Special Report: Demonizing Fat
November 8, 2004
By Jen Christensen
Overweight Americans
Weight is often measured in terms of body mass index (BMI). The figure is obtained by taking body weight (in pounds), dividing that number by height in inches squared and multiplying the result by 704.5. A BMI of 25 to 29.9 is considered as “overweight.” Obesity is defined as a BMI of 30 or higher. Severe obesity is a BMI of 40 or higher. Researchers have also defined two other measures for those who are extremely obese. Superobesity is a BMI greater than 50 and suprasuperobesity (also called massive obesity) is a BMI greater than 60.
Between 1976 and 2000, the number of overweight people in the U.S. climbed from 46 percent to 64.5 percent. The number of obese Americans climbed from 14.4 percent to 30.5 percent. Recent surveys have found the percentage of overweight Americans to finally be holding steady. Currently, the American Obesity Association estimates 127 million Americans are overweight or obese.
Consequences of Excess Weight
Research shows excess weight can take a toll on the body. People who are obese are more likely to have high cholesterol and high triglycerides – conditions that increase the risk of heart disease and stroke. Obesity is associated with increased risk for certain types of cancer, like breast cancer, colorectal cancer, endometrial cancer, kidney cancer and esophageal cancer. A study published last year in the New England Journal of Medicine reported cancer death rates in the severely obese (BMI of 40 or greater) were 52 percent higher for men and 62 percent higher for women, when compared to normal-weight peers.
Obesity increases the risk of development of type 2 diabetes and complicates the ability to manage blood sugar levels. Some other possible health consequences of obesity include: arthritis, respiratory problems, sleep apnea, kidney disease, gallbladder disease, high blood pressure, low back pain, liver disease, urinary incontinence and complications from surgery. The American Obesity Association estimates the condition causes at least 300,000 excess deaths each year in U.S. Healthcare costs associated with obesity are about $100 billion.
Losing Weight: The Options
Weight gain generally occurs because the body takes
in more calories than it needs. Thus, the best way to
lose
weight is to balance energy needs by decreasing
calories and increasing the level of activity. People
who have a lot of weight to lose should seek advice
from a health care provider before starting a diet and
exercise program. Some patients may also benefit from
behavioral counseling and/or medications.
When traditional weight loss attempts fail, doctors may recommend surgery (called bariatric surgery). Obesity surgery aims to decrease body weight by reducing the ability of the body to absorb calories and/or restricting the amount of food that can be held by the stomach. Researchers say more than 45,000 weight loss surgeries were performed in 2001. Most patients lose weight relatively quickly after surgery. The average long-term weight loss for patients having bariatric surgery is about 100 pounds.
Bariatric surgery carries some risks. After surgery, the stomach can hold only a tiny amount of food. Overeating or not chewing food properly can cause nausea, stomach pain and vomiting. Patients may find they are unable to eat certain foods (like diary and sweets). Nutritional deficiency is also a concern, so patients must follow a very healthy diet. About ten percent of patients develop complications, like hernia or leakage and require surgery to correct the problem.
Bariatric surgery is generally reserved for patients with a BMI of 40 or higher, or those with a BMI of 35 to 39.9 who have serious medical conditions. Patients should be fully informed about the benefits and risks of the surgery and be motivated and physically and emotionally capable of participating in lifestyle changes needed to safely maintain weight loss.
Bariatric Surgery for the Super-Obese
Patients who are extremely obese are at high risk of surgery complications and may be denied bariatric surgery. Doctors at the University of Pittsburgh have pioneered a two-step surgical approach that may be safer for high-risk obese patients. In the first step of the treatment patients undergo a laparoscopic sleeve gastrectomy. Surgeons staple a large portion of the stomach, reducing the stomach from about the size and shape of a football to that of a banana. The procedure takes about one hour and is generally well tolerated by most patients. The laparoscopic sleeve gastrectomy enables patients to safely lose a significant amount of weight – often 200 pounds or more. Patients generally reach a weight loss plateau about nine to 12 months later.
The second stage of the procedure is typically done about one year after the first surgery. It involves a laparoscopic Roux-en-Y bypass. Doctors further reduce the size of the remaining stomach (the part that had been turned into a sleeve) to the size of a walnut or plastic medicine cup. Next, the far end of small intestine is cut away from the digestive tract and brought up and connected to the newly created stomach pouch. That process diverts food around most of the small intestine, reducing the ability of the body to absorb nutrients and calories. The combined procedure enables patients to continue to lose weight and be able to maintain the weight loss long-term.
Many doctors consider the Roux-en-Y bypass to be unsafe for super-obese patients. However, by performing the laparoscopic sleeve gastrectomy first, patients can lose weight before undergoing the Roux-en-Y bypass, reducing their risk of complications from the second procedure.
Weight and Societal Expectations: The Downside of Weight Loss
Throughout history, the ideal body image has been shaped by culture. In the late 1800’s excessive weight and a plump body was associated with wealth. But by the turn of the next century, waistlines slimmed and the “hour-glass” figure became the ideal body shape. By the 1970’s and 1980’s women became more health conscious. Aggressive workouts led to thinner, leaner and toned bodies. In the early 1990’s fashion models showed off the tall, unnaturally thin look.
Today, women and men are bombarded by advertisements pushing the “thin” look. Some experts worry the obsession with thinness is becoming unhealthy. People who are overweight yet healthy may be stigmatized or feel pressure to lose weight to conform to a cultural body shape. Those who try to lose weight and are unsuccessful may develop depression or eating disorders. Some health care experts worry patients may also turn to surgery for weight loss, without a full understanding of the risks of the procedure or the skills to cope with the necessary dramatic changes in diet and lifestyle after surgery.
Source:www.hoinews.com
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