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Surgeon highlights increased problem of obesity

Andrew Thagard | Wednesday, April 14, 2004

In a nation where 55 percent of adults are overweight and 1.5 million people are morbidly obese, Dr. Gerardo Gomez, a surgeon and medical director of the Indiana University Bariatric Surgery Program, lectured Tuesday on obesity and bariatric surgery. The presentation was the fourth in the 10th annual “Mini-Medical School Lecture Series,” which is sponsored by the Medical Education Foundation and presented by the South Bend Center for Medical Education.Obesity is a serious problem in the United States, Gomez said. It recently surpassed smoking as the number one cause of preventable deaths in the United States. Each year 300,000 people die from obesity-related causes. Excess weight also puts a significant financial burden on the nation, according to Gomez. It costs the United States $51.6 billion directly and $47.6 billion indirectly annually.”It’s a medical disease and there are medical conditions directly related to obesity,” he said.Gomez attributed the high rate of obesity to the large quantities of readily available food at low costs, particularly fast food and soft drinks, made more abundant in part due to labor saving technology. “Everybody’s eating more and more,” he said. “We eat a lot more than we really need.”Indeed, an average American will consume 30 pounds of cheese, 15 pounds of ice cream, 152 pounds of added sugar, 111 pounds of red meat and 28 gallons of beer each year. And while proper exercise can shed excess calories, the fatty diets that Americans consume are so calorie-rich that it makes it increasingly difficult to do so, Gomez said. One hour on the treadmill might burn 100 calories, for example, but a Whopper from Burger King is packed with 800.Physicians and insurance companies measure obesity using the Body Mass Index (BMI), which is calculated by dividing weight (in kilograms) by height squared (in meters). Ideal people have a BMI in the range of 20-24.9. People are considered overweight if their BMI lies between 25-30 and obese if it’s between 35-40. People who are morbidly obese or super obese have BMIs in the ranges of 40-49 and above 50, respectively.”What causes obesity? Too much ‘in,’ not enough ‘out,'” Gomez said. “It’s pretty simple.”Obesity may be simple to understand, Gomez said, but not easy to treat. While the old fashioned method of maintaining a calorie deficiency by consuming moderate amounts of healthy foods and exercising is the preferred means of losing weight, bariatric surgery is often an alternative pursued by the morbidly obese if it fails. It’s also the only means that ensures consistent and permanent weight loss for morbidly obese patients, according to the National Institute for Health.”At the present time it [bariatric surgery] is the only long-term effective means for patients with morbid obesity,” Gomez said.There are two main forms of bariatric surgery, he said. The first, called gastric restriction, minimizes the size of the stomach so the patient will be forced to consume less. The second, called malabsorption shortens the length of active small intestine to minimize the amount of nutrients that the body absorbs through digestion. Gastric bypass surgery is the most common form of bariatric surgery done today, he said. A new “lap band” or adjustable gastric band wrapped around the stomach is a procedure that is also gaining popularity. The “lap band” can be inflated or deflated by a physician by adjusting a control pad located beneath the skin using a syringe. Even gastric bypass surgery has become less invasive when several small incisions are made to allow the passage of long instruments and cameras instead of a big incision.For the most part, the surgery is safe and effective, Gomez said as he showed those present videos of several of the procedures. Ninety percent of patients who undergo the procedure will lose at least 50 percent of their excess body weight and most obesity related problems either improve or become completely resolved. Generally, the effects of the surgery also change the patients’ outlook on life, Gomez said, as they become more interested in living a healthy lifestyle when they see the rapid weight loss.Complications, however, do exist, including intestinal leakage in the short term and anemia and deficiencies in B12 and calcium in the long term. Long-term deficiencies are treated with vitamin supplements, Gomez said. The procedure is a difficult one that is challenging for surgeons to master. On average, a facility must perform approximately 300 procedures before it sees a dramatic drop in the rate of complications, he said.Gomez emphasized that bariatric surgery is not for everyone. Potential patients are carefully screened to ensure that they have made a serious effort to diet in the past and that they are psychologically stable. The process, Gomez said, is a team effort that involves the surgeon, patient, nurses, dietitians and other patients through a support group.”We have to be careful,” he said. “The surgeon alone is not it. We need to have a commitment from dietitians and patients.”Gomez is an associate professor for the Indiana University School of Medicine.The series will continue next week with a lecture by Dr. Keith Lillemoe titled “Surgery: Past, Present and Future.”