We had strong reaction to WCBA's show on obesity that aired last Saturday and Monday. If you missed it, click on the podcast dated September 26, 2009.
We had many poignant emails from people who are living with the problem and feel they have few if any options for treatment. Catherine Cormack-van Zyl of Windsor, NS, writes:
"I am a 35-year-old woman who suffers from morbid obesity. At 5'6", I weigh 302 lbs, so my body mass index is above 50. I feel like I am the living dead and am very afraid because I want desperately to live a long and healthy life. I have 2 young children, and am an aspiring author/journalist with excellent post-secondary University education and great potential to have a bountiful life. My obesity however is in the way of me living out my full potential. I have type 2 diabetes, asthma, anxiety and am very anemic. I also have a history of a blood clot in my leg that I got during pregnancy. I have been told I cannot have surgery for my obesity due to my history of DVT and the high chance that the surgery will cause another clot. I feel as if I became obese and have been stuck here for 10 or so years and now do not know how to get *un*stuck. I eat well, I am a very busy and active person, but I remain at this weight consistently and have so for at least a year. Any advice, referral to websites, etc. would be greatly appreciated as I truly feel very little hope for the life I so desperately want to live."
One of the major themes of the show was that obesity -- like diabetes or high blood pressure -- is a chronic disease, not a flaw in your character. MDs usually prescribe treatments for diseases, not lectures. For instance, if a patient who is obese visits the doctor because of high blood pressure, the doctor usually prescribes medications to lower the blood pressure. The doctor is unlikely to say, "go lose 25 kg first and then I'll prescribed medication for your blood pressure. In the same way, the new breed of obesity specialist or bariatrician prescribes medical treatment (typically pills or surgery) for obesity in addition to the usual diet control and exercise.
But not everyone agrees with the idea that obesity is a chronic disease. Surprisingly, some of that opposition comes from people who have battled obesity. Mike Langlois of Picton, Ontario, writes:
"Loved your program, but don't necessarily agree that being overweight is a sickness . . . simply an addiction that, with the right support, can be overcome. I have a very supportive wife and many supportive friends. I have been overweight and obese for most of my life and have attempted to lose weight using many different diets (both supervised and form books i.e. Atkins, Nutrasystem, etc). I have now devised my own method of losing weight based on information/experience obtained form my many years of trying. I find that a combination of diet and exercise works best, and that it can take quite a long time to get to the point where you are satisfied with yourself. I was 285 lbs and stood 5' 9" when I started in July of 2008. I am now 180 lbs and am quite happy with myself (I know that I should be 170 for my height but that will still happen with time and patience)".
Finally, Neil Goldenberg, a medical student at the University of Toronto, took issue with some of the scientific evidence behind the new way of thinking about obesity that we presented on the show:
"I enjoyed listening to your podcast about obesity and bariatric surgery today. While I think the overall theme was very important, I believe that several major issues were mis-stated by proponents of bariatric surgery, as well as by those who wish to link obesity to drug addiction or mental illness. I checked The Cochrane Collaboration for reviews of surgical treatment. While they agree that surgical interventions are certainly more effective than conventional ones for morbid obesity, they conclude as follows: "Certain procedures appear to result in greater weight loss than others, but this is based on a very small number of trials. The evidence on the safety of these procedures compared with each other is even less clear. Due to the poor quality and small number of trials comparing each pair of procedures the information should be viewed with caution."
My second issue was with the discussion of the tone of physicians regarding weight loss. Nobody should be spoken to pejoratively by his or her physician. However, let's not throw the baby out with the bathwater. The message of "eat less, move more" is a good one, and would do wonders for the majority of overweight patients. In my opinion, we shouldn't shy away from this message -- we should actually be doing far more to trumpet it. Why do we have a candy store located in a hospital? How does this fit with public health initiatives and individual counselling? I believe that doctors must do much more to impress upon obese patients the importance of weight loss and activity in all facets of their lives. Don't just say, "eat less" and send them home -- clearly, real strategies must be delivered, but if we are going to do our best to care for the obese, we owe it to them to tell them the facts. I am not applying this argument to those with a BMI of 60. These patients require radical intervention -- such as surgery -- to bring them in to a range where other approaches stand a chance. But to me, suggesting surgery for patients with a BMI of 35 seems irresponsible. The real problem to be addressed with the BMI of 60 is that this patient represents an abject failure of the entire system in the broadest sense."
As usual, we love hearing from you.