Let’s be Honest

Posted on July 15, 2013  |   1  |  Permalink

Weight loss is difficult and sustained (read: permanent) weight loss is excruciatingly difficult. Not that it can't be done, but it is hard. We can be comforted by knowing that healthy weight is not just about weight loss and that the benefits of achieving a healthier lifestyle are substantial. A recent publication of a long-term weight loss study to reduce cardiovascular death in obese individuals with type 2 diabetes, the LOOKAHEAD trial, showed that, despite adequate treatment and weight loss, risk of death was not reduced and sustained weight loss was not impressive (New England Journal of Medicine, 2013;369:2). 

     Most obesity professionals have learned to actively downplay a selective focus on the number on the scale (weight loss selectively) in order to reduce body image preoccupation, to avoid implicitly encouraging unattainable weight loss expectations, as well as to promote best weight and improved health and well-being. All well and good; but absolute weight cannot be ignored. This is especially true for those that fall into the morbid obese (BMI > 40) or super obese (BMI > 60) categories. Such individuals may require substantial weight loss in order to achieve health. This is why all treatment options for weight management should be raised by healthcare providers. In cases where substantial weight loss is the goal (morbid or super obesity) bariatric surgery should be considered. 

     There are two types of weight loss surgery; restrictive procedures that do not affect nutrient absorption but reduce the size of the stomach, and malabsorptive procedures that by-pass part of the small bowel. Banding procedures and sleeve gastrectomy are examples of restrictive surgeries and Roux-en-Y an example of a malabsorptive surgery.

     The interesting thing about surgery is that the procedures are brief and effective. That does not mean that they are without risk. Anyone contemplating surgery needs to carefully weigh the risks and benefits and be comfortable with their decision. My point is that the surgical procedure is discrete and brief and associated with a short recovery period. The challenging thing about surgery is living with it in a manner that reduces any tendency toward weight regain. Most surgical centres describe surgery as a tool, not a solution. In other words, people might need help in order to derive the maximum benefit of surgery.

    So now let's talk about Nova Scotia. We have a huge problem with obesity and can expect to have our fair share of individuals living with morbid obesity. We know that there are many people interested in surgery, but only one surgical centre that performs less than 100 surgeries per year. This discrepancy in need versus available service has caused a number of people to pursue surgery outside of the province.

    Given the limited resources available for those who have had or are considering surgery I think 3 issues need to be addressed. These are, I think, unmet or poorly met needs. First, the psychological assessment and screening for readiness for surgery. Second, assistance in helping those not quite ready for surgery, get ready. Third, managing the emotional and social issues in living with surgery. I raise these issues to pique your interest and stimulate discussion. I hope that you will respond to this blog and we can begin a dialogue about obesity surgery. Partners for Healthier Weight is planning to offer help to those who are interested and in need of assistance.