The fight against fat

You don't have to be an obesity expert to realize that Americans are overweight. Just stand in line at McDonald's, ride the T, or walk through a shopping mall. "You have a combination of social and genetic factors interacting with the realities of modern society to create a situation where the mortality of individuals is at risk because of obesity," says Dr. Michael Tarnoff, director of the

Obesity Consult Center for Minimally Invasive Obesity Surgery at Tufts New England Medical Center in Boston.

Mounting statistical evidence bears out Tarnoff's assertion: In the past 20 years, obesity in adults and adolescents has increased an alarming 250 percent. With 60 percent of American adults now classified as obese, the U.S. ranks second only to Australia in its percentages of severely overweight citizens. The consequences of the enlarging of America can't be underestimated, say medical experts. "Heart disease, diabetes, cancer-all have been linked to excess weight," says Dr. Lee Kaplan, director of Massachusetts General Hospital's (MGH) Weight Loss Center.

Promoting a healthy lifestyle
Responding to this health crisis, a number of hospital-based clinics are now offering services that focus on both weight loss and healthy lifestyles. Among them is Beth Israel Deaconess Medical Center's Be Well Tanger Center for Health Management.

The Tanger Center concentrates on employee wellness and fitness, nutrition education, weight management, and smoking cessation through a variety of programs. "Our overall goal is to maximize health and, in doing so, prevent the onset of illness that can be caused by conditions such as obesity," explains director Dan Rooks.

To promote patient weight loss and wellness, the center takes an interdisciplinary approach. "A client who has arthritis, for example, may have difficulty walking," says Rooks. "But by conferring with his or her physician and our pharmacologists, medications can be prescribed which make it easier for the patient to walk as part of their exercise routine."

Many of the center's clients are individuals who have successfully completed bariatric surgery, which is an operation that alters the body's digestive system in order to limit food intake and subsequent weight gain. Typical surgeries include constricting the size of the stomach to reduce the body's capacity to ingest food or shortening the small intestine to limit absorption.

Patients benefit from the center's comprehensive efforts to prevent weight gain after such surgeries. Their efforts include exercise, medications, and nutrition education to promote healthy eating habits. Such a comprehensive approach is vital to helping obese patients win their personal battles with weight control, says MGH's Kaplan. "What needs to be understood is that bariatric surgery can't be successful on its own. Patients can gain back their weight if there aren't proper supports in place to help them.

Preventing weight gain
To help prevent the recurrence of obesity, the MGH Weight Loss Center provides intensive counseling and support programs two months prior to and following bariatric surgery. During this period, special emphasis is placed upon medical conditions that could interfere with weight loss.

"Obese individuals have many health issues-diabetes, high cholesterol and blood pressure-which need to be addressed in a medically appropriate way if weight is to be lost safely," says Kaplan.

Often, this means finding alternative methods for screening patients. "For instance, obese men who are 50 years of age or older are too overweight to be tested for prostate cancer through usual methods," Kaplan explains. "But ultrasound screenings can be used to test for this disease instead."

Once these health issues are confronted, center weight loss services include a 12-week program to counsel patients about healthy eating habits and diets, personalized exercise plans to help maintain weight, and behavior modification surrounding diet and exercise. All of the services are aimed at "breaking old habits about food," according to Kaplan. "Instead of reaching for that high fat treat when stressed, we want people to choose healthier snacks, to exercise, even meditate in response to challenges."

Similarly, Tufts New England Center's weight loss program also uses staff and methods to supplement surgical weight loss procedures. In particular, their three staff psychologists conduct support groups "to deal with problems that may arise," according to Tarnoff. This includes "keeping expectations realistic by discouraging the use of food for comfort or to deal with emotional crisis, such as the loss of a loved one," he explains. When it comes to implementing procedures to help obese patients, safety is a key factor. Vitamin and mineral supplements, for instance, help compensate for the body's reduced food intake as a result of bariatric surgery. "Otherwise, the body would begin to feed on muscle, leading to severe malnutrition for the patient," says Tarnoff.

More to learn
While most obese surgeries are successful, there is still a lot to learn about how the body reacts. Hence, Kaplan's current research project. "We're trying to learn whether manipulation of the stomach and intestines is sending signals to the brain to eat less," Kaplan notes. "We're finding, in general, that bariatric surgery is 80 to 150 times better [than dietary remedies for morbidly obese people] in both weight reduction and keeping off the weight. Patients remain less hungry, they have more cravings for healthier foods such as salads, and the comfort value of food diminishes dramatically."

Through such research, it is hoped that extreme surgical procedures may become a thing of the past. "If we can understand how such operations affect people psychologically, we might be able to replace it with less invasive, non-surgical techniques altogether," says Kaplan.