Interesting read about bariatric surgery in the NYT.
Think of the symptomatics-anyone who is obese and has symptoms- OA I guess is symptomatic obesity, or OSA- which everyone will have. So then suddenly 1/3rd of all Americans, including all those brobdignagian American football stars will qualify. Of course there is no debating the lack of a middle path- weight watchers and surgery are 2 extremes. One often feels stuck when managing obese patients who have no quick fixes than disciplining themselves. Lifestyle change often is a life changing event and not many want or are able to do that.
We know about the effect of bariatric surgery and the resultant weight loss on not just medical problems- I mean imagine coming off diabetic medications-, but also factors like
mood- improving depression, as well as paradoxically,
an increase in suicide risk!! But have you read the fine print in Love Bailey on dumping syndromes and other miscellaneous post gastrectomy complications?!! People do not appreciate how dramatic the weight loss can sometimes be- I have taken care of people who eat 1 cracker for breakfast, 2 for lunch and a few sips of juice for dinner which consists of a few raisins!!!! And lose 1o0 lbs or so in few months. One of my colleagues once presented a case of Wernicke's encephalopathy in a patient after bariatric surgery- aptly titled as "loss of weight and loss of gait" because the patient would just not eat anything at all. Surgical complications exist of course, and quite often the obese with COPD, OSA, CAD, CHF are poor candidates for surgery anyways given all the end organ damage which has already set in. One is stuck thinking as to where to start to remedy this lardaceous mess. I guess addressing it before it assumes gargantuan proportions is an option....but then...suddenly everyone's in. It is tricky ground..one has to loop before taking this leap of faith.
