LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

bariatric surgery

Obesity Now Labled a “Dis-ease,” But Should’ve Been “Dis-aster”

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On June 18, 2013, the American Medical Association voted to classify obesity as a disease. They thought it was a good idea.

This decision was made against recommendations from a subcommittee that had evaluated the pros and cons.

The pros must’ve won out. After all, calling it a disease could open up all kinds of money available for anti-obesity treatments like medications and gastric bypass surgery. It may also increase the likelihood that an insurance company will actually pay for treatment of obesity. Although, with the insurance companies’ just-short-of-lemming-like action to move insureds to high deductible plans, this aspect may not really help anyone.

Not that the financial benefits of drug companies would have had anything to do with the decision of the AMA in this matter, nor would the AMA ever do anything for purely financial gains. Nope. All on the up and up.

So. Obesity is now classified as a disease. No real downside, right?

Well, there wouldn’t be one if the American public didn’t think like the American public. I remember quite a few years back when a patient of mine who was rather large decided to look into bariatric surgery. In order for insurance to cover the procedure, he had to go to the required “weight loss program” put on by the bariatric clinic prior to undergoing surgery. The overall gist of the “weight loss program” was that weight was genetic and there really isn’t anything you can do about it so bariatric surgery is your best option.

This is just what everyone wants to hear deep down inside. It’s a disease. There is something wrong with you that you need external help to control.

Just in case you think I’m being dramatic, I present this particular study. In it, researchers looked at the attitudes of a group of obese study participants’ attitudes following the labeling of obesity as a disease. Here’s what they found:

  • Labeling obesity as a disease weakened the importance of health-focused dieting.
  • Obesity as a disease reduced concerns about weight among obese individuals.
  • With this reduced concern about weight there was a greater likelihood that participants would choose higher-calorie foods.
  • The disease message lowered body-image dissatisfaction (possibly a good thing in the right context), but this attitude also led to higher-calorie food choices.

While on the surface it may seem like a good idea to reclassify obesity as a disease rather than a symptom or as a risk factor for other diseases, in reality it seems to remove the incentive for obese people to make the right decisions. Worse, they seem to be more comfortable in their current weight instead of focusing on making changes.

None of this is saying that obesity is not a challenging situation and that there are not ideal candidates for bariatric surgery. However, we need to understand that getting back to an ideal body weight is a very long term process. I just saw a patient this evening who is 7 pounds away from her 100 pound weight loss goal. This process has taken almost 3 years and she sounded a little disappointed by how long it has taken.

Holy cow! Even if it took her 10 years to lose 100 pounds it is a move in the right direction. Most would not have the patience to wait 3 years for the outcome. I think it is fantastic and illustrates wonderfully the dedication it takes to turn health around.

The biggest challenge is getting started.

LONG TERM IMPACT OF BARIATRIC SURGERY – (04-30-07)

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Long Term Impact of Bariatric Surgery on Body Weight, Comorbidities and Nutritional Status

I’ve recently had a patient go to one of those “info” meetings for those considering bariatric surgery. The information presented was sugar coated and painted a picture of these overweight patients as victims of their genetics, with no real responsibility for their condition. While this alone may be bad enough, there was no mention of the most important information. Once someone has bariatric surgery, their lives will be forever changed. Not even counting failed surgeries and repeat surgeries for adhesions and complication. Not counting the fact that many of these patients end up with the same risk of heart disease and diabetes.

The real issue is that an absolutely essential process of life–digestion and absorption of nutrients–is forever altered. The rest of their life will need to be different, avoiding foods w/ poor nutrient density and only taking in high nutrient density foods. Given the number of bariatric surgeries performed each year, you can bet we will see ever increasing numbers of very sick, post-bariatric surgery, patients.

Read entire article here

ADVERSE OUTCOMES FOLLOWING BARIATRIC PROCEDURES (05-04-09)

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Increased Colorectal Epithelial Cell Proliferation and Crypt Fission Associated with Obesity and Roux-en-Y Gastric Bypass

The concept of bariatric surgery has become so accepted that many now view this as a procedure with only positive outcomes. However, messing with the way our bodies digest and assimilate food is never a good thing, and the long term safety of these procedures have never been demonstrated.

We have, however, seen a variety of research studies finding adverse outcomes following bariatric procedures. This study adds to the weight of this evidence, suggesting that, after this procedure, there is an increased risk of colorectal cancer.

Read entire article here

CAN GASTRIC BYPASS SURGERY CAUSE CANCER?

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Gastric banding.  Gastric sleeve.  Roux-en-Y bypass.  There are in increasing number of procedures available that fall under the category of bariatric surgery.  This is also increasing coverage for the procedures by insurance if certain criteria are met.  Roux-en-Y is the most common form of surgery used.  But are these procedures safe?

Let’s get one thing on the table right now.  ANY time you alter digestion, be it with drugs that suppress acid production (Nexium, prilosec, etc..) or with surgery this is a price to be paid.  That price can be severe, with the end consequence being death.

I have mentioned before that the body does two things–digestion, and everything else.  We already know that malabsorption of nutrients leading to nutrient deficiencies occurs. We know that the risk of gallbladder problems goes up.  We know that the bariatric surgery patient’s diet is forever altered.  Far too often, the patient puts the weight back on because they never learned the right way to be eating for their body in the first place.

But what about the short term?  Well, there are rapid positive changes that can occur such as reversal of diabetes and weight loss.  But what about after that?  We’ve already mentioned the long term nutrient deficiencies that will plague the bariatric patient for the REST of their lives.

This particular article begins to shed light on some more severe consequences of the Roux-en-Y bypass surgery.  Elevation of cancer markers in the rectum are known to be present 6 months after the procedure.  This study looked at what happens 3 years later.  Do the markers improve?  Not even close.  There remains, 3 years after the procedure, a 4,000% increase in the tumor marker macrophage migration inhibitory factor in the rectum.

It is still too early to determine what this does to the risk of colorectal cancer.  But, if I were to place my bets, I’d bet that the rates of colorectal cancer in these patients are going to be markedly elevated.  Some much for the short term benefits…

The bottom line is that the right lifestyle changes are always your best answer.  Our office has also had success with our in house weight loss program as well, that helps to educate patients while assisting with initial rapid weight loss.