Sally was in her late 40s and moved slowly as she walked into her physician’s office. Her gait was more like a waddle as she shifted her weight back and forth with each step. She was tired beyond her years, and most of all, she was disgusted. She was disgusted with herself for weighing more than 300 pounds, and she was angry with the medical community. Taking several medications for hypertension, diabetes type 2, a lipid disorder, and osteoarthritis, Sally was bordering on desperation.
This visit to a physician was different, however. She was seeing a bariatrician, a physician who specializes in the treatment of obesity. Working with her doctor, Peter Vash, MD, of Los Angeles, within six weeks Sally was able to reduce her hypertension medications by 50 percent, eliminate one of the diabetes meds, and reduce her osteoarthritis prescription, all the while sleeping better and walking easier.
“Her quality of life dramatically improved,” Vash says of the woman he calls a typical bariatric medicine patient. “She began to have an outward look of optimism and hope.”
A costly problem
Obese people like Sally are beginning to get the attention of the medical community, insurers, and the government. Although there has been some discrepancy over exactly how many deaths each year in the United States are caused by obesity, everyone involved agrees that obesity is a serious health problem.
The Centers for Disease Control and Prevention last year issued an estimate of 400,000—then revised that to 365,000—deaths a year due to obesity, making the condition one of the leading causes of preventable death. Several months later, in April 2005, it put forth a new calculation of 25,814, dropping obesity to an unofficial seventh-place preventable-death ranking.
While the controversy and confusion over the number of deaths continues, there is no denying that obesity is a health hazard, as it increases the risk for many diseases and conditions, including type 2 diabetes, hypertension, cardiovascular and gallbladder disease, osteoarthritis, sleep apnea, and some cancers. The medical costs associated with obesity are staggering and the problem is growing. In addition, physical inactivity, junk food diets, and other factors in the Western lifestyle have led pediatric experts to call childhood obesity one of the major problems facing children.
According to the Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity, the medical and related costs of obesity in the United States in 2000 were more than $117 billion, and data suggest the emotional costs also are enormous. The International Journal of Obesity in 1991 published a study of former severely obese patients. It concluded:
• 100 percent preferred to be deaf, dyslexic or have heart disease
• 92 percent preferred to have a leg amputated
• 90 percent preferred to be blind rather than be obese again.
Further, 100 percent of those polled preferred to be of normal weight than a severely obese multimillionaire.
All of these facts, plus Medicare’s 2004 decision to discard its policy which stated that obesity was not a disease, may be reflected in physicians’ growing interest in bariatric medicine as a practice opportunity.
The American Society of Bariatric Physicians (ASBP) has 1,100 members. Founded in 1950, in 2000 it achieved its longtime goal of being awarded a seat in the House of Delegates of the American Medical Association. About two-thirds of the society’s members incorporate a bariatric program into their primary care practices, while the other one-third specialize in bariatric practices.
“Our membership has increased,” says ASBP Executive Director Beth Little. “That’s because the government is paying attention to obesity. All the studies show not only the prevalence of obesity and overweight is increasing, but that it is increasing at a faster rate than ever before.”
The number of physicians seeking to be certified by the society’s sister organization, the American Board of Bariatric Medicine (ABBM), is swelling, too.
“The number going through the exam process is increasing exponentially,” says Kelly Wettengel-Dycus, the executive director of the ABBM. “In 2002, 40 were tested. In 2003, 80, and in 2004, over 100 went through the exam process to become diplomates of the ABBM.”
Sameena Rasheed, MD, is one of the ABBM board members who oversees the academic side of bariatrics. She conducts the written and oral exams of those applying for certification and makes site visits to their practices.
“The site visit is very important,” Rasheed says. “You can pass exams, but if you’re not working with patients individually, counseling them, helping them change their attitudes and behaviors and maintain their weight loss—that’s what’s important.”
While physicians frequently come to bariatrics from family practice and internal medicine, they represent a variety of specialties, including psychiatry, ob/gyn, and pediatrics. Rasheed, a former anesthesiologist, is an example of someone who made a major practice change. She has been a bariatric physician for a little more than eight years, ever since she was bedridden with cancer and decided to change her lifestyle.
“I was deteriorating physically, lying in bed and struggling through chemotherapy. I knew I needed better nutrition, and studying that led me to bariatric medicine.” She now has an independent practice in Longview, Texas.
“The patients are so vulnerable. You really have to listen to them,” she says. “On our site visits we make sure the physician is teaching about nutrition, doing behavior modification, and has a maintenance plan. The weight has to be kept off.”
She compares treating obesity to treating hypertension and other chronic conditions. “The patient needs to come back for checkups—one month, three months, six months. What really matters is if the patient has a change in attitude.”
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