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Saturday, January 3, 2009

Surgery is The Only Answer To Obesity

Fears about an obesity epidemic - a predicted 60 per cent of Britons will be obese by 2050 - have prompted a slew of initiatives. Their basic message: reduce your calories, and exercise. But diets rarely work, says Carel Le Roux, leading obesity expert at Imperial College, London - the only answer for most people who are obese (up to 20 per cent of the population) is surgery. Here he explains his controversial view.

Talk about the misery people go through when it's not recognized that people are suffering from obesity because diets have failed them. I eat healthy, exercise and try not to go over the days calories then there is genetics but for the rest of the world the jelly rolls aren't going no where because they're dieting and it isn't working for them.

We are genetically wired to put on weight rather than lose it, and dieting - with a few exceptions - makes this tendency worse. Once a person starts trying to lose weight by decreasing their cals intake the body goes into starvation mode and reduces the amt of energy it naturally expends, making it harder to lose weight.

This is the fundamental flaw in many obesity initiatives.

When people don't acknowledge that in the huge majority of cases, diets won't work they are condemning thousands of obese and morbidly obese people to miserable failure - and destroying their health. They can lose weight but after a while they put it back on and may think the problem is a lack of willpower when it's actually physical.

For them, obesity surgery is the only option - whether it's a gastric bypass (closing off part of the stomach and bypassing part of the small intestine) or a gastric band put around the upper part of the stomach to make it smaller.

Not only do these procedures cut down the amount people can physically eat and absorb, but more importantly they change the hormone levels that determine how hungry the patient feels - as well turning up the metabolic rate.

The fact is, surgery is the most effective way of keeping weight off long-term.

In 2007, a Swedish study followed 2,000 people who were trying to lose weight with the help of the best medication and lifestyle advice.

Over 15 years they actually gained an average of 1.6 per cent.

Meanwhile, those who had gastric bypasses decreased their weight by 25 per cent, while those with gastric bands became 13 per cent lighter over the same period.

Likewise, obesity surgery should be a preventative - offered not just to the 'morbidly obese' (with a body mass index of 35 or above), as now, but also to the 26 per cent of Britons who are 'obese' (with a BMI of 30 and above) and who have health complications such as high

blood pressure or signs of diabetes. Why not prevent the problems in the first place?

But could we cope with the extra numbers? Even those who qualify for the surgery in the UK aren't having it.

Government's guidelines say we should be doing ten times the number of gastric bands and bypasses that we are (now one in 10,000 people; I think it should be one in 200).

Unfortunately, there is a lack of awareness that surgery is an option. There is also a prejudice that this is a 'lifestyle' operation. It isn't.

Obese people feel more hungry and less full than lean ones because they lack the natural gut hormones which cause satiety.

So telling an obese person not to eat is like saying: 'I'll give you £1million if you can hold your breath for ten minutes.'

They can stop the food and lose weight for a short period, but they'll start eating again, just as they'd have to take a breath after a minute.

So obese people end up in a never-ending circle of dieting and gaining weight, and the damage to their health increases.

Meanwhile, it costs the State millions, in medical and social costs.

How much does it cost to keep a middle-aged man, with high cholesterol, diabetes and sleep apnoea on medication for more than 20 years?

How much to pay for a carer because the elderly person's son or daughter is too overweight to lift them?

A gastric band operation costs the NHS about £5,500 and a gastric bypass about £9,000.

Studies suggest that if we do these operations, the NHS would make its money back in three years with the savings on medical care, drugs, surgeries and social benefits. If you're an investor, that's a great return.

Surgery is not an easy option. It changes how you live, what you can eat and can't. And if you're used to using food as an emotional crutch, it's very hard to lose that.

Indeed, a month after surgery, most patients say that they've made the biggest mistake of their lives. But a year after, they say it's the best thing they've ever done.

Obesity surgery won't make you happy, or stick-thin - but it will make you healthy. And we'll all feel the benefits of that.

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