Friday, June 28, 2013

It's not about Blame, it's about Change

Obesity is a disease, as much as alcoholism is a disease.  It's part of our genetics, conditions, choices and behavior within our environment.  It is a complex relationship with our mind and body.  As someone who has experienced uncontrolled hunger that willpower could not overcome, and at other times, felt to be in control of, that makes sense to me-- that it is driven by the impacts of hormones in our bodies. The relationships between our hormones: insulin, ghrelin, leptin, testosterone, estrogen, and the processes activated in the brain between dopamine and seratonin, fed by the circulation of water and nutrients--  are all working together to support our biochemistry and are influenced by all of these factors.  It is certain there are people who eat an unhealthy diet and have no instances or struggles with obesity, and others, who suffer dearly, starving into desperation as certain foods act as a drug for them. We are all impacted by certain substances differently.

Many people have inaccurate opinions, pass judgment, and entertain prejudices towards those who suffer from Obesity, and it is an abomination that there are still people who think it is acceptable to be insensitive to those who do. 

I am sad to say that I know for a fact that there are many very smart people in the medical field that fail to consider that we all differ as individuals and that obesity is not merely caused by overeating, or rather, eating the wrong foods. While I agree with the "Wheat Belly" and Paleo theories, I fear tunnel driven opinions to undermine quality standards, education, support and structural services to aid bariatric patients may be cut from insurance, rather that included and encouraged. Let us lobby that these things DO NOT occur. Bariatric patients need to be able to see their surgeons 1-2 times a year at 3-5 years out. Continuation of care, follow up, and interfacing with multiple MD caretakers has much, much merit in our evolving medscape.

There are notable prejudices that come with obesity treatment. Learning to treat someone with empathy, and while this is not a skill of every surgeon, when their demeanor comes across as compassion: sympathetic pity and concern for the suffering and misfortune of others-- we should treat patients with tenderness and benevolent concern .  It is unfortunate that surgeons can not walk a mile in their patients shoes, though, they could try walking a mile with their patients. I am a big believer in walk and talk therapy.  Trusting relationships and programs built around success are what bariatric service providers need to develop.  Community awareness, education services, commitments to each patient's success. That is the future I would like to see.  To ensure success at the highest rates possible, we must lobby to change our society.

If hospitals would integrate food as medicine kitchens (over pharmacies) as they have wellness centers for exercise physiology and physical therapy, we could change a lot. Attitudes and perceptions are skewed in this "Fight from Obesity," it's not a fight, it's a progressive movement toward change, societal paradigm shifts in attitude and access to care. Support groups should be available every single week.  Topics should be covered on every element of lifestyle change. Our people must push for community gardens and turn around the marketeers to cater to low calorie options at restaurants and in schools.  No one should live in a food desert, community markets should carry natural food products produced locally, and we should make our food at home as often as possible.

Every Step Counts. Why limit "Walks from Obesity" to once a year or even once a month. Once a week with someone who will hold you to your commit, and once on your own every week is both therapeutic for mind and body. But truthfully, the Walk from Obesity is EVERY SINGLE DAY. 20k, 15k, 10k... whatever you can do to move forward. With the help of surgery, we are able to conquer many metabolic imbalances that occur from obesity.

But it is not the end all, be all for everyone. I don't like the idea of obesity drugs, but they have their place in the profit margins of "Big Pharma." With side effects yet to be discovered, we risk developing more dependency on psycho-pharmcology. Everyone has an opinion, but we're all out to make a buck.  There's a difference between an honest buck and a buck of persuasive luck. Good marketing of fads has long driven the weight loss industry. But this thinking that bariatric surgery, which has proven to be an effective form of weight reduction when behavior changes are also made, should not be shot down, deregulated, and allowed to be done in environments that do not support the long term outcomes but rather, hack a gut alteration and send a patient on their way. That is not what this medical specialty area needs, what it needs are constantly examined and improved methods to drive the health of society.

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