OBESITY
A National Epidemic
by Debbe Geiger, Duke Medicine News Office
September 2010
Americans are getting fatter at an alarming pace. According to the National Health and Nutrition Examination Survey, 55 percent of Americans are now considered overweight, and 22 percent are obese. The survey finds as many as nine million Americans are morbidly obese.
It’s not any better here in North Carolina. In fact, it may be worse. The Southeastern states are considered to have the highest obesity rates, according to a recent report by the Centers for Disease Control (CDC), which found nearly one-third of North Carolinians are obese.
What’s Causing the Obesity Epidemic
There’s no easy answer. While self-discipline and a lack of willpower are often blamed, researchers say the roles they play aren’t as significant in the overall obesity picture as the general public thinks. Howard Eisenson, MD, executive director of the Duke Diet and Fitness Center in Durham, says obesity is a complex disease caused by a wide variety of factors including genetics, psychological and societal influences. Studies have also identified multiple abnormal proteins in the brains of morbidly obese individuals that appear to alter appetite satiety, and energy conservation.
Lifestyle factors also play a significant role, especially when one considers how drastically exercise and eating habits have changed in the last quarter century.
"On average, Americans are consuming about 300 more calories per day than only 25 years ago," says Eisenson. "Less time is spent walking and more time is spent driving, sitting in front of computers or watching TV."
Regardless of the exact cause, experts agree that if left unchecked, the consequences of morbid obesity can be deadly.
The Health Risks
The CDC defines obesity as having a body mass index (BMI) of 30 or greater. A person’s BMI is calculated using their weight and height. The calculation is thought to provide a reasonable indicator of body fatness and weight categories that may lead to health problems.
The U.S. Public Health Service considers obesity a serious public health problem that now rivals tobacco use as one of the top conditions leading to increased health problems. Excess weight is considered a risk factor for many serious conditions including:
- Heart disease
- Pulmonary disease
- Diabetes
- Bone and joint pains
- And certain types of cancer
Serious health consequences of obesity include:
- Death and sudden death
- Hypertension and heart disease
- Type 2 diabetes
- Obstructive sleep apnea
- Gallstones
- Cancer
- Other complications, including arthritis and depression
Taking Action/Taking Responsibility
Eisenson says the first step toward treating obesity is taking ownership of the problem. "This is a lifelong condition of which people have to gain control so it doesn’t control them."
Lifestyle modification including dietary management and regular exercise are often the primary approach to obesity management. But that’s easier said than done for some individuals.
That’s where comprehensive, medically supervised, weight management programs like the Duke Diet and Fitness Center can help. The world-renown program has been working with people who are overweight or obese for more than 40 years.
The residential program, which lasts from one to four weeks or longer, immerses patients in education, advice, medical and psychological support, and gives them the tools they need to make long-term lifestyle changes.
The program incorporates the expertise of medical doctors, who address obesity-related diseases, as well as exercise physiologists, nutritionists, behavioral therapists, diabetes educators and clinical psychologists who specialize in assessing each individuals needs and carefully monitor patients’ progress. Classes and support groups cover exercise, nutrition and behavior strategies. No detail is left out, even down to the size of the dishes in your kitchen cabinets.
"It’s a whole new way of looking at life," says Eisenson. "Our therapeutic program helps people achieve better health through weight loss, physical conditioning, and improved self-care habits."
After the program, patients receive ongoing support from lifestyle coaches via regular telephone calls. A free, online weight loss program enables participants to extend the experience indefinitely.
When Diet and Exercise Aren’t Enough
For some patients a program designed only around diet, exercise and behavior modifications isn’t enough to achieve long-term success. At that point, drug therapies and possibly surgical intervention may be appropriate.
The two most common surgical procedures are roux-en-Y gastric bypass and the Lap-Band procedure, both of which are performed at Duke. A physician should discuss all available options to determine which approach is best.
Surgery is not considered a cure for obesity, but doctors agree that it can be an effective tool when used in conjunction with sound medical and lifestyle management. "It might give you the physiological ability to lose weight effectively," says Eisenson. But it’s important to note that lifestyle modifications, including diet and exercise, are necessary for long-term success of weight-loss surgery.
Eligible candidates for surgical intervention include adult patients with a BMI greater than 40, as well as people with a BMI greater than 35 who also have obesity-related health complications. In select cases, the surgery may be offered to individuals under 18 years of age.
Many insurance companies offer some form of coverage for weight-loss surgery. Medicare and Medicaid now provide coverage for their enrollees. Many weight loss options exist. For more information about medically-supervised weight management, and the program at the Duke Diet and Fitness Center, please call 800.235.3853.