Amazing data on the obesity epidemic, from UCSF Med Center

I’m attending a series of health lectures at the UC Med Center. Last night Jonathan Carter, M.D., discussed his surgery practice in bariatric surgery (bypass and banding), and current research regarding the obesity epidemic. He first displayed a 1990 map of the US  and then a map for every year up to 2010. The map for 1990 identified each state as falling  into only three percentage categories of  “prevalence of obesity” including none, under 10%, and 10 to 14% which was the most percentage of obesity. For 1990 California had an under 10% prevalence of obesity, while not surprisingly, many southern states had 10-14%. A few states had none.

As succeeding years’ charts up to 2010 popped up on the screen, along the way additional higher percentage categories were added.  By 2004, California had jumped up to having a 20-24% obesity prevalence, and in 2010 Colorado, the last state to have an under 20% prevalence,  jumped up to that  same level. Once more, southern states with Mississippi at the top, had an even higher prevalence of obesity.

Dr. Carter defines obesity as having a BMI of 40 plus, and sometimes 35 plus for certain at risk patients. He will not operate and shrink a stomach surgically without those numbers showing for his patients. I think it behooves us all to keep a close eye on our BMI, though we all know that our former “Guvenator” Arnold S., has a very high BMI yet is considered extremely healthy and buff. So you can’t always go by BMI alone.

More to the point was research proving that diet results are short-termed and that dieters almost always gain back almost all the weight. Education seems to matter little. The 811 subjects in one study were highly educated Harvard folks, and received all kinds of supportive medical advice, nutrition services, classes, counseling and guidance, and diets, yet they too, failed ultimately to keep the weight off.  By two years they had all gained about half the weight back, and were still moving up. Intelligence matters little when it comes to obesity, but socio-economic class may contribute: Dr. Carter noted that poorer people tended to eat cheaper fast foods, which are ubiquitous;  restaurants and the food industry pack calories into meals and into making and serving larger and larger size portions to tempt us to overeat (and overpay).

Further, the Atkins high protein high fat diet is no better or worse than the South Beach diet or the no carb diet — all of which try to manipulate the content of what we eat.  Dr. Carter himself tried is pre-operation regime he puts his clients on: three cans of Ensure liquid drink each day for a total of 750 calories (plus a small salad for him!) for two weeks prior to surgery; he lost 8 pounds. But changing up what we eat, makes no real difference says Dr. Carter, because the only thing that counts is ‘calories in calories out.’ If we eat more than we burn off, we gain weight. But then, we knew that, right?

Fat control medicines that block certain receptors related to weight, are not promising, he says, because of side effects. Two of the ones on the market are basically speed, while others raise the specter of depression, nausea, and headaches.

Part of the problem is lifestyle choices. Dr. Carter reminded us that the average American walks just 170 yards per day!

I was curious about hunger, so I asked why and how the stomach bypass surgery or the gastric band surgery might affect it or be affected by it? Hunger is said to be one of two major things that defeat a diet (the other is stress). Apparently hunger is reduced. The effect of stomach bypass, is that stimulus is reduced from the stomach to the hypothalmus in the brain, the place that controls secretion of ghrelin that causes or is related to hunger. Ghrelin levels go way down after bariatric surgery (from 500 units to about 100 units in one study he discussed) and they remain stable at the lower level. However, Dr. Carter says there is no answer as to why this happens.

Many of my clients and I have noted that hunger goes way down when we corset, which is similar to gastric banding surgery. It seems there may be no easy answer as to why that happens, but it does.

Note that the first operation costs about $20,000 in hospital bills an insurance company will pay, plus $5000 for the surgeon and a like amount for the anesthesiologist, while the second operation costs about $10,000 and $2500 each doctor.

A final fascinating fact is that bariatric surgery reduces colon cancer and disappears  diabetes. Getting rid of diabetes entirely in his patients, leaves an open question that the medical establishment is current wrestling with: can it be performed safely on thin individuals, to also disappear their diabetes?

While corset waist training can demonstrate amazing results within a few short months, more to the point is the question, does it help change bad habits and instill healthy new ones that maintain most of the weight/waistline inch loss? That is an important focus for our further coaching program, to do longitudinal studies of our students. So far I know four who have gained it all back thru excess stress and falling back into bad habits. Most everyone has gained some back but not all, so it seems fair from this data, to consider the ‘corset diet’ a moderate success.

I have heard of cases where patients have gained a substantial amount of weight back after bariatric surgery. In April Carney Wilson (singer) publicized that she as having a second bariatic procedure, her bypass having not worked well for her in the long run. We welcome further information, personal experience, and data from our readers in order to keep informing our opinion that corsets work just as well as diets with a lot more fun in the process, and perhaps work as well as surgery with much less trauma, risky side effects, and at a hugely cheaper cost!

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