At 39.5%, West Virginia has the highest obesity rate in the country. It also has the second highest obesity rate for children between the ages of 10-17.
According to Obesity.org, in 2000, 23.9% of people in West Virginia were obese — and just 13.7% in 1990.The website works collaboratively with the Trust of America’s Health and The Robert Wood Johnson Foundation to pull statistics from the Behavioral Risk Factor Surveillance System, conducted by the Center for Disease Control and Prevention.
To say that obesity is simply caused by overeating is not true. Many factors play into the problem.
Dr. Laura Davisson was a primary care doctor for many years, and saw a lot of chronic conditions in her patients that were related to obesity.
She is now board certified by the American Board of Obesity Medicine and has turned her sights on medical weight management.
“West Virginia’s been No. 1 in obesity for several years now. The thing about obesity is it’s just not caused from one thing. There are multiple factors that can affect people’s weight,” she said.
Davisson said a lot of the problem stems from patients addressing only piece of the puzzle — which might get some results initially, but can be hard to maintain long-term.
“In my clinic, we try to look at every factor that can affect weight,” she said. “So we know that food affects weight, that movement affects weight, but we also are learning more things like hormones can affect weight. People’s medications that they’re on can sometimes even make it harder for them to lose weight.”
She said analyzing one’s food environment is also part of the process. This puts into account if a patient is regularly exposed to highly processed foods, or if they have access to healthier foods. Access to healthy foods can be a problem throughout West Virginia, she said, whether it’s a financial issue, or because people live in a “food desert,” which limits access to healthy food.
“We address stress, which plays a role with weight. We address sleep. Which actually, there is a big sleep/weight connection that we’re learning more about these days,” she said.
Davisson said the key to solving the obesity problem is going to come from prevention. She said once someone has gained weight, it’s very difficult to lose that weight and maintain that weight loss.
“Our bodies are programmed to want us to maintain weight and to eat as much as possible so we don’t starve,” she said.
Being more active and making better food choices are part of the equation.
Davisson also said that one thing that really needs to be stopped is the obesity in children.
“Food insecurity contributes. When people just don’t have consistent food they just try to … eat whenever they can because they don’t know when the next meal will be coming, and sometimes that can lead to eating poor quality foods and eating too much of it,” she said.
Davisson said the acknowledgement of obesity as a disease is relatively recent.
“I think that’s really important because it is really the chronic disease of all chronic diseases. It is underlying almost all the other chronic diseases that people have,” she said.
Diabetes, sleep apnea, arthritis and some cancers are the short list of what obesity is linked to. It can also be associated with depression.
“There’s discrimination in work and in school. It’s been linked to everything,” she said.
Having it recognized as a disease is important, so it can be addressed and treated with health insurance, said Davisson. When lifestyle changes aren’t enough, medical intervention might prove more helpful.
“We’re still having a big delay in covering anti-obesity medicines and some of the insurance companies do put up roadblocks to bariatric surgery that just make it very challenging to be able to get those procedures done,” she said.
Dr. Ehab Akkary, a bariatric surgeon, shares similar sentiments with Davisson.
Worldwide, there are 27 bariatric procedures available. The three most common procedures in the U.S. are the lap band, sleeve gastrectomy and gastric bypass.
These procedures might seem like an extreme approach to treating obesity, but Akkary said they are not as extreme as they were years ago.
“One of the very important things that we always tell the patients and other physicians is that obesity is an actual disease. It’s not really an issue of diet and exercise,” he said.
Akkary said obesity is a disease of faulty metabolism. People can eat, but they aren’t burning enough or they burn very slowly. Those with a body mass index of 35 or higher can receive bariatric surgery, said Akkary.
“Anything besides surgery for these patients would most likely set them up for failure because patients lose weight, it comes back and they go through the yo-yo weight loss that adds to patients’ frustration,” he said.
Akkary said looking back in the 1990s, less than 15% of Americans were obese. Today, that number is closer to 30-35%. One out of three adults is living with the disease.
“A big part of it is genetic. Part, of course, is behavioral. Part of it is type of food that you are eating, exercise,” he said.
With so many factors in the disease, the treatment itself is also multifactorial. When treating his patients, Akkary said they are offered more than surgery.
“Surgery itself is just a tool to make what they do work, but it’s a very effective tool and it’s a very safe tool,” he said.
Patients take diet classes, have follow up appointments for life after surgery, and behavioral modification is in place. If this part is absent, the surgery only works temporarily and weight will return, said Akkary.
“West Virginia has been one of the top five states when it comes to the obesity disease, and at the same time we are one of the most underserved states when it comes to treatment of obesity and the number of bariatric surgeons that we have in the state,” he said.
He said the economic impact of obesity is also something to look at. A study in 2010 said that the relative medical cost for obese patients compared to normal-weight people goes up by 36-100%.
“When we look at the dollar value, it adds about $86 to $147 billion, and that’s very high,” he said.
There’s also time people spend away from work because of obesity problems. Akkary said it was found that patients who suffer from obesity are 1.5 times more likely to be absent from work than someone with normal weight. That would add $3 billion to $6 billion dollars a year.
“I think it’s important to say affirmatively that it’s not really the patients’ fault, because a lot of patients that suffer from morbid obesity they are trying really hard to lose weight,” he said.
Looking at it from a state level, $2.3 billion a year is spent on obesity.
Treating a patient and offering bariatric surgery can make medical problems go away completely. Akkary said many times people will come off medications after weight loss. If the effects of obesity are treated, rather than the disease, then the patients will be at higher risk of issues likes strokes and heart attacks.
“The problem that we see frequently is that a lot of people, including people in the medical community, think that obesity is an eating disorder and we really have to change this,” he said.
Unfortunately, he said, there is still struggle within the medical community when it comes to seeing obesity as a disease. He said back in 1991, the National Institutes of Health released a statement that said if a body mass index is high — morbidly obese — then diet and exercise alone would have a high failure rate.
“It’s just an ineffective tool for the majority of patients and it’s the wrong treatment,” he said.
Infertility is also a big problem with obese patients. Because obesity is a metabolic disease and affects hormones, a lot of patients will have conditions such polycystic ovaries and some types of cancers.
“I can think of two patients that we did their surgery and they got pregnant,” he said. “One of them actually brought her baby and came to the office and we all took pictures. That was a very nice thing.”
Akkary said success lies in being committed after surgery. Even the surgery is not one-size-fits-all.
“It’s very important to be committed to changing the lifestyle. To the extent that we teach them how to drink water after surgery. Cause it’s different. Everything is different after the surgery,” he said.
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