HCA Midwest Physicians
August 28, 2013

Dr. Nicole Fearing, medical director of Menorah Medical Center's Bariatric Program

by Linda Cruse | Reprinted courtesy of KC Star

We've heard the staggering statistics for some time now: About 34 percent of adult Americans and 17 percent of children are obese.

Obesity is associated with increased disability. disease and death. Soon it will be the No.1 cause of death in the United States.

A good place to address weight issues is with your family physician. Family physicians can provide the education and resources patients need to succeed with weight loss, said Dr. Jeffrey Earl, a family physician at College Park Family Care Center.

"We can also be motivators and cheerleaders for them throughout the process," he said.

The bottom line: the sooner an overweight or obese person loses weight. the better. The longer people are overweight the more difficult it is to recover from conditions associated with being overweight. including type 2 diabetes and heart disease, said Dr. Nicole Fearing, medical director of Menorah Medical Center's Bariatric Program.

"The longer someone is overweight,. the longer their chances of a quality life declines," she said. "Additionally, children who are overweight tend to carry that weight into adulthood and have a higher chance of becoming morbidly obese."

Talks lead to success
Studies show that even after deciding to discuss their weight issue with their family physician, patients can take two years to actually get into the doctor's office to talk about it, Fearing said.

Two local patients who had weight-loss discussions with their physicians both ended up losing significant weight. Each patient took a different route to weight loss.

Heather Turner, 48, of Leavenworth, decided to have gastric sleeve bariatric surgery in November 2012. Once nearly 250 pounds, she has lost 65 pounds in the last six months and said she plans to lose an additional surgery may be necessary because obese people have significantly shorter lifespans and suffer from life-threatening conditions such as sleep apnea, heart and lung disease and cancer." " In gastric sleeve surgery, a portion of the stomach is removed, creat- - Dr. jeffrey Earl, family physician, College Park Family Care Center 30 pounds.

Jeff Borker, 51, of Overland Park, has lost 100 pounds. At one point nearly 400 pounds, Borker made significant lifestyle changes beginning in September 2011 which led to the loss. He continues to lose weight thanks to modifying his diet and incorporating regular exercise.

Turner's story
Turner said she gained weight with each of her three pregnancies. She was able to control her weight with regular exercise until she tore the meniscus in her knee. After that she was unable to exercise. "My husband is a reservist and was deployed to Afghanistan, so the stress of that combined with the injury led to a 1 OO-pound weight gain," she said.

A friend had weight-loss success with bariatric surgery, so Turner approached Fearing regarding the surgery. Her body mass index, however, wasn't high enough.

Fearing said a body mass index of 35 or greater combined with associated health problems or a body mass index greater than 40 is the National Health Institute criteria for bariatric surgery.

Turner's orthopedic surgeon recommended that she lose weight before undergoing knee replacement surgery. His recommendation led to the approval of gastric sleeve surgery. "1 am so happy I had the surgery," she said. "1 wish, in fact, that I had gotten it sooner."

In gastric sleeve surgery, a portion of the stomach is removed, creating a tube-shaped stomach or "sleeve." Fearing said gastric sleeve is becoming more popular than gastric bypass because it's less invasive and the weight loss is quicker. Patients can lose 50 to 80 percent of excess body weight within 12 months of the surgery.

Turner now participates in activities with her children that she wouldn't have in the past. "1 got a season pass to Worlds of Fun and I'm going with my youngest daughter," she said. "I didn't do that with my other two children. I really missed out on a lot due to my weight."

Borker's story
Borker said his journey to weight loss success has been a roller-coaster ride with substantial weight losses and gains. An avid athlete as a child, he was able to control his weight by participating in sports such as baseball and football.

As an adult he tried national weight loss programs and went to a doctor's weight loss center to lose weight. He lost weight but always put it back on and eventually weighed nearly 400 pounds. A foot injury while on vacation that wouldn't heal led to a two-week hospital stay, a type 2 diabetes diagnosis and a toe amputation.

He began taking diabetes medication while in the hospital. "I fell into that trap of thinking I could do whatever I want and the pills would take care of it," he said.

Results of a physical that Dr. Earl gave him in September 2011 at age 50 alarmed Borker. Both his blood pressure and blood sugars were significantly elevated. "Dr. Earl referred me to Mary Willis, a registered dietician, and I began educating myself on my disease and what I needed to do to live to age 60," he said.

Discussions with Willis, Earl and a book titled "Blood Sugar Solution" enabled him to take control of his condition and his life, he said. "I completely changed my lifestyle and took ownership of my condition."

Borker also began attending a diabetes support group and started exercising regularly at the gym.

"I've taken a holistic approach to my health," he said. "1 use smaller plates and bowls as a psychological aid to portion control and I take quite a few supplements, including a fiber taken before meals that makes me feel full faster. The combination has worked."

Talking to your doctor
Earl said he often discusses weight loss issues with patients at their annual physical. "I ask them what they want to weigh and it gives me a clue how they're feeling," he said.

Because weight is a sensitive and emotional topic, his recommendations vary, he said.

"Weight loss is a natural byproduct of a healthy lifestyle," he said. "The adage you are what you eat is true. Some people are motivated to educate themselves on their own. Others say they don't have time, but they could benefit from sessions with a dietician."

Willis assists numerous patients with weight loss. She said Borker had three keys to successful weight loss: support, motivation and a willingness to take ownership of his condition. "He was motivated to get his energy and his life back," she said.

Willis provided Borker a diet and exercise plan. She also recommended supplements designed for his condition and recommended a diabetes support group. "He made significant lifestyle changes rather than looking for a quick fix," she said. "Also, after losing 100 pounds he feels so much he better, so he doesn't want to return to his old ways."

Willis uses a technique called motivational interviewing to determine what will motivate patients. "While men are motivated by health issues, women are motivated by relationship issues," she said. "Women are most concerned about how excess weight affects their relationships with others."

When diet and exercise don't work
In some cases, drastic circumstances require drastic measures, Earl said. "If someone is morbidly obese, has chronic health issues and has had no success with diet and exercise they need to be rescued," he said. "Weight loss surgery may be necessary because obese people have significantly shorter lifespans and suffer from life-threatening conditions such as sleep apnea, heart and lung disease and cancer."

Fearing said most people consider such measures only after they've tried everything else. "When someone is 100 to 300 pounds overweight it's difficult to diet and exercise the weight off," she said. "I can be done, but it's extremely difficult."

Fearing said that sometimes shame is a factor in patients avoiding surgery. "They think they should be able to do it on their own and they're ashamed," she said. "But it's not the easy way out - it also requires lifestyle modifications for long-term success."