exercise, and medication. The recommended lipid levels are summarized in the table below.
Lipid Type Recommended Level
Total Cholesterol <200 mg/dL
LDL Cholesterol (bad cholesterol) <100 mg/dL
HDL Cholesterol (good cholesterol) >40 mg/dL in men
>50 mg/dL in women
Serum Triglycerides <150 mg/dL
3. Diabetes: Type 2 diabetes is a condition in which the body either does not react normally to insulin that is produced in response to elevated blood sugar levels, or insulin is not produced in adequate amounts. Diabetes increases the risk of heart disease as well as blockages of other blood vessels in the body. The detrimental effects of poor diabetes control are so profound that it would take another book to just discuss that topic. If you are diabetic, good control of your blood sugar is so important to prevent problems years down the line such as hardening of the arteries, kidney failure, infections, and loss of limbs due to poor circulation. It has been estimated that the relative risk of diabetes increases by approximately 25% for each additional unit of BMI over 22 kg/m2.
4. Coronary artery disease: The risk for both fatal and non-fatal heart attacks increases in men and women with increasing BMI. Below a BMI of 22 kg/m2, the risk of heart problems at an early age is low. As compared to people with a BMI of less than 22 kg/m2, those with a BMI between 25 to 28.9 kg/m2 have twice the risk of coronary heart disease, while those with a BMI greater than 29 kg/m2 have three times the risk of coronary artery disease. It has also been estimated that a 5 to 8 kg gain in body weight increases ones risk for heart disease related death by 25%. If the weight gain is over 20 kg, then the increased risk for heart attacks and heart disease is 250%. A British study has demonstrated that with each 1 kg/m2 increase in BMI over 22 kg/m2, the risk of coronary artery disease increases by 10%. Clearly, the link between elevated BMI and coronary artery disease and coronary artery related deaths is very strong.
5. Congestive heart failure: Congestive heart failure is a frequent cause of death in overweight patients. Obesity results in excessive strain on cardiac function, leading to thickening of the heart muscle. Chronic strain and thickening of the heart muscle lead to subsequent heart chamber failure. Duration of obesity in years is a strong predictor of developing congestive heart failure.
6. Stroke: There is an approximately 75% increased risk of stroke in women with a BMI greater than 27 kg/m2 and a 135% increased risk of stroke in women with a BMI greater than 32 kg/m2 as compared to women with a BMI less than 21 kg/m2.
7. Gallstones: Women with a BMI greater than 40 kg/m2 have approximately a 20 out of 1000 chance of having gallstones or the need for gallbladder surgery, as compared to 3 out of 1000 women with a BMI less than 24 kg/m2.
8. Arthritis: Increased weight has been associated with increased risk for developing arthritis of the knee and possibly of the hip. Arthritis is known to be the number one cause for workplace disability. More than 70% of women and 30% of men with arthritis of the knee are overweight.
9. Sleep apnea: Sleep apnea is defined as a condition in which the individual does not breathe involuntarily for more than 10 seconds while sleeping. These episodes can occur many times throughout the sleep cycle, leading to poor sleep quality and fatigue the next day. Sometimes, the breathe is held so long that the body’s oxygen level gets very low, leading to heart irregularities. People with sleep apnea have a higher risk for strokes and heart attacks. Sleep apnea has been strongly associated with having a BMI level greater than 30 kg/m2. In addition, neck circumference seems to correlate with the risk of sleep apnea. Men with a neck circumference greater than 17 inches and women with a neck circumference greater than 16 inches are at a higher risk for sleep apnea.
10. Cancer: There is an increased risk for certain cancers associated with obesity. Initially, it was thought that being overweight was only linked to an increased risk of colon and breast cancers. However, obesity has recently been associated with an increased risk for colorectal cancer, postmenopausal breast cancer, endometrial cancer, pancreatic cancer, and esophageal cancer. The exact mechanism for this increased risk of cancer is not known. Recent reports from Sweden and the United States which have shown an improved survival at 10 years in patients who underwent weight loss surgery as compared to those who did not have weight loss surgery also showed some unexpected and exciting results. In the American arm of the study, it was found that the surgical group of patients had a 60% lesser chance of dying from cancer than the non-surgical group. In the Swedish arm of the trial, there appeared to be a decreased risk of developing certain cancers such as non-Hodgkin’s lymphoma, cervical, ovarian, and prostate cancers. However, further studies are needed to definitely prove that weight loss leads to a decreased risk of cancer and cancer deaths.

STATISTICS, PREVALENCE AND WORLDWIDE TRENDS OF OBESITY
In 1991, only 4 states in the U.S.A. had obesity prevalence rates between 15% and 19%, and no state had prevalence rates greater than 20%. In contrast, by the year 2000, only 4 states had an obesity prevalence rate less than 20%. Louisiana, Mississippi and West Virginia had obesity prevalence rates greater than 30%. In terms of the overall population, recent statistics show that the prevalence of being either obese (BMI greater than 30 kg/m2) or overweight, (BMI between 25-29.9 kg/m2) for someone 20 years or older in the United States is 67% for men and 57% for women. That means that over 97 million Americans are either overweight or obese, and that number is increasing. Approximately 30% percent of the entire female and 28% of the entire male population of the United States are classified as being obese. There are differences across racial and sex lines in the prevalence of obesity. For example, approximately 50% of African-American woman are obese, as compared to 40% of Hispanic women and 30% of White women. Hispanic men have a rate of being either overweight or obese of 75%, as compared to 67% of White men, and 61% of African-American men. The incidence of obesity also varies with age. Both men and women have an increased prevalence of being overweight or obese until the age of 60, after which time the prevalence decreases. Socioeconomic factors play a role, with lower income women tending to have a higher prevalence of being overweight or obese. Remember, as with all statistics, these numbers are just information about the general population. If you personally have a BMI greater than 30 kg/m2, it does not matter if you are Black, White, Hispanic, or God forbid Armenian, you are classified as being obese 100% of the time! The overall statistics for sex and race related to the risk for obesity are illustrated in the table below.

Increase in Overweight and Obesity Prevalence Among U.S. Adults* by Racial and Ethnic Group

Source: CDC, National Center for Health Statistics, National Health and Nutrition Examination Survey. Flegal et. al. JAMA. 2002; 288:1723-7 and IJO. 1998;22:39-47. *Ages 20 and older for 1999 to 2000 and ages 20 to 74 for 1988 to 1994.

The obesity statistics for children are even more troubling. Up to one-third of children and adolescents in the United States are either obese or considered at risk for becoming obese. These kids are above the 95th percentile for weight in the height-weight charts. The rate of being overweight or obese has doubled for children over the past 2 decades. The steady increase in childhood obesity takes on special meaning when one considers the long-term implications of being overweight for children. The relationship between childhood and adult obesity is especially strong. If the child is obese at age 4, then he or she has a 20% chance of being an obese adult. If an adolescent is obese, then he or she has an 80% chance of being obese as an adult. Surely prevention of childhood obesity must be thought of as a national crisis and tackled now to prevent years of future medical, emotional, and financial problems for both the individual and society. There is no doubt that the United States has one of the highest rates of being overweight or obese, but do other countries having similar problems? The International Obesity Task Force (IOTF) estimates that 300 million people worldwide are obese. Statistics show that even in developing countries there is a steady rise in obesity rates.

Rather surprisingly, the latest statistics for Europe show that Finland, Germany, Greece, Cyprus, the Czech Republic, Slovakia and Malta have higher rates of being overweight than the United States. There is also an increasing epidemic of childhood obesity in Europe as there is in the U.S.A. England and Poland are noted to have the steepest acceleration in childhood obesity rates. Malta, Sicily, Gibraltar, Crete, Spain, Portugal, and Italy now report that greater than 30% of children between the ages of 7 and 11 are overweight or obese. Crete, England, Italy, Cyprus, Republic of Ireland, Greece, Bulgaria, and Spain report that greater than 20% of children between the ages of 13 to 17 are either overweight or obese. A problem that seemed to be initially limited to the United States is now rapidly becoming a global health issue.

What The Presence of Excess Abdominal Wall Fat Means to You

Research has demonstrated that the presence of extra fat around the abdomen also increases one’s risks for the co-morbidities of high blood pressure, diabetes, and high cholesterol level, as well as early death. This finding is due to the fact that extra fat around the abdomen tends to correlate well with the presence of extra total body fat. In addition, fat in the abdominal area tends to carry a higher risk for cardiovascular disease than fat in other areas of the body. A big belly is indeed more dangerous than a big booty! In that case, J. Lo. should be pretty much immortal! In men, a waist circumference greater than 40 inches is an independent predictor for the co-morbidities that contribute to an elevated risk for cardiovascular disease and death. In women, this number is 35 inches.
These 2 independent factors are used to define a patients’ increased risk for cardiovascular disease. The table below illustrates the degree of risk when BMI and waist circumference are combined to assess the risks for cardiovascular disease in an overweight or obese individual.

Table of BMI and Waist Circumference and Classification of Risk

WHAT DEFINES ONE AS BEING OBESE OR OVERWEIGHT?

A recent Center for Disease Control (CDC) study concluded that approximately 60% of Americans are either obese or overweight. What defines one as being “obese” versus “overweight”? For scientific purposes, as well as for planning treatment, these definitions are extremely important. Essentially, someone is overweight or obese if they have extra body fat. Excessive amounts of body fat may be aesthetically displeasing, but it also increases one’s risk for certain medical problems. These medical conditions, the so called co-morbidities, include high blood pressure, type 2 diabetes and high cholesterol levels. These particular co-morbidities substantially increase ones risk for cardiovascular diseases such as heart artery blockages, stroke, and loss of limb due to peripheral vascular disease. There are numerous other factors associated with obesity including sleep apnea that we will discuss in depth in another section.






To actually measure the amount of body fat, there are accurate but cumbersome techniques that are not readily available to most physicians. An indirect method of estimating body fat has been developed that is easy to use and replicate, and can be used to track fat weight gain or loss over time. This measurement is called the Body Mass Index (BMI), and is calculated by taking body weight in kilograms (kg) and dividing it by the square of height in meters (m2), or in equation form:
BMI = Weight (kg)/ Height squared (m2)
If one measures BMI in pounds (lbs) and inches (in), this calculation becomes:
BMI = Weight (lbs) x 703/ Height squared (in2)
An individual is defined as having a healthy weight if their BMI is between 18.5-24.9 kg/m2. If their BMI is between 25.0 and 29.9 kg/m2, then they are considered to be overweight. If the BMI is greater than 30 kg/m2, then they are considered as being obese. There is even a sub-categorization of obesity into mild (BMI 30-34.9 kg/m2), moderate (BMI 35-39.9 kg/m2), and severe (BMI greater than 40 kg/m2). The easiest way to figure out your BMI is to use a BMI table such as the one reprinted below. Where do you fall on that table in terms of normal, overweight and obese?

Table of BMI as Compared to Weight and Height in kg/m2

BMI Measurement in kg/m2

18.5 or less Underweight

18.5-24.9 Normal
25.0-29.9 Overweight

30.0-34.9 Mild Obese

35.0-39.9 Moderate Obese

40 or greater Severe Obese
50 or greater Super Obese

There are caveats to using BMI as an estimation of total body fat content, and one has to put BMI measurement into clinical context. For example, a bodybuilder may have a large muscle mass that contributes an inordinate amount to their overall body weight. Elevated weight due to extra muscle mass will lead to a higher BMI that might fall in the obesity range based on calculation of weight divided by height squared. However, professional bodybuilders are clearly not obese. Before you think that you are not overweight based on this description, please look in the mirror. If you think you look like the Incredible Hulk, but your silhouette more closely resembles a Bartlett Pear or the Pillsbury Doughboy, then you probably don’t qualify for the bodybuilder exemption! Let’s take another less obvious example, an individual who is 6’3” tall and weighs 218 pounds. This person’s calculated BMI is 27.2 kg/m2, which according to the BMI table falls in the overweight range. I don’t think anyone would consider National Football League wide receiver Terrell Owens as being overweight, but he is listed at 6’3” and between 218-223 pounds with 5% measured body fat.
However, for the most part, BMI is a useful tool to estimate and track the average person’s level of “over-weightedness”. So why is BMI important to calculate when dealing with excess body fat? This whole business of weight, obesity, co-morbidities, and cardiovascular disease is a matter of balancing risks and risk factors. It has clearly been documented that having a BMI greater than 25 kg/m2 due to extra body fat increases ones risk for certain medical problems and premature death. The risk increases slowly as BMI increases until a level of 30 kg/m2 is reached. Above that point, the risk of significant cardiovascular disease and early death significantly increases. Why is that? Having a BMI greater than 25 kg/m2 increases one’s likelihood of suffering from hypertension, sleep apnea, high cholesterol level, diabetes, and a whole host of other medical problems. Some of these co-morbidities increase one’s risk for significant cardiovascular disease and heart artery blockages, leading to an increased chance of for fatal as well as non-fatal heart attacks as well as early death. The higher the BMI, the higher the risk for cardiovascular disease and death, particularly above a BMI of 30 kg/m2. Does everyone with high blood pressure, high cholesterol or diabetes die at an earlier age than their counterparts who don’t have these conditions? Not necessarily so, but the chances are higher that one will die earlier if one has these problems due to obesity. That is why your internist, family doctor, or cardiologist is pushing the so called Statin drugs such as Lipitor and Pravachol, when your total cholesterol level is only slightly elevated, or even in the normal range, but you had heart disease at an early age. People don’t like taking Statin drugs because of the potential side effects of muscle pain or liver damage. However, these medications have been shown quite clearly to lower the risk of recurrent heart attacks and even death in high risk populations. In fact, it has recently been demonstrated that patients without what is termed a “q-wave” on their EKG at the time of their heart attack did as well with medical management with Statins and other medications as with aggressive treatments such as angiography and coronary artery angioplasty.
Now an individual with a BMI less than 25 kg/m2 can still suffer from high blood pressure, diabetes, or high cholesterol. These people also have an increased risk for heart disease, stroke, and death independent of their body weight. Often, this population has a very strong family history of heart disease and heart attacks at an early age, or a long history of smoking cigarettes. But in general, people with a BMI greater than 25 kg/m2 have a higher chance of having the medical co-morbid conditions as compared to people with a BMI less than 25 kg/m2. These co-morbidities subsequently increase the risk of cardiovascular disease such as heart attacks, congestive heart failure, and death.
Another marker for extra body fat is the waist circumference. Waist measurement is made just above the pelvic bone on the side, not at the level of the belly button. This measurement is shown in the illustration below.

Measurement of Waist Circumference

The Inside Truth About Weight Loss And Weight Loss Surgery

A book that explains your options, whether you choose conservative management or surgical intervention for treatment of obesity.

UNDER THE KNIFE THE INSIDE TRUTH ABOUT WEIGHT LOSS AND WEIGHT LOSS SURGERY: A SURGEON’S PERSPECTIVE
1. Summary of content
2. The blog itself

a. Summary of the problem
b. What defines one as being either overweight or obese?
c. Statistics, prevalence and worldwide trends of obesity
d. What’s wrong with being overweight?
The risk factors or co-morbidities to obesity
The medical consequences of being overweight or obese
Social and psychological consequences of being overweight or obese
Cancer risks of obesity
e. Children and obesity
f. The weight equation
g. Calories defined
h. Why do people gain weight? The time line of weight gain
i. Eating disorders, depression, and weight gain
j. Smoking cessation and weight gain
k. Societal influences, advertising, television and weight gain
l. Industry’s contribution to obesity
m. Work-up of obesity and weight gain
n. Evidence for the benefits of weight loss on reduction of risk factors for cardiovascular disease
o. General guidelines for diet and exercise
p. The role of medication in management of obesity
q. Are there any benefits to supplements for weight loss?
r. My recommendations for exercising
s. My recommendation for changing your eating habits
t. If all else fails, and you consider surgery
Who should have weight loss surgery?
Is surgery effective for weight loss and reducing the risks of obesity?
What bariatric procedures are available?
Complications and costs of weight loss surgery
Which surgeon will you pick for your surgery?
How do you pick the facility where you will have your surgery?
13 important questions to ask the surgeon prior to committing to bariatric surgery
A list of accredited facilities and surgeons for bariatric surgery





SUMMARY OF THE PROBLEM
If 25-30% of a certain population contracts a disease, wouldn’t we classify it as having reached epidemic proportions? Well, consider that over 30% of the population in some areas of the United States meets the medical criteria for obesity. More than 97 million Americans are either overweight or obese. These statistics on obesity and weight are just the tip of the iceberg. You can appreciate the problems we will face as a country or as citizens of the world as the incidence of obesity increases over the next 5 to 10 years unabated. In contrast, it has been estimated that between 1 and 1.2 million people are living with the HIV virus in America, and that more than ½ million people have died from AIDS. I am not trying to diminish the worldwide personal and family devastation that HIV and AIDS have caused. But shouldn’t we be taking the issue of obesity a little bit more seriously, in light of the fact that being overweight exposes us to so many other disease problems and shortens our life on average anywhere between 3 to 7 years? Obesity is not a health issue confined to the United States. Many of the studies on the diagnosis of obesity and its treatment options are reaching us from other areas of the world. Even Sweden, which has traditionally been thought of as having a healthy society is not immune from this epidemic. For example, the incidence of obesity in Sweden has risen from 6.4% to 14.8% for men and 7.2% to 11% for women over the past 10 years.
So why is the incidence of obesity on the rise? A certain proportion of the general population has always had problems with weight control, but in the past they were considered the minority. Now, we have Internet websites declaring Houston or Dallas as the “fattest city” in the United States. Obesity is not a viral illness, spread from person-to-person by contact or close interaction, much like the flu; however, I will submit to you that obesity does have characteristics much like a viral illness. For example, it has been documented quite clearly that families and close friends tend to exhibit an uncanny ability to gain weight in parallel. According to a recent report from the prestigious New England Journal of Medicine, friends tend to behave similarly in terms of weight gain even if they become separated by a large geographic gap. The numbers are really quite striking. If a good friend of yours is obese, then you have a 60% chance of being obese. If your sibling is obese, your risk for being obese is 40%. If your spouse gains weight, then you have a 37% chance of gaining weight in sympathy with him or her. So much for Jack Spratt who ate no fat and his wife who ate no lean! This finding may be the explained by the possibility that people tend to hang out with people who look and think like themselves. However, another more worrisome alternative explanation is that our idea of body image is altered by the people around us, and what seemed to be aberrant years ago is now the norm. Obviously, there is more to weight gain than simply overeating. There has been a change over time in the way society views body weight, physical activity, and social norms.
Weight gain therefore cannot be just a simple matter of overeating and not exercising enough. Rather, obesity represents a complex interaction with many personal, genetic, familial, and psychological factors that influence both sides of the weight equation. The financial implications to society, as well as the individual, are profound. The medical consequences of obesity are critical, with decreased life expectancy in obese individuals as compared to their non-obese counterparts. The social consequences of obesity are often overlooked and swept under the carpet, but there are very real human psychological costs to weight gain.
It has been estimated that obesity related diseases cost the United States 51.6 billion dollars in terms of direct patient care, and 47.6 billion dollars in indirect costs in 1995. These numbers add up to a total cost attributable to obesity of over 99 billion dollars, or 5.7 % of the national health care expenditure in the United States. The latest estimates in 2007 suggest that the total cost of obesity related diseases in the United States is over 110 billion dollars, or 9% of the national health care expenditure. When one considers the rising tide of childhood obesity, then future societal implications for the United States and the rest of the world become even more profound. Management of teen obesity 15 to 20 years down the line will dwarf the problems we currently face with adults.
The medical community has been slow to acknowledge and respond to the obesity epidemic. There are many weight loss centers run by well intentioned people with good programs, but your average internist, family practitioner and surgeon does not know or is not taught the fundamentals of weight control in medical school, internship, or residency. There is very little interest in the primary care community in developing weight control programs as part of general practice because it is perceived to be a lot of work with little personal and financial reward for the physician. Surgeons are interested in weight loss because the financial reimbursement for bariatric surgery is high. A good laparoscopic surgeon can perform these procedures in less than one hour and the patient can be discharged within 24 hours. Remember that weight loss surgery only serves to reduce calorie intake and absorption. There is lack of a comprehensive approach by the medical community to weight loss, with lifelong surveillance and care. Obesity is not cured by gastric bypass surgery or Lap Band surgery. There are plenty of opportunities to “eat around” these various ways of restricting oral intake and continue to gain weight despite the weight loss procedure. The idea of prevention in medicine has again taken a back seat to attempts at curing the disease after the fact.
In this book, I hope to point out the magnitude of the problem, and stress the critical importance to not just society, but also to the individual with the weight problem. I will also try to illuminate the reasons why we are gaining so much weight, including the dangers we face and how we can address these factors. In addition, I will condense for you the best in evidence-based medicine, medicine based on what scientific evidence shows has a beneficial effect on weight loss. Weight control is not just about dieting or exercising; it is about a comprehensive and fundamental change in the way we look at the way we lead our lives. I will lead you through a step-by-step common sense program for altering the way you eat. In addition, I will introduce you to an exercise program with measured metrics of performance and success which you can use to gauge your progress.
At the end of the book, I will offer insight in what to do if all else fails, and one is considering weight loss surgery. Who we pick to perform these procedures and the facility where they are performed have a profound effect on how well one does and how one recovers from surgery. As one of my friends, a cardiac surgeon, used to say about his work, “this ain’t hernia surgery”. The potential complications from weight loss surgery can be profound and you need to pick the best person and place to have the procedure performed if all else fails.