Shortfalls to shortcuts

Throw out any thoughts that weight-reduction surgery is a shortcut to svelte. The surgery, performed on about 200,000 Americans a year, is a last resort to save people in danger of dying early from the consequences of obesity.

After years of question marks, studies now show the surgery saves lives, sustains long-term weight loss and combats — maybe even reverses — diabetes.

But it still results in the death of 1 in 200 patients and can result in complications such as blood clots, hernias, bowel obstructions or intestinal leaks that can lead to infection.

Because of these complications, National Institute of Health experts recommend the surgery only for people considered morbidly obese, roughly 100 pounds or more over ideal body weight.

They face a risk of death from diabetes or heart disease five to seven times greater than people of normal weight.

Piling on the calories

The twin remedies to get rid of fat — diet and exercise — are ineffective for people who are vastly overweight. Weight gain leads to arthritis or difficulty in breathing, which makes exercise difficult and, eventually, impossible.

People sit more, move less and don't burn all the calories they consume.

“Once you're in the morbidly obese category, it is very, very hard to lose the weight using nonsurgical means,'' says Dr Melinda Maggard Gibbons, a general surgeon and researcher at the Centre for Surgical Outcomes and Quality at the University of California Los Angeles.

There are two main surgical options. Gastric bypass surgery reduces the stomach from the size of a football to the size of a golf ball using surgical staples or a plastic band.

The most common and successful technique is called the “Roux-en-Y procedure'', named for the surgeon who invented it. Food from the stomach bypasses more than half of the small intestine, where nutrients and calories are absorbed, and heads for the large intestine, from where it's eventually excreted as waste.

Second techinque

Stomach-banding surgery, which is reversible, wraps a silicone belt around the stomach, reducing its size so that as little as a tablespoon of food fits at a time.

Both procedures successfully result in weight loss, although more pounds come off with gastric bypass surgery.

A group of researchers followed about 2,000 obese patients who had undergone weight-loss surgery — gastric bypass or surgical banding — and compared them with about 2,000 similarly obese people who didn't have surgery but were counselled in diet and exercise.

After ten years, those who had bypass surgery weighed 25 per cent less; those who had stomach-banding were down about 15 per cent.

Paul Shekelle, director of the California-based Rand Corp's evidence-based practice centre, which conducts health-care reviews, said he's concerned that too many people see surgery as an easy solution to a difficult problem.

“You've got to make sure that patient understands that this is not like getting your knee repaired,'' he says. “This is going to make your life different.''

Patients won't eat sugar any more, not without risking diarrhoea, gas, bloating and cramping.They won't eat large amounts of anything, ever.

MONEYWISE

Covering costs of weight-loss surgery

The most extreme solution to morbid obesity — weight loss surgery — costs a pretty penny. The cost ranges from about $17,000 (Dh62,561) for stomach-banding surgery to about $35,000 (Dh125,558) for gastric bypass surgery.

If there are complications, add thousands more. Because obesity is a costly and health-eroding condition, US Medicare has developed guidelines, which many other insurers follow, to cover the cost for some people.

Generally, the patient's body mass index must be at least 40. But if a patient has weight-related health complications such as heart disease, sleep apnoea or diabetes, Medicare and many insurers will cover the procedure for patients with a BMI of 35 or more.

Also, many insurers require that people show that they have failed traditional diet and exercise therapy for up to five years.

Like many surgical procedures, practice makes perfect. Surgeons who do many weight-reduction procedures have better outcomes and fewer deaths.

Some surgeons will do the procedure for people with BMIs lower than 35 or 40, although patients probably will have to pay the bill themselves.

The procedures are lucrative and some surgeons can perform several stomach-banding procedures a day.

“It's become known as the plastic surgery of general surgery,'' says Dr David Zingmond, professor of internal medicine at the University of California Los Angeles.

“For an objective opinion, you could go to a physician who is on salary,'' he says. “They probably have the least financial incentive in terms of the number of cases they do.''

Reality TV makes a big impact

Ladies and gentlemen, please give it up for reality television. Because of it, the fitness landscape will never be the same again.

Before The Biggest Loser or Celebrity Fit Club hit US airwaves, fitness and obesity weren't the most TV-friendly topics.

Exercise was relegated to the occasional programme or morning-show segment and obesity was used for shock value through the occasional 500-pound talk-show guest or story of spectacular weight loss.

But when the reality show juggernaut launched about eight years ago, it must have collectively dawned on some executives that fat people on a mission to lose weight would make for great TV — and maybe the process of exploiting them would inspire a few viewers to shed some pounds themselves.

That epiphany resulted in a slew of shows in which obesity and weight loss were treated as either a competitive sport or quasi-circus sideshow and cautionary tale.

I'm an avid watcher of these shows, hooked from Day 1. Because I write about fitness and obesity, I sceptically search for the shows' redeeming qualities. I know they're out to entertain viewers but I wonder if the average person will find inspiration or insight.

Below are reflections on some of these shows' motivational merits — with input from Los Angeles-based personal trainer and author Harley Pasternak (5-Factor Fitness and The 5 Factor Diet).

The Biggest Loser: This prize-driven competition pits men and women against each other in a battle to see who can lose the most weight while sequestered.

Most of the weight loss is dramatic — not surprising, given the fact that competitors are cut off from family and friends.

Pasternak points out that the show has to go for extreme results because regular weight loss isn't very interesting.

“People aren't going to tune in to see that somebody lost another pound this week,'' he said. “So it's not this moderate, sustainable, realistic programme; it's about losing as much weight as possible by any means necessary.''

Celebrity Fit Club: D-list celebs don't have to hide from prying paparazzi — they can let the world see them try to lose weight.

The once-famous starlet who can't get rid of the baby weight, the rapper who lives to eat, the former child star who finds solace in cheesecake — guaranteed, one or more of these types will be ready to do what it takes to slim down.

I had big doubts about Celebrity Fit Club from the get-go — what could viewers really learn from a bunch of has-beens trying to shed their bulk? It's this: Just because you're famous and being paid to lose weight doesn't mean it'll happen.

Contestants aren't sequestered, so they must deal with real-life temptations when the cameras aren't on. We're privy to their excuses — I'm under a lot of stress, I try to be good, I have big bones.

The show is probably the closest reality TV comes to depicting the reality of weight loss — it's difficult and takes constant vigilance.

— By Jeannine Stein/Los Angeles Times-Washington Post
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