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More than 105 million adults in the U.S. have obesity, making it one of the most common chronic diseases in our country. Of those, about 25 million people have severe obesity, representing 9.7% of U.S. adults. Globally, adult obesity has more than doubled since 1990, and adolescent obesity has quadrupled.
The health impact of obesity is undeniable. It substantially increases the risk of many other serious chronic diseases: type 2 diabetes, high blood pressure, heart disease, stroke, sleep apnea, fatty liver disease and at least 13 types of cancer. The annual medical cost of obesity in the U.S. is estimated at nearly $173 billion.
One thing doctors do know is that obesity is a complex disease with many factors; it isn't simply a lack of willpower. Genetics have a huge impact on someone's risk of obesity, and they can influence appetite, metabolism, and how the body stores fat. Hormones, medication, sleep habits, stress, and environment can also impact a person's risk of obesity.
"The antiquated mentality of many (including in the medical community) that obesity is just an individual self-control problem still persists but thankfully is becoming less common," says Dr. Sean Scanlon, a bariatric surgeon for WVU Medicine. Dr. Scanlon sees patients at Wheeling Hospital and Reynolds Memorial Hospital.
For people with severe obesity who have tried and failed to achieve a healthy weight on their own, bariatric surgery is often considered.
"Obesity is a chronic disease that requires ongoing management. This management includes lifestyle modifications and medical/surgical weight loss when indicated," says Dr. Scanlon.
Bariatric surgery has existed for decades, but the introduction of laparoscopic surgery in the 1990s dramatically increased the safety of the procedure and offered a less invasive approach.
"Technology and technique have dramatically advanced to improve outcomes," says Dr. Scanlon.
"Now it is exceedingly uncommon for bariatric surgery to be performed using the traditional open approach. Patients would be surprised at the short length of time in the hospital after surgery and decreased pain."
One of the most notable changes in technology is the introduction of the da Vinci robotic surgery platform, a tool which allows surgeons to operate with improved visualization and dexterity, compared to laparoscopic surgery.
"The small incisions and decreased pressure on the abdominal wall cause less trauma and reduced pain. This translates to shorter hospital stays, faster recovery, and decreased need for pain medication," says Dr. Scanlon.
The health changes that occur after successful bariatric surgery can be profound.
"After the significant weight loss from surgery, complete remission of diabetes is common. Even people on multiple medications and insulin can see a remission or significantly improved glucose control on fewer medications," says Dr. Scanlon.
Sleep apnea and hypertension also commonly improve or resolve entirely.
People who lose weight with bariatric surgery are often able to be more physically active with decreased joint pain. This not only results in physical health benefits; it also can improve mental health and reduce symptoms of depression and anxiety.
The advent of GLP-1 medications has made it possible for many people to lose weight and improve their health, but bariatric surgery is still the best option for long-term weight loss in patients with severe obesity.
Dr. Scanlon says that more doctors will be using weight loss medications as an enhancement for bariatric surgery. It is often advised that a patient try to lose some initial weight before the surgery to reduce risk, and weight loss medication can help with this. It can also be used after surgery to help prevent weight regain, which can sometimes occur.
"Many bariatric surgeons like myself are obtaining additional education and certification to manage these medications so we can provide comprehensive care to patients with obesity," says Dr. Scanlon.
If you are struggling with obesity and want to explore your options, make an appointment with your doctor to discuss possible treatments. You can also learn more about WVU Medicine's Bariatric Surgery department at wvumedicine.org/our-care/specialties-and-services/.
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