We certainly have a lot to worry about regarding our health these days. A global pandemic has a way of doing that.
Yet there has been another pandemic raging around the globe for years that hasn’t captured as much attention as it deserves. That is obesity.
Obesity, defined as a Body Mass Index >30, is associated with the leading causes of death in the United States and worldwide. According to the World Health Organization, 2.8 million people each year die as a result of being overweight or obese. The prevalence of obesity has nearly tripled over the past 30 years. Here in the U.S., over 70 million adults are obese and these numbers are climbing. Not even our children are immune as one in four kids and teens are overweight and obese.
The concern is that obesity can shorten a person’s lifespan. In 2007 the Surgeon General of the United States warned that obesity alone can increase the chance of premature death by 40 percent. Obesity is often associated with other serious health issues including diabetes, heart disease, sleep disorders, breathing problems, arthritis, infertility, and many others.
There is a strong link between obesity and the risk of cancer. Specifically excess body fat increases the risk of colorectal, breast, uterine, esophageal, kidney and pancreatic cancers.
There has always been concern that obesity may weaken the immune system. Several studies have warned that obesity is an important independent risk factor for severe COVID-19 and can double the risk of death in individuals with a BMI >40 (morbid obesity).
Obesity not only contributes to physical disease but also plays a role in mental health. For those who struggle with their weight, the psychological effects can be just as debilitating. Major depression, anxiety, poor self-esteem, and body dysmorphic disorder are common place among obese individuals. Eating disorders such as anorexia, bulimia, binge eating are also prevalent.
So why is it that with so much that’s known about the damaging effects of obesity on physical and mental health are so few people seeking treatment? First it’s important to understand the causes of obesity. It’s more complicated than simply excess calories and physical inactivity. If it were just that, diet and exercise alone would work. It is a multifactorial disease that can be influenced by genetics, medications, psychological factors, hormone disorders (thyroid, insulin resistance, polycystic ovarian syndrome, Cushing’s syndrome) and socioeconomic challenges. It’s not to say that healthier eating, increased physical exercise, and behavior modification aren’t important. It’s just that often times they are not enough.
A growing number of studies have shown that weight loss surgery (bariatric surgery) is the most effective and longest lasting treatment for obesity. More importantly, surgery can reverse the chronic diseases that accompany it, most notably diabetes. Diabetes remission often occurs within a few days of surgery even prior to any significant weight loss. That would again indicate that there may be more biologic or hormonal factors playing as much of a role if not more than just diet and exercise alone.
The effects of bariatric surgery have been well documented and studied since its inception in the 1950s. Breakthroughs in technology and surgical technique have improved the safety and outcomes. Yet, still today only 1 percent of the population eligible for surgery, which for adults means a BMI >40 or >35 with an obesity-related condition like diabetes, actually has it.
It’s puzzling to think why. Consider, for example, if the same were true for people who needed surgery for cancer. It would be unthinkable to withhold a treatment that could improve the quality of someone’s life or provide longer rates of disease free remission.
There is no cure for obesity but there are very effective treatments. The success of each treatment is amplified when used together. The combination of healthier food choices, increased physical activity, behavior modification and surgery can result in excellent long-term results. That’s why individuals who struggle with obesity should seek treatment from a program that offers a multidisciplinary team of specialists who can address all these issues and customize an appropriate treatment plan.
In addition, just as we are addressing the inequalities and bias that exist in society today we have to acknowledge the stigma placed upon obese individuals. Obesity is not caused by laziness, lack of education, or poor will power. It’s harsh criticism and the judgment implied that prevents people from lifesaving and life-changing surgery.
Surgery is not the easy way out. It’s a tool that can help someone to make the necessary lifestyle changes to not only lose weight but to maintain it. For anyone who is struggling with their weight and the effects that it has on their health, it’s time to come out of quarantine and put your health first.
Jeannine Giovanni, MD, is director of bariatric surgery for Care New England.