Tackling Obesity

What motivates individuals who are overweight or obese to shed the extra pounds is as complex as the causes for the weight gain. Equally complex are the reasons people fail to maintain weight loss.

Numerous studies show people who struggle with being overweight or obese can typically lose about 5 percent to 10 percent of their starting weight in the first six months after starting a diet, but the challenge is maintaining weight loss.

“If you look at people and say, ‘lose weight,’ only 5 percent will lose and maintain that weight. And if you add (weight loss) medicine, only 10 to 15 percent will keep it off,” says Dr. Matthew Pfister, a Parkview Physicians Group (PPG) surgeon who is fellowship trained in bariatric, or weight loss, surgery. 

“The struggle is real. It’s really hard to lose weight,” he says, adding it’s an oversimplification to simply frame the problem and solution merely as “calories in, calories out.” Genetics, food choices, socioeconomics, environment, activity level, societal trends and other factors are involved. 

“We need to attack it from all fronts, both medically and surgically,” Pfister says, which is why in late 2017, Parkview launched its Weight Management and Bariatric Surgery program. Services involve a multidisciplinary team which, in addition to Pfister, includes: Dr. Ryan Singerman, a family medicine physician with PPG and medical director of the weight management program; dietitians; a nurse practitioner; a behavioral therapist; a fitness specialist; and a support coordinator. Support groups provide motivation and education.

For many overweight patients, a medical weight loss program may be the solution, but when people have been down the diet road repeatedly and the weight over time continues upward into the morbidly obese category, “It’s time to reconsider the options,” says Pfister.

In the 1980s, U.S. adult obesity prevalence was about 10 percent; today it is nearing 40 percent, according to the Centers for Disease Control. Obesity is defined as having a body mass index (BMI) of 30 or above; overweight is a BMI of 25-29.9.

Medical conditions associated with obesity are many and serious: heart disease and stroke; type 2 diabetes; osteoarthritis; sleep apnea; some cancers; gastro-esophageal reflux (GERD); and depression, though excess weight is not always the primary cause. 

On average, people with moderate obesity die three years earlier than healthy-weight individuals, and those with morbid obesity (BMI 40 and over) die 10 years earlier. 

“We have more than 300,000 people in our nation who are dying prematurely,” Pfister says. Bariatric surgery can reverse that, but lack of education on available surgical options and misconceptions about insurance coverage and safety remain.

Both gastric bypass and sleeve gastrectomy, which are the two main procedures Pfister does, restrict the amount of food the stomach can hold. Gastric bypass also works through malabsorption. Both surgeries help resolve and improve comorbidities such as diabetes, with gastric bypass slightly better than sleeve gastrectomy.

Most insurers now cover weight-loss surgery which has a complication rate similar to gallbladder removal and hip replacement, two of today’s most common surgeries. The recovery period is shorter than many people realize.

“People usually spend one night in the hospital,” Pfister says, noting the procedures today are laparoscopic, “so they are usually back to work in one or two weeks.”

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