The Quiet Epidemic

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.