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.
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.
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