Obesity has been the topic of discussion for several years now and dominates most news outlets daily. Conversation has ranged from diet trends, exercise, surgery, colon cleanses, supplements or prescription medications. The internet is full of claims to cut belly fat, drop 4 dress sizes, or increase metabolism. The fitness industry, tech companies, personal trainers and even doctors have profited from this burgeoning disease state.
But do you find yourself wondering if the war against obesity really matters? Does obesity really increase the cost of healthcare, does it really increase the likelihood of other diseases, and can a person ever reverse it? The resounding answer to those lingering questions is YES, INDEED!
According to the Centers for Disease Control, the cost of obesity in America in 2008 was a $147 billion dollars! During that time frame, an obese person spent approximately $1400 more in medical costs than someone of a normal weight. Do you know what you could do with an extra $1000 per year? Can we say vacation?
A body mass index of 30 or higher is classified as obesity and is calculated based on a person’s height and weight. BMI is an alternative for direct body fat measurement. The amount of body fatness that a person has can be a predictor of future health problems or concerns. Contrary to most beauty shop conversation, BMI is not specific for any particularly ethnicity. Therefore, a 5”3’ woman, regardless of her cultural or ethnic background, should only weigh between 107-135 pounds.
Our bodies were designed to last a lifetime if they are maintained appropriately. Adding increased weight to a small frame increases the gravitational pull and force on our backs, knees and other joints. This added pressure hastens the normal aging process of our joints and causes premature cartilage damage. Patients are now presenting with osteoarthritis in their early forties instead of in the sixth or seventh decade of life.
Joint degeneration becomes a serious issue because once physical therapy and steroid injections have failed to relieve the pain, joint replacement is then the only viable option remaining. Artificial joints have greatly improved over the years but they were never intended for young patients. In addition, surgery to replace a joint is major and comes with serious risks such as infection, leg clots, and possible faulty equipment.
Obesity also affects pregnancy and its outcomes. Obese pregnant patients are at increased risk of gestational diabetes and hypertension. Some private physician groups are refusing to care for obese patients because it increases their medical liability by having patients that are more likely to have complications during delivery such as shoulder dystocia (a baby too big for the canal).
Ok, so what do you do if your doctor has told you that you are obese? The simple answer is MOVE! There is no magic to this formula: you have to expend more energy than you consume. Exercise is a vital part of a healthy lifestyle and there is an exercise for every person. I’m amazed at all of the people that believe that when a doctor recommends exercise that he/she is suggesting you go out and sign up for the next marathon. Slow your roll, my friend! Your doctor simply wants you off the couch for thirty minutes to one hour daily and that time can be done in intervals if necessary.
What about medications such as Xenical, Belviq, and Qsymia? These medications are FDA approved for weight loss but were intended as an adjunct to diet and exercise and at most provide about only a 5% reduction in weight. They are also not void of side effects or other more serious adverse reactions such as gastrointestinal issues and a possibility of heart valve problems. Most non-prescription based weight loss medications except for Alli are not FDA approved for weight loss and the FDA warns against purchasing supplements from another country because they could contain US banned substances.
What if you have done everything in your power to lose weight but to no avail? Should you consider bariatric surgery and what are the options? Again, contemplating surgery is a major life decision and should be discussed carefully with your family, primary care doctor and the surgeon. For those patients whose blood sugars and blood pressures are out of control even on multiple medications, surgery may be the only option. However, a reputable surgeon will require you to consider cognitive behavior therapy, exercise, and a nutritional consultation prior to proceeding with surgery. Your care team wants to insure that if surgery is your choice then you are making an informed decision after carefully weighing your options, you understand the potential risks, and you are willing to do what it takes to maintain the weight loss.
Presently, there are many different procedures used in bariatric surgery such as gastric banding, sleeve gastrectomy, and the traditional bypass. Each of those surgeries carry its own set of risks and complications and it is not guaranteed that it would be covered by your insurance plan. Before even considering paying for such an expensive procedure, many insurers require that the patient has shown some type of effort in weight loss over the last few years.
Obesity discussion is not intended to villainize a large portion of our society but it is intended to spark conversation, ignite change, and improve the health of our country. Let’s move away from embarrassment, ridicule, and stagnancy and progress toward positive outcomes for our community!
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
