Obesity in both adults and children has become a national public health issue. Yet we are also a nation of dieters, eagerly adopting every new, no-fail weight-loss plan. What's going on?
Part of the problem is heredity, says Marc Bessler, MD Surgical Director, Columbia University Center for Metabolic and Weight Loss Surgery Director of Laparoscopic Surgery at CUMC.
"Seventy percent of a person's weight is genetically determined," he says. "However, obesity has been increasing in the United States at a much faster rate than that for genetic changes, which tells us that environment also plays a huge role." By environment, Dr. Bessler means the oversized restaurant portions, high-calorie fast-food servings, and super-sized soft drinks Americans are used to these days, and channel- and web-surfing as the exercise of choice for too many of us.
DIETING MAY BE PART OF THE PROBLEM
Fad diets are also part of the problem. "My sense is that our society's diet craze has actually contributed to obesity," Dr. Bessler says. "We haven't yet amassed scientific data to support what I'm saying, but my theory is that because most diets don't include a maintenance phase that works, many dieters fall into a cycle of losing weight and then regaining it. Meanwhile, every time they lose weight their metabolism slows down that is a scientifically proven fact and the slowed metabolism pushes them to gain even more weight.
"That is why it makes sense when people tell me they used to be able to lose weight, but no longer can. We may actually be hurting ourselves by trying to lose weight using ineffective diets that don't include maintenance." Dr. Rudolph Leibel, renowned for his research on obesity, is investigating these issues at Columbia, to shed light on how weight loss affects basal metabolism.
Surgery is currently the most effective long-term treatment of morbid obesity, generally defined as a body mass index (BMI) of 40 and above (see accompanying chart), or 100 pounds or more overweight. Research verifies long-term effects. "For the gastric bypass operation, we now have a 15-year database showing that half of excess weight loss is maintained," Dr. Bessler says. In addition, surgery results in dramatic improvements in overall health. "I can't think of another operation that positively affects as many medical problems as gastric bypass and laparoscopic banding," he says. Examples of these obesity-related conditions include
"The goal of most surgery is to return the patient to baseline health," Dr. Bessler says. "With obesity surgery, our goal is to make patients feel better than they've felt in years."
For all its benefits, surgery for obesity is a last-resort measure. Eligible candidates are morbidly obese and have had no success at keeping weight off by dieting. Patients with a BMI between 35 and 39.9 must also have experienced obesity-related medical problems.
For procedures currently being performed by Dr. Bessler, please click here.
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