Transcription:
Can Obesity be Considered a Disease

Scott Webb: Obesity is not a choice. It's actually a metabolic disease. The good news is that it's a disease that can be treated. And when it is treated medically or surgically patients live longer and healthier lives joining me today to discuss obesity and treatment options is Dr. Adrian Dan he's a Bariatric Surgeon at Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Doctor, thanks so much for joining me today. We're talking about obesity. So I'd like to have you just start by defining the terms. How do we define obesity?

Dr. Dan: With regards to obesity, there are various definitions through the years, but over the last few decades, it has become more, more consistent. And typically it's based not just on a person's weight, but on their weight related to their height, or what's called a body mass index. The BMI. And class one obesity begins with a BMI of 30 to 35. And over 40 is what we refer to as morbid obesity. And over 50 BMI is what we refer to as super morbid obesity.

Host: And is BMI something that we can measure ourselves or do we really need to see a doctor for that?

Dr. Dan: Nobody will need to see a doctor for that specific calculation. There's various calculators available online, and also this information, the weight and the height are easily and readily available to everyone and readily available to Doctors. That's why it's so commonly utilized. But one thing I think is important to underscore here is that obesity, excess weight in various other conditions are really the same disease and same condition with different manifestations. So we have to look beyond just the weight, beyond just the BMI.

Host: Yeah, I hear what you're saying. That that's a good place to start, but there's more to completing that picture. And when we talk about obesity Doctor, is it technically or medically speaking a disease?

Dr. Dan: There is no doubt that obesity is a disease in 1998, the World Health Organization deemed it to be an academic in 2013, the CDC declared it a disease. And it seems like the right thing to do. A lot of people suffering from conditions related to this root condition. But over the past few years, we have been able to gather refutable scientific evidence and proof of the dysfunctions in the body. They make it a disease, no different than any other condition, such as a thyroid problem or cancer or any other condition that we refer to asthma as a disease and I'll tell you, it's got one of the biggest hurdles that we're facing right now, before we even talk about what the treatments for obesity can do before we even talk about any of that, we have to get over the hurdle of living with the premise that obesity is a choice or an act or a behavior. All too often, we see obesity as a condition that has social consequences rather than medical consequences. And unfortunately we portray it many times as a character flaw, willpower issue, discipline issue. And it turns out that we couldn't have been further from the truth.

Host: You know, I think that's so true. And I think that like with many things there probably is a lot of mental stigma about obesity in terms of the obese, you know, dealing with it and really understanding, you know, kind of how they got there. And with everybody else understanding, as you say that it's not a behavior, it's not a choice, right?

Dr. Dan: Absolutely. So the stigma, the prejudice, the bias against not individuals with obesity, but those seeking treatment for it is highly pervasive in our society. And that's the first thing that we have to put aside. This is no different than people who think that the earth is still flat. And when you look at the evidence that I cited earlier mentioned for example there are very sophisticated labs throughout the world that are conducting research on obesity. Identifying that the GI hormones peptides and the communication between our GI tract and our brain is highly different in patients with obesity, even the bacteria, what we call the microbiota, the bacteria that lives in our GI tract is very different. We haven't been able to look at the way that the brain perceives food and responds to food with pleasure stimuli.

And we see all these things amongst many others to be very different in patients with obesity. And what's even more interesting is that when these measurable parameters are looked at after bariatric surgery, they all change. So while the reactor is not able to change your genetics, we have found it to be highly, highly effective tool in changing the metabolic dysfunctions that lead to obesity. And I'll tell you I'll have patients a year after surgery coming to my office on the way to the gym, in their workout clothes, with pictures of things they never thought they'd ever do again, just thrilled about having their life back. And I can promise you that I did nothing to their discipline. There's no such thing as a discipline burden, but what we did do is we did fix the metabolic dysfunction that leads to obesity, diabetes, and fatty liver disease, amongst many other things, again, the same disease with different manifestations.

Host: That is really cool. So awesome that you can help people. And I do want to get to the surgical and nonsurgical options, but before we get there what other health complications or implications are there for obesity?

Dr. Dan: First and foremost, I think people all know that that obesity can lead to diabetes, high blood pressure, gastroesophageal reflux, obstructive sleep apnea, high cholesterol, and Scott, the list goes on and on. I could sit here for the next 10 minutes and read a list of the 229 conditions that have been linked in some way or another to obesity. But those are the big ones that really erode people's health. And at the end of the day, they decrease their lifespan. So whether it's medical, weight loss, or surgical weight loss, it's important to realize that obesity really can affect your health and taking care of the obesity will also lead to the resolution of many of those conditions and putting them into remission. But in addition to that, newer data shows that resolution of obesity, whether it's through medical or surgical means can lead to preventative aspects to your health. For example, in women who undergo bariatric surgery and are morbidly obese, they actually cut their cancer risk by 50%. And my listeners have heard me, right, I'm going to repeat it five, 0%. The weight of stroke, heart attack, congestive heart failure, mortality, atrial fibrillation, and development of kidney disease are caught by substantial numbers anywhere from 33 to 70%.

Host: Those are some amazing numbers of 50% and 33 to 70. And you said 229 of that list could be. Really amazing. And so let's get to the surgical and medical options for the obese. If you're consulting with a patient, where do you start with them?

Dr. Dan: By the time that a patient has seen me as a bariatric surgeon, they've already tried numerous diets with their primary care physician when people are affected in their lively hoods their quality of life is ravaged by obesity. By the time they see us, this is not a wake up call. This is something we've been dealing with for years, we perform bariatric surgery, we have done so with the minimally invasive approaches here at Summa Health System for nearly 20 years. We also have one of the most robust obesity medicine centers and both aspects of treating obesity, whether it's through medical means with diet and exercise, sometimes medication or with surgical are important, but the literature overwhelmingly shows that obesity surgery is by far the most effective way to obtain long-term resolution of obesity in the associated comorbid conditions. And I think everyone is in agreement with that, including our obesity medicine Doctors who compliment what we do and support the patients, not just for the portion before surgery and immediately after, but for the rest of their lives to ensure that the tool that's in place can be utilized to maintain that weight loss and those health benefits for decades to come.

Host: It's so great that there are medical and surgical options and the surgical option, you know, can be so life changing, so game changing and great that people have a support system in place, you know, before, during and well after the surgery. That's really amazing. As we wrap up here today, Dr. Dan, and thank you so much for your time, a little off script, but are people suffering from obesity at higher risk for COVID-19 complications?

Dr. Dan: Absolutely. So the data is still early in preliminary. We have identified a few things that tend to make people more susceptible to having a bad outcome after COVID-19 infection. There's a lot of insurers out there that don't feel that weight loss surgery, or metabolic surgery to resolve diabetes. And these conditions that we mentioned is part of the comprehensive healthcare package that some patients should get. But now we've seen that it's tremendously important portion of somebody's overall healthcare armamentarium. In addition to that with a COVID-19 crisis, we've seen that obesity, diabetes, hypertension in age are the main factors that lead to poor outcomes after infection. Now, age, we've all admitted and have to come to the realization we can't do much about that, but obesity, diabetes and hypertension are treatable. And it's also important, we mentioned at the beginning that the one thing we have to advocate is a pervasive notion that this is a choice.

And when we tell people that this is their choice and their behavior alone, that's leading to this, they'll stop seeking the help that is so important to improve their overall health. People are also sometimes also concerned about the safety of the operations. I always say, if you think of Bariatric and metabolic surgery is potentially unsafe, boy, you've got to take another look at what we're doing today, because things have changed tremendously. In data from the CMS, obesity surgery, whether with a gastric bypass or a gastric sleeve has been shown to actually be safer than a average gallbladder surgery or an average hysterectomy, or an average hip replacement. And in patients with diabetes, those who have the condition, it's safer then all of those are even safer than an appendectomy. And low and behold, that's the operation that actually cures diabetes and it's the safest of all of them. So those are the things we have to keep in mind. And COVID-19 was just another reminder of how much those conditions that are related to obesity can affect your overall health.

Host: Absolutely. And thanks so much for your time today Doctor, for your time, your expertise and understanding. It's really helped me to understand a little bit better. And really, especially to know that obesity is a disease and like many diseases, it is treatable, of course, but people have to seek the treatment. And whether they're dealing with the stigma or prejudice, whatever they're dealing, whatever's holding them up, basically in the end what we want them to do is to seek medical advice, treatment, possibly leading to the surgical options, the very safe surgical options that we've discussed today. So thanks so much Dr. Dan and you stay well.

Dr. Dan: Thank you, Scott. And we're here to support those patients along their entire journey, whether they're interested in medical or surgical weight loss options, and that we're going to do that in a compassionate and nonjudgmental way. And we're looking forward to taking care of anybody who needs our services. Thank you, Scott.

Host: Thanks again, Dr. Dan, for more information or to book an appointment to visit Summahealth.org. If you found this podcast helpful and informative, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well and we'll talk again next time.