Obesity

“I tried it all,” recounts Kathy Freeman, a registered nurse who tried and failed at using weight loss programs throughout her adult life. “As a nurse, I knew the health consequences of obesity, and I knew I didn’t want to live that way.” At age 49, Kathy weighed 299 pounds, was on medications for high blood pressure and chronic joint pain, and was plagued with constant fatigue as a result of the excess weight she carried.

A Treatable Epidemic

By Linda Benton and Natalie Counts

An Alarming Reality

Dr. Jack Rutledge, co-director of Memorial Health Care System’s bariatric surgery program, says that the statistics in America are alarming. Tennessee ranks in the top three most overweight states in the country according to a recent report from the Center for Disease Control. While being slightly overweight may not affect a person’s quality of life, being significantly overweight can.

According to Dr. Rutledge, being 100 pounds overweight can shorten a person’s lifespan by seven years and increase the risks of sleep apnea and other serious illnesses such as diabetes, heart disease and even cancer.

The problem is that “98 percent of people struggling with obesity cannot lose 10 percent of their weight and keep it off for five years,” says Dr. Rutledge. He also notes that there is only a two percent chance that losing weight will realistically work with diet and exercise alone when people do not seek help.

A Costly Issue

Obesity is costing us. According to the National Business Group, obesity costs employers $13 billion per year in related medical and disability claims. Diet and exercise are essential to a healthy lifestyle with or without surgery, and local companies like BlueCross BlueShield of Tennessee are pioneering ways to promote healthy lifestyles among their work force. Their recently launched Well+Wise program provides on-site wellness events and activities that educate and engage employees in making better health decisions. Volkswagen is starting its stay in Chattanooga with a health and wellness center to benefit employees, and Unum also offers health initiatives and incentives. No doubt, the fiscal health of corporate America is linked to the physical health of its workforce.

What Causes Obesity?

Obesity is defined by body mass index (BMI), calculated by a ratio of weight to height formula. An ideal BMI is between 19 and 25; between 26 and 29 is considered overweight; 30+ is considered obese; and 40+ is considered morbidly obese. Generally speaking, being more than 100 pounds overweight is considered morbidly obese.

Obesity is on the rise, and researchers regularly point fingers at various causes: our sedentary society; processed fast foods and junk foods; high fructose corn syrup; as well as genetic, hormonal, psychological and environmental factors. Dr. Jaime Ponce of the Gastric Band Institute, medical director of Hamilton Medical Center’s bariatric surgery program and co-director of Memorial Health Care System’s bariatric surgery program, agrees that lifestyle, environmental factors, and genetics are the culprits. Some people’s genes cause their bodies to store more calories; and coupled with external factors, obesity can be an uphill battle.

Dr. Rutledge stresses the significance of the metabolic changes that take place during the weight loss process. He notes that the need for food is both biological and psychological, and that weight loss, in order to be effective, must be a slow and gradual process if to be achieved through diet and exercise. “Our bodies don’t mind gradual weight gain over time, but they will not tolerate weight loss, especially quickly,” Dr. Rutledge explains. “A lot of times, our bodies override our minds, and as the body loses weight, the body also wants to eat.”

Diet and Exercise

For the average person, the demands of work, family commitments, and pure economics make weight loss a challenge, but with a focus on lifestyle rather than simply dropping pounds, many programs in Chattanooga offer a multidisciplinary approach to healthy and sustained weight loss. Programs like The Sports Barn Evolve program, Erlanger’s Pro-Fit Plus and ProMed/Optifast programs at the Chattanooga Lifestyle Center, Weight Watchers and more have many weight loss success stories. These programs provide nutritional counseling, fitness assessments, training, support, and monitored progress.

Dr. Ponce urges patients to become involved in a monitored program for the “accountability, coaching, and support that is key to success.” Dr. Ponce also notes that about 99 percent of people can be helped through diet and exercise, bariatric surgery, or a combination of the two.

Dr. Rutledge stresses, “Lifestyle is critically important in the weight loss process.”

When It’s Not Enough

When Kathy Freeman, at 299 pounds, realized that she needed more help, she decided to try one last option – bariatric surgery. Twenty-one months post surgery, Kathy now weighs 145 pounds less and no longer needs medications to control her blood pressure or joint pain. “I think it is important for people to realize that bariatric surgery is not the solution; it is one of the stepping stones towards major weight loss,” says Kathy. “Like any weight loss program, I had to make lifestyle changes in diet and exercise to be successful.” And, because the surgery is irreversible, these changes are for life. “And what a life it is,” she adds enthusiastically.

Bariatric Surgery

Dr. Rutledge notes that bariatric surgery for weight loss has been around for many years, but it has not been until fairly recently that the surgery could be performed laparoscopically (with minimal invasiveness), thereby reducing the some of the risks and the recuperation time. Dr. Chris Sanborn, director of bariatric surgery at Erlanger Health System, says the procedure has improved greatly in recent years, with improved medical devices and surgical techniques. “Bariatric surgery is no longer looked at as merely a weight loss surgery,” Sanborn points out. “Now, the surgery is recognized as a way to improve or resolve obesity-related diseases such as diabetes, hypertension, degenerative forms of arthritis and many others. There is also a reduced risk of death from obesity-related causes.”

How does Bariatric Surgery Work?

Essentially, bariatric surgery changes the gastrointestinal structure to make weight loss possible. Bariatric surgeries are generally divided up into three categories: restrictive, malabsorptive, and mixed procedures. Each patient’s situation is unique and careful evaluation by a bariatric surgeon will determine the best approach to desired weight loss.

The restrictive types of surgery are called gastric banding and gastroplasty. These procedures reduce the size of the stomach, and in reducing the size of the stomach, the feeling of fullness can be achieved with a much smaller intake of food. Band and sleeve procedures decrease the amount of food that can be taken into the stomach by either constricting the stomach (band) or actually decreasing the size of the stomach (sleeve). Fewer calories consumed means more weight lost.

The best example of restrictive procedures is the laparoscopic adjustable gastric band. The adjustable gastric band works by placing a prosthetic band around the stomach, creating a constriction or choke point that allows food to collect in a small area of the stomach above the constriction.

The newer procedure is the laparoscopic gastric sleeve resection, also known as the vertical sleeve gastrectomy. It works by creating a small stomach tube by taking out (resecting) the majority of the stomach tissue. While usually thought of as primarily restrictive, the gastric sleeve resection is widely regarded as having a significant hormonal effect by decreasing the levels of one of the hunger hormones (ghrelin) produced by the stomach.

Malabsorptive (intestinal bypass) operations decrease the calories actually absorbed, but they are seldom performed alone and are usually combined with restrictive procedures.

Mixed, restrictive-malabsorptive procedures incorporate both restriction and some degree of malabsorption. The best example of mixed procedures is the laparoscopic Roux-en-Y gastric bypass. This procedure works by the restrictive effect of forming a small stomach pouch and the malabsorptive effect of bypassing some of the early portions of the small intestine. This is done by attaching the small stomach pouch to a portion of the small bowel past the bypassed intestine. Additonally, the procedure has significant effects on the body’s satiety hormones. These hormones are increased and therefore decrease the desire to eat.

Risks and Benefits

As with any surgery, there are always significant risks, and Dr. Sanborn strongly encourages individuals to weigh the risks against the benefits. “Certainly, living with obesity and obesity-related diseases, such as diabetes and heart disease, has its own inherent risks,” he says. Knowing the risks associated with surgery is an important step in the decision making process. It should be noted, however, that a recent study released by the New England Journal of Medicine found that there were no greater risks associated with these types of surgeries than with any other surgical procedure.

Post-surgery complications can include blood clots, infection, and sometimes a tightening at the opening between the intestines and stomach. Vomiting and diarrhea may also occur. Regaining lost weight is also a risk if the diet and exercise protocols are not followed closely.

On the upside, the National Institutes of Health (NIH) evaluated bariatric surgery patients 10 to 15 years after their surgery and found that they were less likely to develop and/or more likely to recover from diabetes and other heart disease risk factors as a result of their weight loss.

Often times not having the surgery presents greater risks than the surgery itself. Surgery solves many health issues. “A person may be on 20 pills a day, and after the surgery only have to take three to five pills,” says Dr. Ponce. He also notes that “surgery resolves diabetes related issues in about 80 percent of cases.”

Success Stories

Kathy Freeman, like many others, says the results of her surgery and her focus on lifestyle changes has exceeded her expectations, and she now enjoys a life full of activities she never thought possible. She has committed herself to helping others with similar obesity issues.

The opportunity to live a fuller life with more confidence and fewer health complications is only the beginning of the rewards gained from weight loss. Whether through diet and exercise alone or through surgical procedures, shedding excess weight pays off in the long-run. A longer, healthier life awaits.

Are You a Candidate for Weight Loss Surgery?

Take the National Institutes of Health assessment quiz. Weight loss surgery might be a choice for you if you meet the first or second of the following criteria and criteria three, four and five:

1. Is your body mass index (BMI) greater than 40? You can calculate your BMI using the following mathematical formula: 703 x (weight ÷ (height x height)). Enter weight as pounds and height as inches.

2. Is your BMI is greater than 35, and do you have obesity-related health problems that could improve with weight loss such as obstructive sleep apnea, severe arthritis, diabetes, or hypertension?

3. Have you failed at losing weight through traditional weight loss methods like diet and exercise?

4. Are you ready to commit to permanent lifestyle changes after surgery? Weight loss surgery is no quick fix, and surgery is only the beginning of a new healthy lifestyle that involves careful monitoring of food intake and strict adherence to a fitness program for life.

5. Do you understand the risks and benefits of weight loss surgery?

As with any surgical procedure, it is essential to be well-informed before considering weight loss surgery. The benefits of surgery and the risks of remaining obese should be should considered carefully.

Linda Benton is a resident of Signal Mountain. She earned the distinction of Magna cum Laude with a BBA in Marketing from the University of Memphis. Linda has been an active member and leader of community and health organizations. She is married to Dr. Oliver Benton III and has three children.