The Challenges From Morbid Obesity

By Sharon A. Cark, M.D.

In September 28, a terrific column in the New York Times caught a lot of people’s attention with the title, “Will the Spirit of the Twinkie Live On?” Writer Clyd Haberman pointed out that the earnings and stock of Krispy Kreme Doughnuts have fallen. Entenmanns Bakery closed one of its sites. And Interstate Bakeries, the country’s largest wholesale baker and maker of Hostess Twinkies and Wonderbread, has filed for bankruptcy. Those interested in health care and nutrition have reason to believe that the American people may be starting to recognize the value of whole grains, fruits, and vegetables. This could be a start at prevention of future obesity-related problems.

Unfortunately more than 23 million Americans are morbidly obese. What does this mean? Their weight is at least 100 pounds more than the ideal body weight (BMI greater than 40 kg/m2). I will never forget the day a patient presented for consultation, sat on my electric examination table, and broke the mechanism as it groaned under the unusual weight. Such patients can be referred to our general surgery colleagues who perform different procedures to treat morbid obesity. These procedures include the Lap-Band restrictive procedure, the restrictive vertical gastrectomy or gastroplasy, the Roux-en-Y gastric bypass, and the Duodenal Switch procedure. It is recommended that certain vitamins be taken with these procedures. Also there is a magazine published for this patient population entitled Obesity Help Magazine, now published bimonthly. And there is a nonprofit organization that helps with provision and administration of scientific research grants and professional education initiatives named Obesity Help Foundation.

Whether patients present to plastic surgeons after weight loss by diet alone or after surgical intervention, these formerly obese patients bring in photographs of almost unrecognizable individuals. Each one may have lost a whole person in weight; however, the skin often has striae and hangs in festoons of drapery. This lack of elasticity makes it necessary to perform such surgeries as abdominoplasties; buttock and thigh lifts; brachioplasties; mastopexies with or without augmentation mammoplasties; and facial rejuvenation surgeries such as facelifts, brow lifts, and blepharoplasties. After individuals tackle these changes, one is happy to see how well they look in clothes and the new self-confidence evidenced in every way. But there have been such dramatic changes that I have also seen patients go on to divorce spouses.

One is left wondering about the complexity of body image in this society so controlled by media and fashion. Do some people get frustrated by the impossibility of looking like an android model with breast implants when born with gynecoid hips and full breasts? Is the mere availability of large sizes prolonging the duration of an individual’s acceptance of morbid obesity? Is the absence of home economics courses resulting in fewer families aware of the definition of a healthy diet if they have not been trained in nutrition in their own homes? Frequently entire families suffer with morbid obesity. Is it that we are a fast-food nation because we rush to respond to federal express packages, faxed messages, electronic mail, voice mail, call waiting, etc.?

Recently the quadruple coronary artery grafts of former President Clinton resulted in such articles as “Bubba Can’t Bypass the Past,” an article focusing on his life of eating fast foods. (Tom Kuntz, “Word for Word,” the New York Times, September 12, page 7). He was never morbidly obese, but his recognition of his poor eating habits has made him seem more like the common man of America.

This country may be going through a current trend of acceptance of the old adage, “You are what you eat.” But we need to go further to enforce this message of nutrition. Blue Cross of Florida says it may eliminate coverage for bariatric surgery in January 2005. In California, Blue Cross of California recognizes weight loss surgery as an effective treatment option for some patients. As recently as September 30, Gina Kolata wrote an article on the front page of the New York Times entitled, “Health and Money Issues Arise Over Who Pays for Weight Loss.” Currently Medicare covers treatment for morbidly obese patients with other associated diseases such as diabetes. Now the federal government is considering the use of federal funds to cover other treatment options for obesity in addition to surgery.

Maybe the solution is simpler still. What if we stopped having coffee and beverage holders in cars? What if the baby strollers and children’s car seats did not have cup holders? What if we sat at a table for every meal or snack and paused to talk to a friend or family member? We might have healthier, happier, more creative people who simply did not have time to overeat and to become morbidly obese.  

Dr. Clark is plastic surgeon and hand surgeon in San Mateo.