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Obesity as a Disease - Our Position
Our position is that Obesity (and Overweight Stature - we make no distinction between the two) is the most important disease facing our society. Obesity, and the inflammation that it engenders, is the key driving force underlying adult onset diabetes, hyperlipidemia, hypertension, sleep apnea, and the heart disease that inevitably follows. Cancer risk increases, arthritis pain worsens, and given our wish to look like TV stars, our self esteem falls. 50% of the drugs that I prescribe as a Cardiologist are to deal with the secondary consequences of obesity. Overweight patients do not do as well as their trim colleagues; they do not respond well to drugs and their risk with interventions and bypass surgery is greater. Two thirds of Americans are overweight, and facing middle and old age at dramatically increased risk of poor health, at a time when our society can no longer afford to provide them health (or better stated disease management) care. If we do not conquer obesity then we are not going to regain good personal or national health, nor will we have a chance to save our health care system.
We dropped the ball - why? As stated above, 2/3rds of American adults are overweight and at increased risk of heart disease and cancer, and we, America's health care providers, have dropped the ball. Actually, we didn't just drop the ball; we didn't even see it coming, nor did we wish to see it coming. Now its here - America is an overweight nation - and we don't know how to handle it, nor do we wish to. I dropped the ball. I'm supposed to be this gung ho preventative and nutritionally oriented heart doctor. Why did it take me so long (2009) to get involved? Why did I not see the problem and rise to the challenge?
In my defense, I did try to help my patients lose weight - 15 years ago, but it didn't work. I worked with my patients on diet, asking them to cut back on carbohydrates and fat, and to decrease their caloric intake. After all, a calorie is a calorie, so if you cut back your intake your weight will fall. This is what we were taught is med school. It didn't work. You cut back your calories to half what I take in, and your weight didn't fall. You might have lost a few pounds by starving yourself for two week, but then you would gain it back, and more. I accused you of cheating and you decided I was a fool. We were taught wrong in medical school. Its not about too many calories, but rather obesity is a disturbance in one's biochemistry, one that we are now getting a handle on. We were taught that obesity was not a disease, but rather a personal failing - the overweight people just weren't trying to help themselves. This is all wrong, but what is taught to us by our professors is difficult to unlearn. Thus doctors of my age (50s and above) were taught wrong and we did it all wrong. We did not address obesity as a metabolic condition - that was not doctorly - no, we simply gave you drugs to address the consequences of obesity (diabetes, high BP, high lipids, heart disease, cancer, etc.). This was all politically correct and we got paid to do it, but it hasn't worked. Many of the drugs we give you to treat diabetes and hypertension actually make you gain weight, so then you need more drugs. The end result is that 2/3rds of Americans are overweight, rates of obesity related disease states are rising in epidemic fashion, and our health care system is broke. Adding to the misery is the position of health insurers not to cover care that focuses on weight control, and a bias amongst physicians and regulatory agencies regarding Bariatric Medicine (medical care designed to promote safe and effective weight loss). The Phen-Fen disaster (patients receiving the combination of Phentermine, an appetite suppressant with a long standing record of safety, and Fenfluramine, a serotonin receptor stimulator, probably did develop valvular heart disease at a rate above that of individuals not on this regimen) set public and medical acceptance of Bariatric Medicine as a safe and effective approach back a decade.
The decade is over, our health problems are worse, and science is showing us that obesity is an inflammatory metabolic disease. So this practice is going to assert some common sense and get involved in what is turning out to be the most effective approach to cardiovascular and overall health care - weight loss. Our patients are losing weight, their drug requirements are falling, their lab studies are improving, and so is their health and sense of self esteem. Multi-drug regimens that I spent years coming up with for my difficult to treat patients are being torn apart in four weeks - they just don't need them anymore. Thus our slogan:
weight, lose the drugs, save money, save your life!
I didn't wake up one day and decide to do this. I got involved only because a patient completed a HCG-based weight loss program behind my back. He came back looking great and feeling great, with markedly improved lab studies. I could see that something positive was going on. My staff and I read up on HCG and Bariatric Medicine, and we attended two Bariatric Medicine meetings. We started helping our patients. With the results that our patients have achieved, we see no reason to stop - that is until all of our patients have lost weight to a medically safe level. We feel that we can help you lose weight in a safe and effective fashion. If you are on drugs to deal with disease states (Diabetes, Hypertension, Sleep Apnea, and Coronary Disease) that are due to or aggravated by being overweight, we feel that we can improve or resolve these conditions such that your need for pharmacologic intervention is lessened. Please look through our website or look through our DVD. Then please give us a call.
James C. Roberts MD FACC 11/26/09