Individuals, nations bear increasing burden of obesity

Amy Phipps says she was “heavy the day I breathed air.” She attended her first Weight Watchers session at age eight and struggled with her weight as a teen and adult, topping out at 330 pounds. In 2004, she had lap-band surgery, in which a silicone belt is implanted around the upper part of the stomach, reducing its size; she lost 70 pounds but eventually regained 40.

Phipps acknowledges the seeming irony of being a nurse practitioner who once worked at an adolescent weight center. She knows what people think when they look at obese individuals. But she also knows what she’s observed in her career. At that weight center, for example, most of the teen clients consumed junk food: “Why were some 120 pounds, while others were 300 pounds?” Phipps queries. “We don’t know all the answers about what causes obesity.”

Many health care professionals view obesity as an increasingly costly health problem – medically, financially and psychologically – that has increased dramatically in the United States and many other countries over the past two decades. According to the Centers for Disease Control and Prevention, more than one-third of U.S. adults – 35.7 percent – are obese, as are approximately 17 percent, or 12.5 million, of American children and adolescents ages two to 19.

Also prolific are so-called solutions to obesity, from fat-fighting pharmaceuticals to fad diets to extreme fitness routines. There’s no quick, one-size-fits-all fix, however. After gastric banding stopped working for Phipps, she turned to Moses Shieh, D.O.’99, FACOS, a former neighbor who is a bariatric surgeon with Surgical Healing Arts Center in Fort Myers, FL. Shieh was among the nation’s first surgeons to perform the sleeve gastrectomy procedure, in which a major portion of the stomach is removed, reserving its function but drastically reducing its volume.

“The surgery reshaped my stomach to be about the size and shape of a banana,” says Phipps, who had the procedure in 2010. “It’s not a get-out-of-jail-free card. It’s the start of a lifelong journey.”

“The Last Form of Prejudice”

At five feet, eight inches tall and 160 pounds, Moses Shieh doesn’t know what it’s truly like to be obese. He does know, however, how bariatric surgery – including gastric bypass, laparoscopic adjustable gastric banding and sleeve gastrectomy – can change the lives of people willing to take it as the first step in that lifelong journey Phipps describes.

“The surgery is the tool; the person’s lifestyle is the key,” Shieh says. “We tell people they’re our patients for life. Their success involves counseling, diet and exercise. Support groups are important, too, in helping patients keep each other on track.”

Some might consider surgery a drastic solution to being overweight, but alumnus Moses Shieh and many others consider obesity a drastic problem that merits it.

While significant advances and his own training in laparoscopic surgery – considered minimally invasive in its use of very small incisions – convinced him of the technique’s effectiveness, its impact on his patients continues to show him its transformative potential. He sees it every day: the 470-pound patient who originally came into his office on a scooter, nearly unable to walk; post-surgery and 125 pounds lighter, her scooter is gone. Another patient who, once 450 pounds, is now able to tie his own shoes for the first time in 20 years. The young woman now down from 460 pounds who was able to ride her first roller coaster. Many patients experience lower blood pressure, reduced risk of diabetes, less joint pain and other health benefits.

“This is a type of surgery that saves lives,” Shieh says. “People who have been overweight since elementary school are stigmatized and picked on. Obesity is the last form of prejudice.”

Phipps, now the bariatric program coordinator on Shieh’s staff, agrees. “Getting overweight early in life changes everything – one’s spouse, one’s career choice,” she says. “No one really likes obese people.”

Except for Shieh, she says: Phipps praises him for pursuing additional training in cosmetic surgery so he can remove the excess, baggy skin that some people retain after massive weight loss.

“For a normal-weight guy to ‘get it’ as much as he does makes him very special,” she says. “He wants to establish a place and culture where people can come and not be judged, but have their lives changed.”

How did we get so fat?

According to the National Geographic, the Puget Sound ferries in Washington have increased the width of their seats from 18 to 20 inches to accommodate people with bigger bottoms. A Colorado ambulance company has retrofitted its vehicles with a winch and a plus-size compartment to handle patients weighing up to half a ton. An Indiana manufacturer of caskets now offers a double-oversize model – 38 inches wide, compared with a standard 24 inches.

Why are we increasingly super-sized? Researchers are exploring the chemical and genetic factors that may foster fat. The hormones leptin and Peptide YY3-36 have been found to decrease appetite, while the hormone ghrelin stimulates it; scientists are investigating the implications of dosing or blocking these hormones. A study by a group of scientists in Washington found that obese dieters who succeeded in losing weight had higher levels of ghrelin than people of healthy weight levels, which might explain one way the body fights against weight loss. That was key to our survival over much of the course of human history, but today it might explain why so many dieters can’t maintain their weight loss.

That’s a case for surgical intervention, Shieh says, for patients with a high body mass index (BMI), an estimate of how much one should weigh based on one’s height. (To calculate your BMI, multiply your weight in pounds by 703, divide that answer by your height in inches, and divide that answer by your height in inches again.) An adult with a BMI between 25 and 29.9 is considered overweight; a BMI of 30 or higher puts one in the category of obese.

“Among people with a body mass index of more than 40, their chances of weight loss through diet and exercise is less than five percent,” he says. “In addition, their risk of disease like diabetes is very high.”

Diet, genetics and our environment all weigh in on our weight. Given the buffet of processed foods on our grocery store shelves and TV fare like “Man V. Food,” it’s a wonder anyone is thin.

More obvious reasons we’re rotund include our cheap, plentiful, lusciously fat- and sugar-packed foods, sedentary lifestyles and our tendency to take in more calories than we burn. Our environment plays a role, from aggressive food marketing and misleading or confusing food labels, to urban areas without sidewalks or safe parks and agricultural subsidies that make high-fructose corn syrup cheaper than produce.

“We have to make choices conscientiously, because our environment is set up to work against us,” says Pamela Duffy, Ph.D., P.T., assistant professor in DMU’s public health and global health programs. “In some areas, the unhealthiest foods are the cheapest.”

Changing Patters to Allow Better Choices

After she had sleeve gastrectomy, Phipps worked to change how she previously responded to environmental cues. “You have to recognize the patterns that you struggle with and create new ones that let you make better choices,” she says. “For me, every time I put gas in my car, I went into the 7-Eleven to get chocolate milk and cookies. I had to learn that was a danger zone for me, so now I strictly pay at the pump.”

Phipps also always packs her own lunch and talks with her two pre-teen children about healthy choices and portion control. While she’s not yet to her weight goal of 180 pounds, she’s dropped more than 110 since her surgery, a fact that’s allowed her, she says, “to go to a concert or get on an airplane and fit in the seat.” It’s also given her personal experience she shares with patients at Shieh’s practice.

“This job, for me, is such a gift,” she says. “To take all my years of failure – because no one gets here without years and years of failure and frustration – and put it to a positive use for other patients is so rewarding.”

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