As part of the 38th Annual Legislative Conference held September 24-27, 2008, the Congressional Black Caucus focused on the health of African Americans. Below is a speech given by Terrence Fullum, MD, FACS, on the obesity epidemic facing America today, especially the African American community.
Dr. Terrence Fullum Photo: upperchesapeakebariatricsurgery.org
An estimated 97 million adults in the United States are overweight or obese (Centers for Disease Control [CDC], 2008). African Americans represent 13.4% of the American population; however account for sixty-two percent of Americans who are overweight, defined as having a body mass index (BMI) of 25-29.9 kg/m2, while 23.4 % are obese (National Center for Health Statistics [NCHS], 2006). As the BMI increases, so does the mortality rate from all causes, which is 100% above that of persons who have a BMI of 20-25 kg/m2 (National Institutes of Health [NIH], 1992). Obesity is a complex condition that is affected by genetic, metabolic, social, behavioral, and cultural factors. The health, psychosocial well-being, longevity, and functional capacity are factors that affect the quality of life for those with weight challenges (National Institute of Health, 2000). Nevertheless, 365,000 deaths a year are related to poor diet and physical inactivity. Obesity is a national problem within America and the African American community is at greater risk of disease and several predictable clinical syndromes due to the disproportionate amount of African Americans affected by the disease (National Heart, Lung and Blood Institute, 1998).
The U.S Department of Health and Human Services has labeled morbid obesity as “the first epidemic of the 21st century” (HHS, 2002). Obesity has been identified as a risk factor associated with multiple health risks for African Americans including Type 1 & 2 diabetes, coronary heart disease, stroke, sleep apnea, hypertension, cancer related to the colon and chronic back pain, which affects over 9 % of adult African Americans (Liburd, 2003). Approximately 20% of obese women who seek weight reduction report significant symptoms of depression or are diagnosed with Dysthmic Disorder (Wadden, Anderson, et al., 2000).The burden of being overweight or obese has a critical impact on an individuals physiological as well as psychosocial well-being.
Bariatric surgery has become an answer to aide in the treatment of morbid obesity. Morbid obesity is generally defined as being 100 pounds or more overweight or having a Body Mass Index (BMI) of 35 and above with one or more obesity related health conditions including but not limited to diabetes, hypertension, and cardiovascular conditions (Fullum, 2008). In the United States approximately 40,000 obesity surgeries were performed in 2000 (Lynch, et al, 2007). In 2004, 140,000 obesity surgeries were performed with weight loss surgery being “one of the most common general surgical procedures (Lynch, et al, 2007). However, we are currently serving only 1% of the people who suffer from obesity in the United States.
Photo: independent.co.uk
As increasing number of people use bariatric surgery as an intervention for morbid obesity, researchers are beginning to explore the consequences of the operation. The primary benefit of bariatric surgery is weight loss. Many individuals lose between 40% and 75% of their excess body weight, and treatment is considered a success when the patient maintains a 50% loss of excess weight at the 5 year marker and beyond (Choban, Jackson, Poplawski, & Bistolarides, 2002). On average, the mean loss of excessive weight gain following bariatric surgery is 61.2% for all patients; 47.5% for gastric banding, 61.6% for gastric bypass. 68.2% for gastroplast and 70.1% for biliopancreatic diversion or duodenal switch (Grindel & Grindel, 2006).
Although these results are strongly positive, they relate only to physical well-being less well answered questions are the extent to which bariatric surgery and the subsequent weight loss, improves the psychosocial quality of life of the patients. It would be expected that the dramatic improvement in physical health would be a life-transforming experience or many patients. The overall finding is that bariatric surgery has favorable impact on personal relationships, a marked increase in self-esteem, paralleled by improvements in physical, social, and occupational functioning (Herpertz, Kielmann, Wolf, Senf, & Hebebrand, 2003), self-confidence, and assertion, improvement in social activity and interpersonal relationships, and the alleviation of depression and anxiety (Van Germent, Severeijns, Greve, Groenman, & Soeters, 1998).
In our community it is critical to identify our most common barriers to weight loss such as time and access to resources, issues regarding control, and identification with a larger body size. It is our role as health care providers to identify these behavior related attributes. Furthermore, health care providers need to be cognizant of cross cultural barriers to weight loss surgery and assist in individualizing appropriate therapies. Through overcoming these perceived barriers to weight loss we can direct appropriate care and resources to reduce excess weight and prevent the chronic medical problems that commonly accompany overweight and obesity within the African American community.
Terrace M. Fullum, MD, FACS, is Associate Professor of Surgery, Howard University College of Medicine, and Chief, Division of Minimally Invasive and Bariatric Surgery
Howard University Hospital, Washington, DC.
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