The Fight for Relevance in the Obesity Epidemic

Published in April Issue             

The recent Lancet study reveals worsening obesity trends in Body Mass Index (BMI) among adults worldwide. The continued progression of the global epidemic of severe obesity is astounding to those of us who grew up understanding that starvation was the single critical global nutrition issue.

Underweight has diminished dramatically around the world, and obesity is now the greatest nutrition disease faced by mankind. As such, re-examination of treatment options is warranted and one quickly finds that bariatric surgery is the most reliable and durable weight loss intervention for the severely obese.

Despite this, bariatric surgery procedure numbers in the United States have grown by only an estimated 4 percent annually in recent years. One might easily conclude that surgical treatment, despite its effectiveness, remains nearly-irrelevant in the U.S. battle against obesity, not because of its potential value to patients but rather the disturbing statistic that just over 1 percent of eligible adults undergo surgery each year.

Multiple studies now clearly demonstrate that even the fundamental issue of long-term survival in patients with obesity is improved when surgical treatment is compared to non-surgical treatment. Despite dramatic improvements in invasiveness, safety, and available surgical options that reliably produce better weight loss, improvement in comorbid disease, and improved quality of life, the sad state of affairs is that patients generally remain unaware and uninformed of the benefits of bariatric surgery.

When patients are informed, many are frustrated when they learn their health insurance coverage excludes surgical treatment for the disease whose complications will ultimately kill them. Surprisingly I find many patients have not been informed of the most basic component of an obesity treatment discussion, i.e. that he or she might be a surgery candidate.

Unfortunately, doctors frequently fail to educate regarding evidence-based options for obesity treatment. In my hospital, I walk by a patient's room nearly every day who is beyond hope for surgical treatment as they lay dying of obesity related diseases.

When I suggest any surgical procedure to a patient, I am required ethically and legally to have a discussion about alternative treatment options before we proceed with surgery, particularly options that avoid surgery. Why are our colleagues not held to this same level of accountability and required to discuss obesity treatment options from an evidence-based perspective, including surgery?

I find many of our medical colleagues report anecdotal “negative” experiences with a patient who had bariatric surgery in the past. Does that justify ignoring published peer-reviewed scientific evidence in large population studies regarding the overall success of bariatric surgery outcomes? If it does, surgery will never grow to make a major impact in the global battle against the epidemic of obesity and its related diseases.

As the article concludes, if we do nothing to alter current trends, the probability of meeting the global obesity control target is virtually zero. In the years to come, many more will die of diseases like diabetes, hypertension, stroke, coronary artery disease, and cancer. But we who fight obesity every day will see through those statistics and know that obesity is often the underlying and under-treated cause.