The story of obesity in America is complex, with factors of lifestyle, diet and genetics playing equally important roles. Balanced nutrition is emphasized as the eighth pillar of Florida Hospital’s CREATION Health model, but for some patients struggling with their weight, more drastic measures may be needed.
Florida Hospital bariatric surgeon Dennis Smith, MD, performs a variety of weight-loss procedures to help patients regain their health, their hope and their quality of life. We asked Dr. Smith to give us the backstory of the obesity epidemic, and some ways we can overcome it.
Q: What’s going on with obesity in America?
A: This is an ongoing problem we’ve watched through the years and have seen get worse and worse. If you look back at the ’80s, the rate of obesity was far less. It’s been a dramatic rise in the last couple of decades and it shows few signs of slowing or reversing.
To me, perhaps the most shocking of all the data is in the age group two to five, where there is something like a 13 percent obesity rate. Even at that early age, it’s already started and the problem just swells from there.
Q: Can you comment on the statistics shown in this new report? What is the impact of this staggering increase in obesity rates across populations?
A: There are a lot of comorbid diseases that go hand in hand with obesity – maybe not caused by obesity, but made worse by it. These include diabetes, hypertension, sleep apnea and infertility, as well as many others. Infertility is a common problem in obese women.
Many of these problems contribute to other disease processes such as heart disease. There’s a cascading domino effect. We see most of these diseases recede as a person loses weight.
Then there are the social ramifications of obesity. Many obese individuals experience self-esteem issues and relationship issues. Biased perceptions of obese people can contribute to difficulties obtaining or holding jobs that they’re well qualified for.
We see a lot of abuse of various kinds in our patients’ histories, both males and females, and at a young age. Sometimes their weight problems trace back to traumatic issues in their past. There are a lot of misconceptions about obesity and obese individuals. We haven’t lived in their shoes. There are many social, economic and health issues people face that stem from being heavy, and many of these stand to improve as they lose a significant amount of weight.
Q: The report also reaffirmed higher obesity rates among particular ethnicities (Hispanics and African-Americans). Is there a reason why these groups are affected at higher rates?
A: There is not any certain gene we can point to, but there are perhaps some genetic tendencies we can identify. Obesity runs in families. This can be a result of cultural things, like diets, but can also be genetic predispositions. For example, many Caribbean diets are very rich in starches. Whether it’s genetic or environmental, it definitely runs in families.
Q: In your opinion, how do we overcome the obesity epidemic?
A: First, it helps to look at why it’s become such a problem. When you go back and look at how culture and civilization has changed, you can start with looking at the sugar in the average diet. The amount of sugar people consume has really exploded in the past few decades. If you look at the sugar intake, it parallels with the diabetes and obesity epidemics.
One of the triggers of this was people adopting a low-fat diet. This made people think it’s okay to eat carbs and sugars. But really, there are a lot of fats that are good for us. What our bodies aren’t good at handling is sugar in its many refined forms. People consume roughly 150 pounds of sugar a year; and younger people can often consume two to three times that.
Another factor is that our lives are much more sedentary than they used to be. Many people these days work desk jobs. Many of our forms of entertainment involve us sitting down, as opposed to how things were decades ago.
We are so busy with our jobs that we don’t have time to cook anymore. Junk food is readily available for us and it’s affordable and it’s easy. There are so many things stacked against us.
I always try to educate people about nutrition and reading labels. The food being sold to us is not necessarily what we should eat. People often try to eat in moderation, as we should, but it’s hard to avoid falling for the quick diets that are out there and that don’t work.
Q: What is the prescription to overcome obesity?
A: There are no simple or easy answers. It’s a very complex problem and we need to attack it from several different angles. In general we need to support the adoption of sustainable diets that work in the long term. In our practice we try to teach people to eat small, high-protein meals, probably more frequently than they are used to eating. We try to eliminate liquid calories and simple carbs. Simple carbs turn into sugar very rapidly in our bodies and end up making us hungry too soon after eating.
We set patients on a path of gradual weight loss rather than rapid weight loss, eating in a way that they can live with for the long term to help them lose weight more gradually. We don’t look at a temporary diet; we look at implementing a permanent change in what they are eating. Their diet should be a way of life, instead of something they do temporarily.
It comes down to the individual to make healthier choices. It’s an uphill battle for sure. Bariatric surgery helps to make anatomic and physiologic changes that control the hunger that people are constantly fighting against as they try to lose weight.
Q: What holds people back from treatment?
A: Considering the number of people who would qualify for bariatric surgery, we’re only operating on a tiny percentage of those people. There are a lot of people out there who either don’t want it, don’t know about it or are scared of it. And there are also many, unfortunately, who would love to undergo a definitive treatment like surgery but can’t because their insurance plan doesn’t cover it, and they can’t afford to pay for it themselves.
Q: What drove you into this field?
A: I got into it by accident. This was in the late ’90s, when I was sharing an office with a doctor who did this kind of surgery in his practice.
I had the same kind of biases most people do about obesity, and thought these people should be able to lose weight with the right diet and exercise. But I was totally wrong. The patients I encountered in that practice were incredibly determined to lose weight, but they all tried different weight-loss programs, and failed. Many of these people were successful in nearly every area of their life except with their weight.
I really gained an appreciation for these patients and their determination. I really feel like I’m doing something that is making people’s lives better.
Q: What makes your job rewarding?
A: Seeing the results of someone having bariatric surgery is often truly profound. Not just medically, such as with resolution of diabetes of infertility, but also in terms of improvements in our patients’ everyday lives. Things like being active with their kids, being able to go to resorts and fit on rides, being able to walk around Disney World with their family without being left behind. It really changes their lives.
We’ve seen people get better jobs, improve their social lives, and become much more active, among other things.
I had a patient who was a year out from surgery come in with her daughter, about 10 years old. There was a moment when her daughter wrapped her arms around her, and the girl said it was the first time in her life she was able to put her arms around her mother. You can’t put a value on that. Those moments are priceless.