By Becky Wiese
If obesity were a virus, its current levels of “infection” would correctly be called an epidemic. Preventative measures to ensure we didn’t “catch” it would abound. We might even be a little panicked. Maybe that’s why Americans spend more than $60 billion a year on diet programs and products.
But in spite of an excellent supply of healthy food choices, constant diet options, and endless exercise possibilities, we still don’t have the obesity epidemic under control. The statistics regarding the prevalence of obesity in the U.S. are frightening.
Data from the Center for Disease Control (CDC) show that more than a third of adults in the U.S. are affected by obesity, and almost 70 percent are overweight. Yet, this tidal wave of the obesity “bug” and the many health issues that accompany it don’t seem to be sounding alarms.
Americans are not the only ones dealing (or not dealing, as the case may be) with such a weighty malady. Studies by the United Nations show that there are now more people in the world who are overweight or obese than there are who are suffering from hunger and starvation.
The epidemic of obesity is also costly, both in economic terms and in terms of additional health problems caused by or exacerbated by excess weight. While this information may not be new, prevention and treatment for obesity certainly doesn’t carry the same urgency as maladies such as measles, Ebola, or Zika. Perhaps it should.
Obesity as a Disease
Dr. Sidney Rohrscheib, a board-certified general surgeon, founded the Illinois Bariatric Center for the express purpose of fighting the obesity epidemic. “Even though weight loss programs have multiplied over the past 15–20 years, obesity is still undertreated and overlooked as a diagnosis,” he says. Patients and even some physicians tend to avoid the topic or, at the very least, have a casual perspective about weight even when obvious comorbidities such as diabetes, heart disease, and high blood pressure result.
Why? “The pervading message in society is that obesity is something that should be controllable,” says Dr. Rohrscheib. “Many obese patients, even morbidly obese patients, are still hopeful that they can treat themselves with yet another diet plan and new exercise regimen—or, conversely, they give up.”
Unfortunately, this would be like a cardiac patient trying fix their heart problem on their own. At some point, surgical intervention is necessary—diet, medication, and physical exercise aren’t enough when arteries are completely blocked.
Both the World Health Organization and the American Medical Association now recognize obesity as a chronic, progressive disease that requires lifelong treatment and control. It’s not just a matter of carrying a little too much weight due to overeating and no self-control. It is a disease and needs to be treated as such.
Defining Obesity
The general equation for gaining or losing weight has to do with caloric intake and energy usage. If your caloric intake is less than energy usage, you lose weight. If they are equal, you stay at the same weight. If caloric intake exceeds energy usage, the body stores the excess as fat, and weight increases. Obesity is a condition of excess total body fat.
The definition of obesity is often based on a number given by the individual’s body mass index (BMI). BMI uses a ratio of weight and height to reflect the amount of excessive body fat the person has.
All levels of being overweight have physical repercussions, but as obesity increases, the complications become more severe. Sleep apnea, breathing problems, hypertension, diabetes, heart disease, cancer, osteoarthritis, and depression are all typical problems for which obese people have a higher risk.
The highest BMI range, morbid obesity, is defined as a state in which a person weighs at least twice or 100 pounds more than ideal weight. At this level, in addition to the comorbidities listed above, morbid obesity may also reduce life expectancy.
“Someone with a BMI of 25–30, the ‘Overweight’ category, can usually address their weight problem through diet and exercise—either on their own or working with a dietician or maybe their primary care physician, making significant lifestyle changes and using common sense,” says Dr. Rohrscheib.
For those who are morbidly obese, he goes on to explain, the universally-recommended treatment is to have weight loss surgery because the body no longer responds to diet and exercise. “There is a full-blown surgical need at this point,” he explains.
Factors Contributing to Obesity
What happens to make a person reach the point of needing surgery for obesity? According to Dr. Rohrscheib, the factors are not completely clear. Research has shown that it is a physiological problem caused by the inability of the body to regulate the feelings of hunger and satiety (feeling full).
“The human body has a ‘barostat’—which is similar to a thermostat in a house. The barostat in the brain regulates what we eat by receiving information from the stomach about how ‘full’ it is, thus controlling the feelings of hunger and nutritional intake. If we feel hunger, we eat; if we feel full, we don’t eat,” he explains. “But like a thermostat, the barostat can become miscalibrated—it simply doesn’t send the ‘I’m full’ signal, and the person develops a natural tendency to overfeed.” Over time, overfeeding leads to obesity.
Genetics and the environment may also have roles in obesity causation. We eat different foods than our ancestors did and for different reasons: they ate to survive; we eat for entertainment and comfort—we are much more attuned to the flavors, consistency, and even appearance of our food. Our food supply is easily accessible, but many of the foods we eat are not nutritionally beneficial. We eat too fast and overwhelm our barostat system, and, similarly, we eat at regimented times, not necessarily when we are hungry.
Our sleep cycles can affect our eating habits, as can the level of stress we encounter on a daily basis. The higher our stress level, the more likely we are to eat to comfort ourselves. Stress eating is real—the central nervous system is calmed by the eating process. Even medication can affect our eating patterns.
A person suffering with obesity also may face the stigma that it is their fault, which, according to Dr. Rohrscheib, is not true: “Obesity is an acquired disease, and the behavior (overeating) is a part of the disease, not vice versa.”
Treating the Disease
Like many other diseases, obesity has stages at which different treatment options are preferable. The overall goal is to reset the barostat so that the person feels full prior to overeating. In the Overweight (pre-obesity) stage, the most common treatment is diet and exercise. For early stages of obesity, medication prescribed by a physician to help curb the patient’s appetite may be added into the mix.
Sometimes patients fall into a gap in which the best treatment option isn’t obvious. For example, a severely obese person may still have some success with diet and exercise, but weight still creeps up slowly over time. Surgery may not be warranted at this point, but temporary and intermittent treatment, such as that offered by a gastric balloon, may be a good option.
“A gastric balloon is often used for lower BMI obese patients who haven’t had the disease as long but are creeping up into the gap BMI range,” explains Dr. Rohrscheib. “This person has likely had success with dieting and exercise until recently.”
A gastric balloon is a temporary measure to help patients lose a significant amount of weight. Typically inserted for 3–6 months at a time, the balloon acts as a constant filling presence in the stomach—the saline-filled, one-and-a-half pound balloon literally makes the stomach feel full so that the signals to the brain to stop feeding can’t be ignored. The balloon also causes delayed emptying of the stomach, so the patient feels fuller longer.
“Patients receive nutritional counseling while they have a balloon. It’s typically removed after six months, but if the patient re-gains weight, it can be inserted again,” says Dr. Rohrscheib. “In fact, a patient may need a balloon every 3–4 years to maintain weight loss for a longer period of time.”
Gastric bands, such as a LAP-BAND®, are used for a different, yet similar, purpose. “Gastric bands and gastric balloons are two different treatments to help fight obesity; they are used for different purposes and at different stages of the disease,” says Dr. Rohrscheib.
A gastric band is used to treat chronic, progressive morbid obesity. This treatment is for a patient who has tried everything, including diet, exercise, weight loss medication, perhaps even a gastric balloon, but these strategies no longer have an effect in combating the disease. At this point, the patient is also experiencing one or more consequences of being obese—joint pain, sleep apnea, diabetes, heart disease, or other serious complications.
Gastric bands are intended to be a permanent, lifetime therapy for modification of hunger. Inserted under general anesthesia similar to gall bladder surgery, the band is adjusted on a monthly basis. It typically takes 12–18 months of adjusting the band to create behavior modification. The band restricts the amount of food in the stomach and delays emptying. When the band is adjusted tighter, the patient feels full sooner. When the patient feels hunger, the amount of food it takes to feel full is much less, so hunger is suppressed.
Other surgical options, such as gastric bypass and sleeve gastrectomy, are options for obese patients, but Dr. Rohrscheib restricts treatments available at Illinois Bariatric Center to the non-invasive procedures of gastric banding and balloons. “These other surgeries are very invasive, and the risk doesn’t justify the results—especially when patients have been very successfully treated with bands and balloons,” he explains.
Unfortunately, in spite of the success of these treatments, we, as a society, are still doing an “abysmal job” of treating this disease. And obesity gets harder to talk about as it affects more and more people and becomes “average.”
Dr. Rohrscheib’s message is simple: Anyone with a BMI of more than 40 should be counseled for surgery. “Gastric banding has been universally covered by insurance for more than 10 years, largely because the savings in other medical expenses are recouped in 2–4 years.”
Patients who have had weight loss surgery say that they are not as hungry, they feel full faster and with less food, and they stay full. This is exactly the process that will reset their barostat, thus changing their hunger patterns.
“And if you can change the person’s hunger, you can change the disease,” says Dr. Rohrscheib.
For more information, you may contact Illinois Bariatric Center at www.illinoisbariatric.com or 217-935-7037. They have offices in Clinton and Champaign.