19 October, 2005

Obesity rant #7

It's been a long time since I went on a rant about obesity, which I used to do far more frequently back in the day. One of those foregoing rants was about the Department of Health and Human Services' decision to specify obesity as a disease. Included therein was the startling recommendation that gastric bypass surgery be included as an accepted, and even primary, treatment.

This seems unwise even to the ill-informed and conjures up the disquieting phrase "unnecessary surgery". Now a pair of recently-released studies provide some good statistcs to bolster that disquietude. Check out the horrifying graph to the right. Even more disturbing is the fact that the number of people electing to have this sort of surgery is galloping upwards, from 13,000 in 1998 to 103,000 in 2003.

I don't mean to imply that gastric bypass surgery should never happen. Nevertheless, I do find it to be an extreme reaction to something we know to be a problem of lifestyle and nutrition. There's simply no reason why our government should be responding to it as a disease.

Fifty years ago when lung cancer rates started shooting up, few people had any idea that cigarettes were to blame. When that correlation was established, the public health imperative was abundantly clear: stop smoking. Stop smoking, and you will stop lung cancer. In this case, we can say just as certainly that obesity has a lifestyle cause. It isn't as concentrated or obvious as cigarettes, but it's probably far more reversible. It's the responsibility of public health officials to push healthy lifestyle changes first, especially when treatment is a dangerous and undesirable option.


Atul Gawande has a good essay in his book, Complications , about some people who undergo gastric bypass surgery. He too is horrified by the idea, but he manages to find some people who very obviously need it. What struck me by the essay is that it did not end up as a paen to the technique--instead, by highlighting the very extreme lives of those who do need it, it made one realize what an almost absurd tool it was, how very few people actually have that extreme a problem, and how bad it has to get for the ordinairy obese to work their way to that stage--which for some of his subjects was not a lifestyle issue, but a glandular or similarly physical issue.

Of course, you're probably down the hall from him, so you can run my interpretation by him yourself. :-p


Posted by Saheli

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