Battling Obesity
With costs to treat obesity-related
illnesses soaring and
the outlook grim for the nation’s children, forward-looking
physicians see a bright future for bariatrics.
the outlook grim for the nation’s children, forward-looking
physicians see a bright future for bariatrics.
Sally was in her late 40s and moved slowly
as she walked into her physician’s office. Her gait
was more like a waddle as she shifted her weight back and forth
with each step. She was tired beyond her years, and most of
all, she was disgusted. She was disgusted with herself for
weighing more than 300 pounds, and she was angry with the
medical community. Taking several medications for hypertension,
diabetes type 2, a lipid disorder, and osteoarthritis, Sally
was bordering on desperation.
This visit to a
physician was different, however. She was seeing a
bariatrician, a physician who specializes in the treatment of
obesity. Working with her doctor, Peter Vash, MD, of Los
Angeles, within six weeks Sally was able to reduce her
hypertension medications by 50 percent, eliminate one of the
diabetes meds, and reduce her osteoarthritis prescription, all
the while sleeping better and walking easier.
“Her quality of
life dramatically improved,” Vash says of the woman he
calls a typical bariatric medicine patient. “She began to
have an outward look of optimism and hope.”
A costly problem
Obese people like Sally are beginning to
get the attention of the medical community, insurers, and the
government. Although there has been some discrepancy over
exactly how many deaths each year in the United States are
caused by obesity, everyone involved agrees that obesity is a
serious health problem.
The Centers for Disease Control and Prevention last year issued an estimate of
400,000—then revised that to 365,000—deaths a year
due to obesity, making the condition one of the leading causes
of preventable death. Several months later, in April 2005, it
put forth a new calculation of 25,814, dropping obesity to an
unofficial seventh-place preventable-death ranking.
While the controversy
and confusion over the number of deaths continues, there is no
denying that obesity is a health hazard, as it increases the
risk for many diseases and conditions, including type 2
diabetes, hypertension, cardiovascular and gallbladder disease,
osteoarthritis, sleep apnea, and some cancers. The medical
costs associated with obesity are staggering and the problem is
growing. In addition, physical inactivity, junk food
diets, and other factors in the Western lifestyle have led
pediatric experts to call childhood obesity one of the major
problems facing children.
According to the Surgeon General’s Call to Action to
Prevent and Decrease Overweight and Obesity, the medical and related costs of obesity in
the United States in 2000 were more than $117 billion, and data
suggest the emotional costs also are enormous. The International Journal of Obesity in 1991 published a study of former
severely obese patients. It concluded:
• 100 percent preferred to be deaf,
dyslexic or have heart disease
• 92 percent preferred to have
a leg amputated
• 90 percent preferred to be
blind rather than be obese again.
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All of these facts,
plus Medicare’s 2004 decision to discard its policy which
stated that obesity was not a disease, may be reflected in
physicians’ growing interest in bariatric medicine as a
practice opportunity.
The American Society
of Bariatric Physicians (ASBP)
has 1,100 members. Founded in 1950, in 2000 it achieved
its longtime goal of being awarded a seat in the House of Delegates of the American Medical Association. About two-thirds
of the society’s members incorporate a bariatric program
into their primary care practices, while the other one-third
specialize in bariatric practices.
“Our membership
has increased,” says ASBP Executive Director Beth Little.
“That’s because the government is paying attention
to obesity. All the studies show not only the prevalence of
obesity and overweight is increasing, but that it is increasing
at a faster rate than ever before.”
The number of physicians
seeking to be certified by the society’s sister
organization, the American
Board of Bariatric Medicine (ABBM),
is swelling, too.
“The number
going through the exam process is increasing
exponentially,” says Kelly Wettengel-Dycus, the executive
director of the ABBM. “In 2002, 40 were tested. In
2003, 80, and in 2004, over 100 went through the exam process
to become diplomates of the ABBM.”
Sameena Rasheed, MD,
is one of the ABBM board members who oversees the academic side
of bariatrics. She conducts the written and oral exams of those
applying for certification and makes site visits to their
practices.
“The site visit
is very important,” Rasheed says. “You can pass
exams, but if you’re not working with patients
individually, counseling them, helping them change their
attitudes and behaviors and maintain their weight
loss—that’s what’s important.”
While physicians
frequently come to bariatrics from family practice and internal
medicine, they represent a variety of specialties, including
psychiatry, ob/gyn, and pediatrics. Rasheed, a former
anesthesiologist, is an example of someone who made a major
practice change. She has been a bariatric physician for a
little more than eight years, ever since she was bedridden with
cancer and decided to change her lifestyle.
“I was
deteriorating physically, lying in bed and struggling through
chemotherapy. I knew I needed better nutrition, and studying
that led me to bariatric medicine.” She now has an
independent practice in Longview, Texas.
“The patients
are so vulnerable. You really have to listen to them,”
she says. “On our site visits we make sure the physician
is teaching about nutrition, doing behavior modification, and
has a maintenance plan. The weight has to be kept
off.”
She compares treating
obesity to treating hypertension and other chronic conditions.
“The patient needs to come back for checkups—one
month, three months, six months. What really matters is if the
patient has a change in attitude.”
“Committed patients in the right
hands of a physician who is trained in bariatric medicine can
be successful,” says Peter Vash, MD, the secretary of the
American Obesity Association and the executive medical director
at the Lindora Medical Clinics in southern California.
photo/ ©2005
Steve Goldstein
Steve Goldstein
