THE ARIZONA REPUBLIC LIVING WELL A-Z
Vol. 2, No. 1 January 2012
 
If tradition holds true, chances are good that for many of us, our New Year’s resolutions involve losing weight. Kurt W. Sprunger, M.D., FACS, is a board-certified surgeon specializing in advanced laparoscopic and bariatric surgery at Surgical Weight Loss Solutions at Tempe St. Luke’s Hospital. He said that obesity is defined as a body mass index or BMI—a calculation that quantifies an individual’s weight related to their height—of at least 30.
“A person is considered severely obese when their BMI is 35 or greater. Morbid, meaning having damaging health effects, obesity refers to a BMI of 40 or more,” he said.
 
Why people become obese
 
As Vishu Jhaveri, M.D., senior vice president of health services and chief medical officer for Blue Cross Blue Shield of Arizona pointed out, obesity has been a problem in our society for some time and is now affecting children as well as adults.
“Obesity probably reflects many of the factors in our western culture like the changes in the way we cook and
the ingredients that we use or don’t use,” he said. “More than one-third of kids today in our country are obese, and another one-third are overweight. So that is two-thirds of our kids beyond what they should be in terms of their weight. That is a problem.”
 
The modern diet is a major contributor to obesity because it is so unnaturally high in salt, sugar and fat, which in turn ends up confusing the nervous, endocrine and gastrointestinal systems, said Jason Reynoso, M.D., a bariatric surgeon at Scottsdale Healthcare.
 
“The hormone system, which helps us avoid starvation, malfunctions and this can cause obesity, ”he said.“There is also a genetic component. It is well-known that if a parent is obese, especially the mother while she is pregnant, the child is more likely to grow up to be obese as well.”
 
Medical issues
 
Obesity-related health issues are numerous, said Anne-Marie Reed, D.O., with Camelback Health Care in Phoenix.
“The most common health issues associated with obesity are cardiovascular problems along with diabetes, high cholesterol, high triglycerides, thyroid disorders, asthma, sleep apnea, heartburn and gastroesophageal reflux disease or GERD,” she said.“Since having more weight can put a real strain on the joints, we commonly see more osteoarthritis in people who are obese. It really runs the whole gamut.”
 
Why diets often fail
 
With so many obese people trying to lose their excessive weight, why does it seem so rare to find those who are successful at shedding extra pounds? Megan Kniskern, M.S., R.D., executive clinical nutrition director at Rosewood Centers for Eating Disorders in Wickenburg, said that too often, people start diets that are just too restrictive.
 
“You don’t want to eliminate entire food groups like fats, carbohydrates or fruits. That sets people up to fail. We can’t maintain that type of diet forever and it usually just leads to temporary weight loss,” she said.
Reed agreed. “Fad dieting is not the way to go. Losing weight is really a combination of teamwork
between the physician and patient, healthy eating habits and regular exercise,” she said. “What I tell my patients is that they need to have a concrete plan for healthy eating and exercise.”
 
Surgical options
 
Some obese people are turning to surgical procedures in order to lose weight. Reynoso said the main bariatric surgery he performs is a gastric bypass procedure called Roux-en-Y. “We turn the stomach into a 15-milliliter
pouch and attach the small intestines to it,” he said. “The food goes straight from the pouch to the small intestines, bypassing the stomach, the pancreas, the duodenum and other organs.”
A benefit of this surgery, in addition to typically significant weight loss, Reynoso said, is that conditions like type 2 diabetes are often reversed.
“By changing the way food travels through the intestines, t ere is a change in the hormones. The patient doesn’t even have to wait for the weight to come off completely in some cases before seeing an improvement in this area [of type 2diabetes],” he said.
Like any surgical procedure, Reynoso said gastric bypass does involve some risks, including pneumonia and pulmonary embolism or blood clots.
“There can also be a leak in the staples that we use to seal the intestine, and if the staples don’t line up and hold properly, gastric fluid can leak out and cause the patient to become septic,” he explained.“Since we are changing the route of the intestines, there can be a hernia inside the belly that can cause an intestinal blockage that would require another surgery to fix.”
When deciding who is a good candidate for gastric bypass surgery, Reynoso said looking at the patient’s BMI score is the first step. “If it’s over 40, it is generally accepted that bypass surgery is appropriate and that it would be beneficial,” he said. “For this group, the risks of surgery are less than the risks of being obese. If the BMI is 35 and up and there are obesity-related co-morbidities like diabetes or hypertension, the surgery can also be beneficial.”
 
Little changes help
Despite the fact that so many people have tried unsuccessfully to lose weight, Reed said there is definitely hope for those who need to trim down. She acknowledged that it’s not easy, but with a lot of effort, discipline and determination, it can be done.
“People need to have a good understanding of nutrition, they need to exercise regularly and do portion control,” she said.
“They also need to eat smaller, more frequent meals, which can help increase metabolism. Drinking a lot of water can also really help.” Kniskern added that overall, the best strategy is to eat three meals and three snacks a day.“Meals have to be smaller, but doing it this way helps keep the metabolism going and the energy levels up,” she said.
 
Combating childhood obesity
Jhaveri said it is important for parents to focus on the amount of physical activity their kids are getting, taking into account how much time they are spending with technology like phones and video games.
“The American Academy of Pediatrics and the Arizona chapter put out an initiative based on a national model that we like here at Blue Cross Blue Shield of Arizona called 5-2-1-0,” Jhaveri said. “This is based on a child getting five servings of fruits and vegetables a day, two hours or less of screen time, one hour or more of significant physical activity, and zero calories from soda. A lot of states have rallied around these concepts.”