obesity

Diabetes and Weight Loss Surgery: Controlling Portion Size

Gretchen Becker Health Guide December 03, 2010
  • I've always felt that one reason Americans eat too much is because so much of our food is tasteless. So we substitute quantity for quality.

     

    Speaking at the Cleveland Clinic Medical Innovation Summit in November, this view was supported by a professional chef who had bariatric surgery at the age of 39. His BMI was 52, or 150 pounds over his ideal body weight. Now looking quite trim, Mario Izzo said, "Now I know I can only eat a small volume of food, so I want it to be tasty. Before, I went for volume." He said he maintains his weight loss with a "high-protein diet."

     

    Unfortunately, I think most Americans still go for volume instead of taste.

     

    We grab fast food or microwave processed dinners and gobble them down. They have so little inherent taste that the manufacturers stuff them with sugar and salt, or provide sugary, salty sauces.

     

    The French, on the other hand, traditionally worship food, shop at the market every day, spend hours preparing tasty meals at home, and then spend a long time at the table. Until recently, when American fast food and quick eating became popular in Europe, the French had no major obesity problems. They ate rich food, but not a lot of it.

     

    Chef Izzo was one of three bariatric surgery patients who gave their stories at the clinic Summit. You can hear the three men describe their situations here.

     

    Izzo said he always thought he was OK because even though he was obese, he was thinner than his father and didn't have diabetes, high blood pressure, or high cholesterol. Then his diabetic father died from a heart attack at 59 and Izzo wanted to avoid the same fate. So he had the surgery, lost 140 pounds, and now works out 5 days a week.

     

    Another patient, William Baughman, was diabetic and had cirrhotic NASH (nonalcoholic steatohepatitis), or fatty liver, which caused low platelets and easy bleeding. His BMI was only 32, but he needed to do something about his medical problems.

     

    The third, David Brown, was overweight (370 pounds; BMI of 41) and diabetic. He said he was taking 27 pills a day, plus 5 daily injections of insulin.

     

    None of the three men said they had any regrets about their surgery except that they hadn't done it sooner.  (Of course, because the surgery was done at Cleveland Clinic, which sponsored the Summit, it would be unlikely they'd choose for the presentation patients who had complications or who regained all the lost weight.)

     

    Baughman successfully battled the insurance industry. Because of his relatively low BMI, they first refused to approve the surgery. He went ahead with it anyway. And eventually, because he was doing it for medical problems, not obesity, they paid.

     

    When asked if they thought obesity is a disease or a lifestyle choice, Izzo suggested that in his case lifestyle was important: as long as he was thinner than his relatives, he thought he was OK, and "I'm going to eat this because that's what our family eats."

     

    Baughman said that once you get comorbidities, it's a disease. Brown said it's a disease: "I tried to live a lifestyle that would keep me at a good weight. But I couldn't."

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    And earlier, Alex Gorsky, worldwide chairman of medical devices and diagnostics at Johnson & Johnson, said, "Obesity is not just a lifestyle issue; there are a variety of factors: genetic, environmental, and psychological."

     

    Surgeon Philip Schauer, who performed the surgeries, said that once you reach a certain weight, "it's very difficult to lose," something most people with a weight problem would agree with but thin people don't seem to understand, thinking, "Why doesn't he/she just lose weight?" He said that before the surgery, several of the patients had lost more than 1000 pounds over the years. The trouble is, it just kept coming back.

     

    Pierre Cremieux of The Analysis Group said that after bariatric surgery, "Within a few years you will get your investment back," because patients become so much healthier. He said this quick return on investment is rare in the medical world. Yet others said some insurance companies continue to view bariatric surgery as cosmetic, rather than disease modifying.

     

    Several speakers said that because bariatric surgery can have such beneficial effects, they don't understand why more people don't have it. Insurance may not be the problem; only about 1% of those who qualify actually have the surgery.

     

    I don't think it's difficult to understand. If it were a perfect solution, you wouldn't have so many companies trying to develop procedures to avoid invasive surgery.

     

    For one thing, most of the surgery is irreversible, although some bands can be removed. If a better method comes up in the future, the patients won't be able to take advantage of it. (Of course if they've died by that time from complications of diabetes, they won't be able to take advantage either.) After most types of bariatric surgery, you have to eat a lot less, and some people who have always had huge appetites worry about that. Because you don't absorb nutrients as well, you have to take a lot of vitamins. And like any surgery, there are risks. Some people get infections or other complications from the surgery itself.

     

    Choosing the best path to correct what I think is a medical problem is not easy. Surgery does work for some people. If you're leaning in that direction, do a lot of research before you make up your mind, and try to have the surgery done at an institution that has a lot of experience with it. Much can be done laparoscopically today.

     

    Or focus on improving your health in other ways, not just on losing weight.