Services must accommodate obese people with specialist equipment such as much wider chairs. Bakewell J (2007). "Bariatric furniture: Considerations for use.". Int J Ther Rehabil (7) : 329–33 . . (Photo credit: Wikipedia)
Why bother with attaining an ideal weight?
A cultural norm in the western world is that people should weigh about the “right” amount for their body types
Current Western culture supplies its members with ideas about how things are supposed to be. There is a body of knowledge that people use to navigate our world. This knowledge gives us expectations and rules for life in our surroundings. People who do not measure up to cultural standards are often made to feel uncomfortable about it.
America is experiencing an epidemic of obesity: Americans who weigh much more than the norm allows learn, early on, that obesity is something that other people notice. And many of those who notice the difference do not think it attractive. Cultural disapproval is such a strong motivator that at times it seems that half the nation is on a diet! People who try to lose weight are more likely to do it because of disapproval of the obese, than because of something a doctor said.
What non-cultural reasons would lead a person try weight loss?
The list is quite large and much of it is supported by sound scientific research.
Here are some of the health consequences of being obese:
- Heart trouble
- Digestive problems
- Skeletal and joint problems
- Early demise
- Psychological problems, above and beyond those of being obese
- Diabetes
The list is incomplete, given our lack of medical expertise. Unfortunately, we believe in the scientific method and we believe the doctors are probably right.
Why would anybody avoid weight loss and remain obese?
There is no easy cure for obesity.
Witness the fascination people have with individuals who are successful in losing weight. It’s a HUGE challenge to lose weight and an even GREATER challenge to keep it off. Our physician is the first to admit that his toolkit is pretty empty for helping with this condition. Humans are exquisitely equipped to survive famines: We like fat and sweets, and we like them served together even more. Our culture has changed a lot over the last 500 years, but our metabolisms were shaped over a much, much longer time frame. Our physical selves have not caught up with our cultural selves.
What weight loss techniques are currently available to treat obesity?
Let me count the ways:
- Hypnosis
- Mental health therapies
- Faith-based techniques
- Just Do It! (with or without weigh-ins)
- Medication
- Diets! All meat to no meat; low carbohydrate to all carbohydrate; a balanced diet (USDA redefines this periodically;) portion control; and other, gimmicky ones.
- Exercise with or without trainers, yoga instructors, classes, groups, buddies, equipment, swimming pools, and so forth.
- Hospital-based fasts and last, but not least,
- Surgical interventions.
Why not pick a non-surgical approach and get it over with?
They don’t work, except for surgery, and surgery is problematic.
Even if one can handle a regimen long enough to lose weight, it’s nearly impossible to keep it off. Statistics vary on successful maintenance of goal weight, but most range around 5-15%.
If it works, why not have the weight loss surgery?
Pro:
Today’s bariatric surgeries are better than they used to be. Doctors have more experience now, and better surgical techniques and tools are available. The doctor and patient can fit the procedure to the patient from the array of available surgeries. Much current weight loss surgery is laparoscopic, so there is no large abdominal incision. Post-op support has become a system that includes dietetic help, support groups, lots of visual aids in the learning modules, specialist nurses, exercise training, and many other helpful modalities.
The main reason to undergo surgery is to get rid of excess weight that will likely kill you eventually, and will cramp your enjoyment of life while obese. Some comorbidities decrease or vanish, with particularly good results in diabetes and joint problems.
Con:
Weight loss surgery is a Big Deal–and it doesn’t always work. Statistics predict that 50% of patients eventually regain their excess weight and that 50% of patients return to the hospital at some point because of complications. These can include leaking incisions, strictures, infections, inability to resume eating, changes in taste perception, depression, cognitive problems, nausea, bowel problems, gall bladder problems, etc. Most frightening of all: 5% of weight loss surgery patients die from the surgery or its complications.
Most patients also require cosmetic surgery to deal with excess skin, and some patients need to have the whole procedure reversed due to complications. Patients with implanted devices like restricting bands (“lap bands”,) will need to have them surgically removed.
Many patients experience uncomfortable problems while recovering from the surgery, but it’s impossible to predict who is likely to suffer from them.
To sum it up:
To undergo or to reject surgery for weight loss is a decision that affects a person the rest of his/her life.
People who have weight loss surgery stand a good chance of losing a substantial amount of weight, but not all of them can maintain this weight loss.
People who choose the surgery are often poorly informed about what to expect during recovery. Physicians know the poor health outlook for obese patients, and they enthusiastically promote the benefits that can come of having the surgery. Surgical consent and similar disclosure forms are usually written in jargon that a patient can’t easily understand. Many patients sail through the process without difficulty, but a significant risk of having severe problems exists.
People who decide against the surgery still must deal with their obesity and its effects on their lives and health. Obese people are statistically likely to die earlier than expected for normal weight people. They will still suffer from discrimination and the many obesity-related ailments while still alive.
Reference for the following four items:
Change your stomach, change your brain – health - 23 May 2012 – New Scientist. (Note: viewing this entire article online may be restricted to registrants or subscribers. Registration was free as of May 31, 2012.)
Changes in taste: the post-op patient expected a refreshing beverage flavor but experienced a fish taste!
Brain re-wiring: post-op patients’ brain reward centers no longer activated strongly when the patients saw pictures of delicious food.
Changes in body structure: Patients’ thalamus glands shriveled to half their former volume.
Cognitive changes: A number of patients found that “tip of the tongue” word-finding problems plagued them, almost as if they were experiencing age-related memory problems.
Further Reading:
