Indianapolis Medical Society

President's Message February 2012

We can Offer Support and Guidance to Patients

One of the most common and most dangerous healthcare problems in the United States is obesity, where Indiana ranks 15th in the country with obesity rates of nearly 30 percent. In the last 25 years, obesity rates have more than doubled. Why? In a society that seems to value slimness to the extreme, why is obesity running rampant? The health problems are widely known and obviously seen, so why is America (and Indiana) fatter than ever?

There are many accepted causes of obesity. Genetics and health can contribute to a person's risk of obesity. The American Society for Metabolic and Bariatric Surgery's obesity fact sheet says that children's weights tend to be close to that of their parents, and that metabolic variation from person to person may point to varied weight gain and loss from person to person. Illnesses can cause weight gain, as can certain medications like contraceptives and anti-depressants. Psychological stress can also lead to weight gain. Overeating as a form of emotional displacement or as a defense or comfort mechanism is a common psychological response. However, what seems to be the most important and influential cause of obesity in America is environment and societal norms. Drs. Deborah A. Cohen and Thomas A. Farley make an argument in "Eating as an Automatic Behavior" in Preventing Chronic Disease that environment has a big effect on eating habits. If food is visible and within reach, a person is more likely to eat it, even if he or she is not hungry. People are likely to eat past the point of fullness if food remains on their plates. In a society that seems to value enormous portions, even of terrible food, this instinct is problematic.

The most obvious problems caused by obesity are those related to health. Obesity increases the instance of comorbidities. Some of the most common health problems that can result from obesity are type II diabetes, heart disease, sleep apnea, GERD, degenerative joint disease, chronic back pain, shortness of breath, chronic fatigue, and body aches. With these problems come greater unhappiness, increased dependencies on medicine to control the symptoms, and lower quality of life. Return to a healthy weight has shown a dramatic reduction in these conditions and their symptoms.

Obesity is also economically costly. Obese people incur more medical costs than people of a healthy weight. More frequent doctors' visits, hospitalizations, and prescription drugs are all a costly side effect of obesity. Dangerously overweight people are statistically more likely to miss work due to health problems, minor or major, affecting their incomes. The cost of obesity is astronomical. The combination of healthcare costs and potential lost wages are a personal economic strain. One treatment option that immediately comes to mind is bariatric surgery. Studies have shown that in the United States the cost of bariatric surgery is generally equivalent to the healthcare cost of two years of treatment of the side effects of obesity. Treatment is much more cost-effective than maintaining the condition. While it is a very effective treatment for obesity, the surgery itself is just part of the treatment. Full treatment of obesity needs to include nutritional counseling and psychological support. Even with the physical changes that result from the surgery, support and guidance are still absolutely necessary for achieving and maintaining a healthy weight. A less drastic but wider-reaching treatment is societal, not personal. If environment and culture are two of the leading causes of obesity, then they are two areas that need to undergo major change. If junk food disappeared from schools and work places, if restaurant portions were decreased, even slightly, our caloric intake would be slashed. If eating is an automatic behavior more than a conscious one, then we need to remove the temptation and accessibility of unnecessary food. Bariatric surgery is an excellent treatment for qualified patients, but to put a stop to the epidemic there needs to be a shift in society's beliefs about and feelings toward food.

Obesity is an obvious problem here in Indiana, and changes need to be made to improve our health. Some changes can be personal, such as portion control or bariatric surgery. Some need to be made on a larger scale through increased education and support. As physicians, we can offer support and guidance to patients who are struggling with their weight, and help them find long-term solutions and healthier lives.