This is a particularly good time for a book on weight loss surgery aimed at individuals who may be considering this option. We now understand that obesity is a chronic disease caused by many different factors. Scientists have discovered numerous genes that contribute to weight gain, and at last count, over 200 genes and gene markers have been identified. There clearly are biochemical differences in the bodies of people with obesity compared to non-obese people. If an obese person loses weight by standard medical therapy, the biochemistry to that individual does not return to that of a non-obese person. Biochemical changes occur after weight loss that tend to favor weight gain and fat gain. Although the genetic contribution to obesity is clearly important, it probably causes only about 40% of the obesity in the total population. The other 60% of obesity may be attributed to environmental causes. The presence of an abundance of inexpensive, good tasting, high calorie, high fat, rapidly available food allows the genetic traits present in most of us to come through as an increase in body weight. More ominous, recent research demonstrates that certain viruses produce obesity in animals and there are links for at least some of these viruses to human obesity.
It is not surprising that the prevalence of obesity in the United States and across the world is exploding. In the last 20 years the percentage of adult Americans with medically significant obesity has increased by 75% and more than 55% of Americans are overweight. The World Health Organization has declared that there is a "global epidemic" of obesity. The number of people who meet the criteria for weight loss surgery is now almost 5% of the population. Nevertheless, there is still great fear and misunderstanding about weight loss surgery. Many patients in my practice refuse even to discuss the option of weight loss surgery. Many physicians will not consider sending their patients for this surgery. These attitudes are based in the belief that none of the treatments for obesity are effective and that any treatment for obesity other than diet and exercise may be dangerous. The reality is that there has been a great deal of research on treatment for obesity and we now understand that weight loss surgery is the single most effective treatment for individuals who have the most severe form of the disease of obesity. Long term studies on patients who have undergone weight loss surgery show that extensive weight loss may be attained by the majority of patients and that complications of obesity, such as diabetes, high blood pressure, sleep apnea, arthritis, and gastro-esophageal reflux disease (heartburn) improve markedly or disappear. One study has even shown that weight loss surgery decreases the higher death rate associated with obesity.
"A Doctor's Guide to Weight Loss Surgery; How to make the decision that could save your life." explains how the severity of obesity is graded and who is a candidate for weight loss surgery. In practical terms it describes the types of operations that have been used for obesity and the advantages and disadvantages of each. Each operation has a balance of benefits and risks that should be understood by anyone considering weight loss surgery. Patients need long term follow up after surgery because some of the complications may not show up immediately. The book takes the prospective patient through the whole process of weight loss surgery: from the pre-surgical evaluation, to what will occur in the hospital at each step along the way, how long the hospitalization will be, how long before normal activities may be resumed, and what to watch out for in the months and years after surgery. Eating after surgery may need to be different than before, so guidelines are given. Finally, practical advice is given on choosing a surgeon and a follow-up program, as well as steps that can be taken to improve the chances that the insurance company or third party payer will pay for the surgery.
In summary this book takes the mystery out of weight loss surgery and allows a patient to make an informed decision about this important step in the treatment of their disease. It is a well-written and much-needed guide to the most effective treatment for extreme obesity and should be read by all severely overweight people who are considering surgery as a treatment option.
Richard L. Atkinson, M.D.
American Obesity Association