National obesity and public health leaders are pressing Congress to address health needs of the morbidly obese

November 9, 2009

As the House of Representatives and the Senate debate companion bills to make health care more affordable and accessible, a coalition of obesity and public health experts is urging Congress not to overlook the needs of the more than 15 million Americans who suffer from severe obesity and are at the greatest risk for chronic disease and death. A recent USNewsire article reports.

According to the article, through a newspaper advertising campaign targeting lawmakers, Shape Up America!—an anti-obesity crusade launched by former Surgeon General C. Everett Koop—and 20 organizations and public health officials published an “Open Letter to Congress” to lay out the need for affordable, quality medical care for Americans with “morbid obesity.” “Morbid obesity” is defined as a chronic medical condition of genetic, environmental and behavioral origins where the amount of excess weight is often more than 100 pounds.

The “open letter” states that the severely obese are 2-3 times more likely to die of preventable disease than Americans at a healthy weight. The letter urges Congressional action so that the health reform package provides severely obese Americans with access to the comprehensive obesity counseling and treatment regimen, including the option of weight-loss (bariatric) surgery followed by the appropriate lifelong medical care and nutritional monitoring.

"As the Congress considers reform to the health care system, no workable agenda can overlook the pressing issue of combating obesity in America, including addressing the difficult challenges associated with morbid obesity," says Barbara Moore, Ph.D., president and CEO of Shape Up America!. "An intensified focus on improving the health outcomes of those with severe or morbid obesity is essential to reducing the risks that threaten the lives and future health of more than 15 million Americans."

Declaring that morbidly obese Americans—now representing approximately 5.9 percent of the U.S. population—have been left out of the health reform debate, the "open letter" zeroes in on the reasons why many severely overweight individuals are not receiving quality medical care. This includes the continued belief that morbid obesity is a moral failing of overeating and lack of willpower, not really a serious medical condition.

According to extensive medical research, morbid obesity is not only a disease in itself but is directly linked to more than 30 serious diseases and medical conditions, from Type 2 diabetes, stroke and high blood pressure to asthma, osteoarthritis and sleep apnea. As a result, morbid obesity is a major factor in the nation's $147 billion yearly price tag for treating obesity-related diseases.

The "open letter" also refutes the conventional wisdom that adults and adolescents needing to lose 100 pounds or more can achieve lasting weight loss through methods that are effective for the moderately obese—diet, exercise, behavior modification and drug therapy. While these interventions work in some significantly overweight individuals, controlled studies show these efforts alone are usually ineffective for the majority of morbidly obese patients.

This is in contrast to a growing body of research demonstrating that weight-loss surgery followed by appropriate lifelong medical care produces significant, lasting weight reduction in the majority of morbidly obese patients and can lead to the complete resolution of obesity co-morbidities.

Today, two major kinds of bariatric surgery are performed in the U.S.:

  1. Roux-en-Y gastric bypass (RYGB)
  2. Laparoscopic adjustable gastric banding (LAGB.

Of the two, LAGB is less invasive and results in fewer major complications. But regardless of the type of weight-loss surgery performed, long-term studies show that up to 10-14 years after surgery, morbidly obese patients maintained a much greater weight loss and more favorable levels of diabetes, cholesterol and hypertension, as compared to those who did not have surgery.

Other studies find a significant reduction in the risk of death from obesity-related chronic diseases in patients who had surgery, including a 92 percent drop in death from diabetes, a 60 percent reduction in cancer deaths and a 56 percent reduction in deaths from cardiovascular disease.

Based on this data, a number of medical societies have issued consensus statements that morbidly obese patients should be offered the option of weight-loss surgery, followed by appropriate lifelong medical care, including nutritional monitoring. This consensus is also supported by the Centers for Medicare and Medicaid Services, many state Medicaid programs and even a number of commercial payers.

In terms of controlling health costs, the obesity advocates argue that weight-loss surgery for the severely obese produces significant cost savings, especially now that patients have access to less invasive surgical options offering cost-effective care with fewer major complications.

Along with Shape Up America!, three former U.S. Surgeons General and 17 prominent national public health, nutrition and obesity organizations and officials signed onto the ad and support its message such as VADM C. Everett Koop, MD, ScD, 13th U.S. Surgeon General; VADM Joycelyn Elders, MD, 15th U.S. Surgeon General; VADM David Satcher, MD, 16th U.S. Surgeon General; American Dietetic Association; the American Society for Metabolic and Bariatric Surgery/American Society for Bariatric Surgery and more.

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