Numerous health issues have been given the national spotlight in recent years.  Some, like AIDS, have resulted in strong political demonstration while others, like multiple sclerosis, have resulted in quiet but powerful movements.  Both of these, as well as several other high-profile diseases, have generated hugely successful fund-raising efforts headlined by civic leaders, celebrities and professional athletes.  Sympathy and compassion have been generated for those suffering from these ailments, and rightly so.  These are indeed severe medical conditions resulting in disability, and sometimes death.  There is, however, a far more prevalent disease which also carries profound consequences, and which results in disability and, often, early death.  In fact, it is the leading cause of preventable death in the United States and the most prevalent “epidemic” in America today.  This is the disease of obesity; a disease that most of society does not truly understand and does not readily speak about. This is a quiet epidemic, and it now affects over 95 million Americans, or about 40% of the population!

Many studies, including studies of families and studies of identical twins, have demonstrated a strong genetic predisposition associated with obesity.  Other studies have demonstrated alarming new trends, such as childhood obesity now presenting in societies that have never had a measurable problem with obesity.  An ominous and alarming fact is that childhood obesity typically leads to severe obesity as an adult.  And for severe obesity, study after study has demonstrated an amazing lack of long-term success with even the most intensive behavioral modification programs. These reports, and numerous other well-designed studies, clearly show that we are facing a true epidemic.

But identifying obesity as an epidemic does not mean we cannot influence its course by changing our behavior. Obesity, like many other diseases, would dramatically diminish or resolve completely, if most people changed their behavior such as adherence to a very low-calorie diet and an increase in exercise.  Of course, this is also true about many other diseases such as many cancers and diabetes.  Most type 2 diabetics will have complete resolution of their diabetes if they adhere to a low-calorie diet, increase their exercise and lose weight.  Nevertheless, we treat diabetes aggressively with medication, and respect it as a disease, despite our inability to treat it effectively through behavior modification.  Lung cancer is an even more obvious example of a preventable disease.  This form of cancer would almost cease to exist if tobacco smoking were eliminated.  However, we permit smoking, and we treat lung cancer aggressively and with compassion for those afflicted.  Obesity, like diabetes and lung cancer, is a devastating disease and we should treat those afflicted aggressively and with the compassion they deserve.

The main problem with treating obesity lies in the fact that successful medical treatment for severe obesity remains elusive.  There are no medications proven to be successful with severe obesity.  If we had medications that effectively controlled excess weight, then severe obesity would be treated as any other disease, and we would expect physicians to treat it aggressively.  Unfortunately, this lack of successful medical therapy has enhanced the prejudice against those people suffering from obesity, not only throughout our society, but also within the medical community.  This prejudice is compounded by the fact that very few medical doctors have received any formal training in the treatment of excess weight.  This embarrassing professional neglect has left the door open to opportunists who prey on desperate people suffering from obesity by promoting ridiculous diet formulas, useless weight loss pills, and strict diet plans that are almost impossible to follow.

The only truly good news is that there is a very successful treatment for severe obesity, called bariatric surgery. In fact, all scientific studies on modern bariatric surgical procedures have shown that the majority of people with severe obesity will be effectively and safely treated by undergoing one or the other of these procedures.  Unfortunately, due to the bias against people with obesity, these highly successful treatments have either been neglected or have had to withstand substantial criticism.  This has resulted in a situation where the vast majority of patients who would benefit from these procedures are either not referred for evaluation or are actively discouraged from exploring this option.

Fortunately, scientists are working to define the physiologic causes for obesity and new medications are being tested which may become effective for certain people. However, for the time being, the medical community must recognize the need for aggressive treatment of patients with severe obesity and be willing to refer patients to surgeons who focus on obesity as a distinct medical illness. Unless effective surgical treatment for severe obesity is used aggressively, hundreds of thousands of people that could benefit from these treatments will continue to suffer.

Everyone now knows that being overweight leads to numerous disease processes.  What most overweight people do not realize is that their size severely limits the ability of physicians to even tell them what’s wrong.

A new study has just revealed that the number of inconclusive imaging tests, CAT scans, MRIs, X-rays, etc…, has doubled in the last 15 years because many patients are too big.  In other words, radiologists are unable to accurately use these tests to make a diagnosis because the patient is simply too large.

Over the years, physicians have become increasingly dependent on testing like mammograms and CAT scans, called radiological imaging, to assist in their ability to diagnose many diseases.  Of course, a physical examination is always important, but a physician needs to be able to feel abnormalities when examining a patient and this is often impossible to do when the patient is obese.  When the doctor cannot tell what is wrong after examining a patient, an X-ray or other test is typically scheduled, but now we are learning that even these tests are inaccurate in larger people.

The reasons for this are many.  For example, it takes a much stronger “X-ray” to penetrate, or look inside, the body of a patient who has a large amount of fat; and, the quality of the images obtained decreases as the patient gets larger.  In some cases, even though the dose of radiation is dramatically increased, the images obtained are “fuzzy” and do not help to diagnose the patient’s problem.  Another example is ultrasound which is used to diagnose breast cancer, gallstones and many other disease processes.  Ultrasound sends high-frequency sound waves through the patient, where they bounce off internal organs, like a submarine’s sonar.  The ultrasound machine detects the returning sound waves and creates a picture of the organs.  Unfortunately, the thicker the patient is, the less the sound waves are able to penetrate, and the image quality is poor.

When radiologists are trying to obtain the tests they need, the problems caused by excess weight involve much more than difficulties interpreting poor quality images.  Special beds, extra personnel and “super-sized” wheelchairs are needed just to move patients safely when performing these tests.  There has even been a rise in the number of injuries sustained by hospital employees while transporting heavy patients.  Due to the extra equipment and personnel required, it typically takes longer to complete the tests, causing further delays in these patient’s diagnosis and care.

What has now become evident is that, not only do obese people have increased health problems due to their weight, but physician’s abilities to diagnose these disease processes is severely limited.  A large patient can no longer walk into a hospital and expect the best quality care because X-rays, CAT scans and other imaging studies are unable to detect and diagnose the problem.  Unfortunately, with the incidence of obesity on the rise, we can expect this situation to only get worse.

Considerable evidence has shown that being overweight plays an important role in the development of cancer.  Based on the American Cancer Society’s 2002 estimates for cancer incidence, 51% of all new cancers diagnosed among women were directly related to obesity.  Among men, cancers linked to obesity comprise approximately 14% of all new cancers.  In terms of mortality, for women obesity-related cancers cause 28% of cancer-related deaths, and for men, obesity-related cancers are estimated to cause 13% of cancer-related deaths.

Now, a recent study has looked at the effect of excess weight on the surgical treatment of men with prostate cancer.  Specifically, the study looked at the newest, advanced robotic technique for prostatectomy and analyzed the effect of excess weight on the difficulty in performing this surgery.  When normal weight patients (BMI=18 – 25) were compared with patients who were overweight (BMI=25-30) or obese patients (BMI greater than 30), they found a significant difference in outcomes.  For overweight and obese men there was more bleeding during surgery, the surgery time was longer (30 minutes longer for obese men) and obese patients stayed in the hospital one extra day.

This study sends a clear message that being overweight not only increases a person’s risk of developing and dying from cancer but being overweight makes surgery for cancer more difficult and costlier. In short, the results from surgery to treat cancer are worse for overweight or obese patients than for patients who are at a normal, healthy weight.  This is just one more reason to stress the importance of maintaining a healthy weight. 

For people who need help controlling their weight, The N.E.W. Program provides a new non-surgical weight control program in addition to a surgical program. Neither program promotes traditional diets, and both programs promote lifestyle management as the key to achieve long-term healthy weight goals.

The Covid-19 global pandemic has finally exposed the fact that obesity kills. The truth is, in the United States, obesity is now the most prevalent threat to your health. It’s not diabetes, heart disease or even cancer. Obesity affects 42% of all Americans and it’s a killer.

On July 24^th Public Health England reported that being overweight or obese “puts you at greater risk of serious illness or death from Covid-19.” In fact, having a body mass index (BMI) of 30-35 puts you at 40% higher risk of DEATH from Covid-19. That’s just 45 pounds of excess body fat if you’re 5’4” tall! And for a person with a BMI of 40, your risk of dying from Covid-19 goes up by 90%!!

The truth about your weight and the risk of death from Covid-19 is so well know that it was recently reported on Real Time with Bill Maher. https://youtu.be/vDaQOy7ML38

This is not new information to doctors. We have known for a long time that obesity and metabolic syndrome affects your immune system. A report from January 2016 in the journal Advances in Nutrition warned that the “increased risk of both metabolic and infectious diseases” caused by obesity was devastating. And if you are obese and hoping that a vaccine will solve your problem, think again. Vaccines are less effective in obese adults, and Covid-19 will likely be the same. When asked if there will be a Covid-19 vaccine tailored to work better in obese people, Dr. Shaikh, a professor of nutrition at the University of North Carolina, answered “No way.” In fact, when asked if the vaccines being developed will work in people that are obese the answer was “Our prediction is no.”

Since coronavirus epidemics will likely be part of our lives for years to come, doing something now to fix your problem with excess weight might be the most important thing you can do.

The world may be getting smaller, but it’s people are getting bigger……and bigger…..and bigger.

Back in 1963, when the boats that carry customers through Disneyland’s “It’s a Small World” ride were first designed, an adult’s height was roughly the same as today, but the average adult weighed far less than 200 pounds.  Not anymore.  Today, the boats at Disneyland’s famous ride frequently “bottom out”, overloaded with today’s overweight passengers.

The “Small World” ride has been handicapped by a “Big Rider” problem.  Instead of carrying mainly healthy-weight patrons, the ride must now accommodate adults who often weigh much more than 200 pounds.  Increasingly, over-weighted boats get to certain points in the ride and become stuck on the bottom of the pool.  In an attempt to avoid this problem, Disneyland employees have been trained to leave empty seats on many boats to compensate for hefty patrons, but this routinely upsets the hundreds of other paying customers waiting in line. When a boat does bottom out, the long line of boats backs up behind it, their passengers becoming upset while listening to the ride’s theme song over and over.  The ride monitors must then find the stuck boat and attempt to tactfully help a heavy rider, or two, to an exit at one of the emergency platforms.  To make things even more uncomfortable, some of the embarrassed, overweight riders do not deal with this situation graciously.

As a result of this growing inconvenience, Disney has been forced to close down the “It’s a Small World” ride for an entire year in order to complete a massive renovation in which the boats will be redesigned, and the flume deepened, to accommodate their patron’s additional poundage.  Unfortunately, this problem is not just isolated to Mickey Mouse’s home town.

Although America is well known to have an obesity epidemic, the problem is not confined to American shores.  Even Mediterranean countries, touted for their heart-healthy diets, are being faced with expanding waistlines. In Italy, 42 percent of adults are overweight and 9 percent are obese, according to the World Health Organization. In France, 41 percent of adults are overweight and 11 percent are obese.

Though some experts blame America’s obesity problem on soft drinks or the use of high-fructose corn syrup as a sweetener, the problem goes much deeper.  We live in a culture that encourages lifestyle patterns that include frequent overeating and minimal physical activity.  Unfortunately, if obesity trends continue, researchers at Johns Hopkins University estimate that 75 percent of American adults will be overweight or obese in just eight years and 41 percent will in fact be obese.

Because obesity has been linked to at least 53 diseases, including diabetes, heart disease, stroke and cancer, and because the costs of obesity on society have become so huge, governments are now being forced to take action.  In countries like Mexico, Brazil and China, the health costs of excess weight are rapidly becoming a big part of their budget.  As a result, governments from Scotland to China are already debating how to tackle this issue.  Planned maneuvers include taxing sodas and sugary drinks, revamping agricultural subsidies to make fruits and vegetables cheaper, banning junk-food ads on children’s television, and demanding equal advertising time for healthy food.

However, no matter what government initiatives are applied, the first steps to rectify this epidemic need to be made on an individual level.  People must make positive changes in their lifestyle, especially eating habits, not just to lose their excess weight, but to avoid becoming overweight in the first place.  It’s a sad day in our society, when instead of being able to successfully address the underlying issue of obesity, we are forced to tear down a famous ride and rebuild it in order to accommodate our unhealthy way of life.