Recurrent Breast Cancer

Tuesday, August 7, 2012

Are you having an uphill struggle?
Thirty five percent of American adults are obese and five and a half percent are morbidly obese.
The annual cost for obesity and overweight in the U.S. is two hundred seventy billion dollars.
Obese people spend forty percent more on health care compared to those with normal weight.
Medical conditions linked to obesity include hypertension, asthma, joint pain, diabetes, elevated lipids, sleep apnea, gallbladder disease, and arthritis.

A tool to evaluate obesity is the BMI (body mass index). It is calculated by a formula that incorporates body weight and height.  

Here are BMI guidelines.
                         Less than 18.5: underweight.
                        18.5 to 24.9      normal weight.
                        25.0 to 29.9      overweight.
                        30 and higher:  obesity.           

BMI scoring doesn’t consider distribution of muscle and bone mass. It underestimates body fat in lean and elderly people, muscle wasting disease, eating disorders, and morbid obesity. It overestimates health risk in body builders and athletes. Have you noticed body physiques of the current Olympic participants?
Over the Counter weight loss products. These include Raspberry Ketone, Sensa (malto-dextrin), and Belvic Diet Patch. Beware: Safety and effectiveness of these products are unknown.

Prescription weight loss medicine. Qysmia, a combination of Phentermine and topiramate, is pending approval by the FDA. Its side effects include memory disturbance, depression, anxiety, dizziness, and elevated heart rate.

You might consider traditional treatment options, such as diet, exercise, and calorie restriction. A ten percent weight loss over six months is possible but difficult to maintain. Exercise combined with calorie reduction is more effective than diet alone.

Operative treatment. Bariatric surgery is an alternative for people with high BMI who’ve had no success with diet and exercise. The three available procedures are gastric banding, bypass, and Rou-En-Y. In 2010, the American Diabetes Association recommended that bariatric surgery “should be considered for adults with BMI greater than thirty five and diabetes,” especially if the diabetes is “poorly controlled with lifestyle changes and prescription medicine.” The American Heart Association recommends bariatric surgery as “the only effective long term treatment option for the severely obese patient.”

The FDA approved gastric banding in 2001. Its advantages include no stapling or stomach removal, gradual weight loss, and an approximate sixty percent weight loss over five years. The band is adjustable and has minimal side effect risks, such as loose stools. Periodic postoperative followups and healthy lifestyle are crucial to maintain weight loss.

Rou-en-Y surgery involves bypassing most of the stomach and rerouting the intestine. Weight loss is rapid during the first year. Complications include difficulty in reversing the stomach sapling, vitamin deficiency, longer post-operative recovery, and “dumping syndrome,” a condition that causes nausea, flushing, and sweating.

In sleeve gastrectomy, two thirds of the stomach is removed. There is rapid initial weight loss. However, this procedure can affect secretion of stomach fluids and is not surgically reversible.
Source: First Report Managed Care; June 12; Special Disease State Update; Obesity: The Economic Burden, The Disease, and the Solution.

If questions, contact Dr. Clem at