OBESITY Obesity afflicts and affects children, women and men, of all the nationalities and races of the world, and is becoming the Number One killer disease of the century. About fifty or seventy years ago, fat and fair women in Egypt were considered beautiful, of whence the nicknames of “ishta”, (cream, for fair) “muzza” (for luscious meat), “aassal” (for honey) and other fattening foodstuff were the compliments of the era, brought forth till this day! On the other hand, a man's paunch, ranging from large pot-belly to a huge ‘beer belly', were also considered as signs of prestige, affluence, wealth, stability, and easy living! However, these days, Big is no longer Beautiful, but dangerous and could be fatal. Consulting some General Surgeons and well known Bariatrics (doctors specialized in obesity) they verified the worldwide phenomenon and problem of increasing obesity, enlightening us on the following reasons: It is said that obesity is a problem worldwide. For example, about 31 percent of American adults – (61 million people) – are considered obese, with a body-mass index of 30 or more. That's based on height and weight. Someone 5-foot-4 is obese at 175 pounds; 222 does it for a 6-footer. Dr. Alaa Abbas Sabry Moustafa, FRCS, Professor of Surgery & Bariatrics Specialist (specializing in obesity) explained the following: There are three main radical procedures for losing weight. They are the three types of surgeries: 1. GASTRIC BYPASS: (This is growing popular in the USA) In Gastric Bypass, a small pouch is stapled off from the rest of the stomach and connected to the small intestine. The patient eats less because the pouch is small and holds little quantities of food. Therefore ‘the pouch' absorbs fewer calories because much of the intestine is by-passed. After the operation, the patient must compensate by taking supplement doses of protein and vitamin to prevent deficiencies. American doctors prefer this procedure because it produces faster, greater weight loss. Side Effects: Death can occur. One recent study of Medicare patients found deaths a year after gastric bypass as high as 3 to 5 percent. Several years ago, an 8-months pregnant woman also died of complications, even 18 months after the gastric bypass. 2. ADJUSTABLE STOMACH BAND: (Preferred in Europe & Australia): The “Adjustable Band” procedure has been available in the US only since 2001, but far longer in Europe and Australia, where it is dominant. It accounted for 17 percent of USA obesity procedures in 2005. A ring is placed on top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach. In fact, it acts and even looks like a ‘rubber band', which grips the stomach. The bands' reversibility, make them more suitable for children and safer for women attempting pregnancy, doctors say. The weight that you can accomplish in a year with a gastric bypass, you can accomplish in about five years with a laparoscopic band. Side Effects: Deaths from this procedure occur and are 0.1 percent compared to about 2 percent for gastric bypasses. Other pregnancy-related deaths have been reported. One recent study of Medicare patients found that 3% and as high as up to 5% deaths, a year after the gastric bypasses were performed. 3. CUTTING OFF: (Surgery, by cutting away part of the stomach, and throwing it away, then rerouting the intestines). This is increasingly being recommended for severely obese people, as a last resort. It gives maximum weight loss but also is the riskiest solution. BPD, which stands for bilio-pancreatic diversion, is with or without a second procedure called a ‘duodenal switch'. Studies show it can cause loss of up to 80 percent of excess body weight in a short time, and last for at least as long as 10 years. Surgeons remove three-fourths of the stomach to leave a ‘sleeve' or banana-shaped organ that is connected to the small intestine, and bypassing more of it than a standard gastric bypass does. Side Effects: This type of surgery gives the maximum weight loss, but is also the riskiest solution. It can be done in two operations, a year apart, to reduce its severity and the chances of death, which can be as high as 5 percent. (Both procedures (in 1 and 2) are made through incisions on the abdomen, as regular operations, or small incisions (laproscopically) on the abdomen, with tiny instruments passed through the small cuts.) Q. Dr. Alaa Abbas, it is said that obesity is a problem worldwide. For example, about 31 percent of American adults – (61 million people) – are considered obese, with a body-mass index of 30 or more. That's based on height and weight. Someone 5-foot-4 is obese at 175 pounds; 222 does it for a 6-footer. Is obesity common in Egypt, and to what extent, as in percentage? A. It is a common disease all over the world, and not just well developed countries like the United States, but even in the underdeveloped countries like in the Middle East. As for obesity in Egypt, 25% of Egyptians are obese. Statistics say that our population has reached 73 million. That's a huge number of people suffering from obesity, which in itself combines a long list of other related diseases. Q. Please define ‘fat' versus ‘obese', as in gender, age, and height, and when does someone cross the line from being fat to being obese? A. “Obesity” is a Greek word, which means ‘fat'. From the medical point of view, and by many insurance companies in developed countries, they define the weight of individuals according to the risk of disease…So, when you are in the normal range, the risk of developing other diseases related to obesity is less, therefore you pay less insurance. The more obese you are, the greater the risk for other diseases and fatalities, therefore insurance policies abroad oblige you to pay more premiums. By the way, many years ago, insurance companies were the worst affected by obesity, because at that time, it was not considered a fatal disease nor a risk-related factor. Consequently, more studies have been undertaken, and the guideline tables related to age, height, gender and weight was then invented, dividing people according to weight in categories of what's normal, and what's not normal. Therefore, international insurance companies now consider obesity a risk factor, even equal to bad heart conditions. In fact, international insurance companies have been the incentive and pioneers in grading people according to their health. For them, a healthy person isn't a risk factor and won't need much medical care, therefore they pay less premium, whereas people with medical history and health problems pay more in case of future complications, operations, deterioration of health, or fatalities. Obesity is now in the category of health problems and risk factors. Tables were invented for guidelines. Q. How were these tables formed? A. They started out by dividing the weight, in kilograms, and the height, in meters. For instance, to get the correct ratio, your weight is divided by the square of your height in meters. For example, if a female weighs 70 kilograms and is 1 metre 50 cm (1.5) tall/short, the calculation is follows: the weight 70 (kilos) is divided by the square height, 1.5 x 1.5 (or, 2.25) to get her ideal weight. In other words, your weight is divided by your height in square meters, to achieve the correct weight. Q. I used to do it another way, like say, if a female is for example 1.50 tall, then just take off the one meter; and her weight should be 50 kilos, more or less. A. Yes, that's another way to calculate it, and the easy way! Just remove the 100 from the height, for males, but remove an extra five (5) for females. As another example, if a man is one meter 57cm (1.57), then take off the 100 digits, and his ideal weight should be 57 kilos. As for a woman, take off another five, and her ideal weight should be 52 kilos. Naturally, men weigh more because of their body mass, larger bones and muscle structures. But in the medical profession, we use the former way of calculating accurately. However, if the individual is more than the ideal weight by ten kilos, then it is not a case of obesity, but called simply ‘overweight.' An extra ten kilos, is called ‘simple obesity'. Add another ten to that, and the individual is ‘obese.' Q. In Egypt, are there more obese women, or more obese men? A. It's the same all over the world; there are more obese women than men. For each obese man, there are seven obese women. Q. Why? Is it due to their hormones? A. Women are more liable to become obese for many reasons, including their hormones, menstrual cycles and pregnancies, not moving much, bad eating habits, staying at home, and being less active in general than men. Q. Is obesity hereditary? Or, is it a combination of genes, and bad eating habits, inherited? A. It's a combination of genes, bad eating habits, lack of exercise, and an unhealthy lifestyle. In fact, it's a long list of factors which coordinate together to cause obesity. Q. What are personally your own best methods for curing your patients, apart from exhausting all sorts of diets and exercises, when diet and exercises and all else fails? And, when does obesity become dangerous? A. Actually, I deal in patients who are dangerously overweight; i.e. obese, and that's when they come to me when they are forty kilos more than their normal weight, going up – or 35 kilos overweight plus accompanied with diseases caused by that obesity. Surgery shouldn't be considered unless the patient has tried and exhausted the conventional ways to shed kilos or is at least 100 pounds over ideal weight, or has a BMI (body mass index) over 40 or a BMI over 35, plus weight-related medical problems, like diabetes or high blood pressure. If the operation is not reversible, I don't touch it. I never do the third type of surgery; i.e., cutting off and throwing away any part of the stomach or intestines. Most Middle-Easterners have this same way of thinking as I do; this same mentality of wondering why and how one could throw away a body part that is perfectly healthy and functioning. In my opinion, this should be done only for cancer cases, in which the afflicted parts have to be eliminated by surgery, or else the cancer will spread and cause eventual death. On the other hand, not less than twenty-five types of diseases can be triggered or caused by obesity. Obesity in women increases the chances of getting cancer of the breasts. In men, obesity increases the chances of developing lung or prostrate or colon cancer, and so on. These are the extreme negative sides of obesity, mind you. I don't want to frighten you. Not all obese people get cancer, but if there is even a chance of obesity triggering it, then it is better to cure the obesity as soon as possible, especially if there were some cancer cases in the family's history. In the less extreme cases of bad side-effects directly triggered by obesity, many other health problems arise, such as osteoporosis (which means that the bones become fragile and break easily after a fall, because there isn't enough calcium in the bones) rheumatoid or rheumatism, and arthritis of the knees, fingers and/or the joints. By the way, osteoporosis is age-related, obesity-related, bad eating habits, and calcium deficiency, all combined or separately, and more common in women at menopause. Q. Dr. Abbass, now women are advised to take hormones, after menopause. Why is it that the doctors during our mothers' or grandmothers' era didn't advise taking hormones, and that this procedure didn't even exist then, and is relatively new now? As you say, hormones help in fending off osteoporosis, as well as slowing the ageing process. Is it because of the new medical and scientific researches made within the last fifty years, or what? Paradoxically, they now say that artificial hormones can cause cancer, so what are your comments and advice? A. Women before used to be more active. So, how a woman looked after herself reflects on how she may suffer from menopausal symptoms afterwards, and whether or not she was physically active before. Don't forget we are still talking about obesity on top of it all! So, an active woman who exercised regularly, took normal and regular doses of calcium, and is not overweight, usually does not need to take hormone replacements after menopause, because they have strong bones. Q. Dr. Abbass, some children are obese, and I see more and more of them, from toddlers to school children. What causes this phenomenon? A. Usually it's the parents' faults. They stuff their babies with food, thinking that chubby babies are cuter. Gradually, this becomes a bad feeding habit, then turns into a bad eating habit, and the children cannot outgrow this bad habit when they are teenagers. They continue to eat all day, including the unhealthy ‘junk' food sold outside of schools or on stalls in the street. Or, they meet at the known restaurants for greasy fries and other unhealthy food filled with starch, fat and carbohydrates, swallowing it with more carbohydrates in their soft drinks. Going back to obesity, for example if you are forty kilograms above the normal weight, it can give you forty times the chance of getting other obesity related diseases, such as diabetes mellitus - (the full term of diabetes). Once the patient loses weight and goes back to the normal weight range, the patient will most likely automatically be cured of diabetes. That's what happens to most of our diabetic patients. After the operations are performed, they get completely cured of their long bout of diabetes as well. As for other obesity-related diseases, it can cause hypertension, coronary heart diseases, and a long list of other ailments and diseases. Once the weight is in control, most diseases can be either fully cured or kept under control. Q. Could you give us a brief recipe for a daily healthy diet? A. I suggest that a person eats everything, but in moderation, and not huge portions. Even starch and fat are important to have in any diet. A balanced diet with daily meals containing the correct amount of starch, fat, minerals and vitamins, is important to keep a healthy body, healthy mind, and maintain a healthy and happy life! And, speaking about healthy minds, researchers in the medical profession are looking into the possibility of controlling weight through areas in the brain, as certain ‘hunger' nerves. But…lets not go into that today! Q. Can obesity affect a person, psychologically? A. Obesity can ruin a person's whole life. It can cause the patient to acquire many types of skin rashes triggered off by psychological factors and stress because of his or her appearance. It can ruin the patient's chance of getting a good job, or even of getting married. Furthermore, it could ruin marriages, as many couples, especially women after childbirth, become obese, and their New BIG Look could put a real distance between their spouses and eventually break up their marriages…if they're not careful. ~~~~~~~~~~ By Hoda Nassef
