Battling Obesity (cont.)
Defining the players
A discussion of bariatric medicine
wouldn’t be complete without some background information
and clarification of terms:
4 A bariatric physician is different from a
bariatric surgeon, who performs surgical procedures for the
treatment of obesity.
4 Bariatricians or bariatric physicians, on the
other hand, treat the obese patient with a comprehensive
approach that includes diet and nutrition, exercise, lifestyle
changes, and when appropriate, medications such as appetite
suppressants.
4 The word bariatric comes from the Greek word
barros, which translates as heavy or large.
Changes in the way obesity is viewed by
the medical community have paved the way for the practice of
bariatric medicine. For example, obesity is no longer seen as
the result of lack of willpower, but as the result of a complex
interaction of genetic, behavioral, and environmental factors. The
American Obesity Association says
no human condition—not race, religion, gender, ethnicity,
or disease state—compares to obesity in prevalence and
prejudice, mortality and morbidity, sickness and stigma.
Obesity is defined using
the now widely accepted body mass index
(BMI) measurement tool. A BMI of 25 to 29.9 is considered
overweight, while a BMI of 30 to 39.9 is considered obese.
Extreme, or class III, obesity is a BMI greater than 40.
According to the National
Institutes of Health, a
20-percent rise above the desirable body weight is the point at
which excess weight begins to be a health hazard.
Because the current
generation of children, adolescents, and young adults is the
most overweight in the nation’s history, the CDC says
reducing young people’s obesity is one of its top
priorities. At the other end of the age spectrum,
Medicare’s statements are key, also. In removing the
language in Medicare policy that said obesity was not an
illness, Health and Human Services Secretary Tommy Thompson
said in 2004 that the new policy would allow Medicare officials
“to review scientific evidence to determine which
interventions improve health outcomes for seniors and disabled
Americans who are obese.”
Physicians have
typically not been encouraged when treating their obese
patients because they were not able to get reimbursed for it,
except as part of other disease states, according to Vash, who
is also the secretary of the American Obesity Association and
an assistant clinical professor at UCLA School of Medicine.
However, as the lead author on a research study for publication
in the spring edition of the American Journal of Bariatric
Medicine: The Bariatrician, he says he has great hope.
“The medical
treatment of obesity has been pretty dismal and doctors have
been pretty discouraged over their obese patients,” Vash
says. “But we found that committed patients in the right
hands of a physician who is trained in bariatric medicine can
be successful.”
The study followed
2,000 obese patients at the Lindora Medical Clinics in southern
California for one year. These 34 clinics, based in Costa Mesa,
treat nearly 4,000 people a day. Vash is the executive medical
director for the clinics.
“If patients
committed to treatment after the first month, we followed them
for a year and found an average weight loss of 25 pounds or 12
percent of body weight.” For comparison, Vash says a
10-percent loss maintained over a year is the “Gold
Standard.”
“The key is the
physician’s interactions,” he says.
“It’s important to see the patient not just as a
number. It’s rarely just about hunger and calories.
People use food as a coping mechanism.”
Craig Keebler, MD, the medical director of
the Center for Medical Weight Management at Swedish Medical
Center in Seattle and the chairman of the American Board of
Bariatric Medicine, says self-insured corporations are more
likely than HMOs to offer benefits for obesity treatment.
“Insurance companies in general need to hold down costs,
so they’re less likely to look at obesity treatment,
which is preventative, but corporations are paying out of their
own pockets, and they see an expensive problem down the road
that they want to avoid.”
photo/ ©2005
Rex Rystedt
Rex Rystedt
