While Oprah tests and touts the calorie-cutting plans of Weight Watchers, Cincinnati medical centers continue to grow a multi-pronged array of weight loss and weight management solutions. 

As one doctor observes, it’s been an evolution. 

“My view in the field is probably somewhat longer than most as I trained at the University of Cincinnati Department of Surgery in the early 1980s,” says Dr. Dwayne Smith, of St. Elizabeth Healthcare. “Yes, there were surgical weight loss procedures at that time, but our understanding of causality of obesity and approach has changed significantly over the years.”

That understanding, combined with a true medical appreciation of the obesity epidemic, and a dose of compassion, is what these centers offer patients.

As the Doctors See It 

“Those patients do not want to live like that,” beset by mobility issues and a host of associated maladies like high blood pressure, diabetes and hyperlipidemia, says Dr. George Kerlakian, medical director of the TriHealth Bariatric Program.

“We [in the public] have a tendency to discriminate against the morbidly obese,” he says. “We are in the business of helping people and healing their diseases.” 

“Morbid obesity is no different than cancer or heart disease. It should be treated as such,” he adds.

It starts with an understanding of the underlying factors of the disease. There are many possible causes for morbid obesity, defined as 100 pounds overweight, Smith says. They include genetics, behavior and, according to some studies, “activation of the satiety centers within the brain, with food similar to that seen with other addictions (alcohol, narcotics, gambling, etc).” 

“Our current understanding is that weight gain/loss has significant hormonal mediation,” Smith says. 

This is seen particularly with the two most common types of weight loss surgery—Gastric Sleeve and Gastric ByPass. 

Besides the rapid weight loss, there is an apparent “resetting of the thermostat with respect to body habitus,” he says. “Even more exciting, for Type 2 Diabetics (adult onset), insulin resistance drops by at least 80 percent within a week or so after surgery.”

Many of these patients go home after surgery needing no diabetic medications and their diabetes remains in remission for many years, Smith says. Generally these two procedures can result in sustained weight loss five years later of 50 to 60 percent of a patient’s excess weight, meaning the amount of weight over their calculated ideal body weight.

While a surgical procedure may be necessary for some, Kerlakian notes “a selection process has to be in place to maximize results for patients.”

Smith says The National Institute of Health formally recommended in 1991 that surgery be considered for patients where diet and exercise had been ineffective and with BMI over 40, or about 100 pounds over “ideal body weight.” The risk of dying is four times as great in any given year for morbidly obese patients as compared to patients of ideal body weight, he says. 

For those people who meet the criteria of being morbidly obese, the likelihood of the patient to lose the weight on their own is less than 1 percent, Kerlakian says. 

“Reality is diet and exercise does not work for this particular population,” he says. “With surgery, 75 percent of those patients will lose and keep off half their excess body weight assuming they change their dietary habits and raise their activity level.”

Kerlakian counters the perception that bariatric surgery does not work.

“If someone is 200 pounds overweight, and the surgery gets rid of 100 of those pounds, it may appear the surgery was ineffective,” he says. “In reality, the quality of life and life expectancy of those patients improves dramatically.”

As Patients See It

Doctors report patients are becoming better versed in the issue of weight loss. 

“There is definitely an increased awareness of the obesity epidemic in general,” says Mercy Health’s Dr. Mohamed Dahman, who specializes in bariatric medicine and general surgery. 

“We find that our patients are researching and obtaining lots of information about weight management before they come in to discuss their options with us,” he says. “We see this as a great advantage, since they are already engaged in their weight loss journey and this is a good indicator of long-term success.”

Other doctors are noticing a new trend in patients being referred by their primary care physicians. 

Such was the case for Villa Madonna Academy teacher Eileen O’Connell, whose retiring primary care physician had simply, but routinely, suggested she “should try to lose some weight.” It was her new physician who essentially made it a doctor’s order.

On the first visit with her new doctor, O’Connell was told, “you are going to weigh less the next time I see you.”

So O’Connell took the doctor’s suggestion of checking out St. Elizabeth’s program, where she met with a doctor and nurses, then a dietitian every other week, and classes in the opposite weeks. She sees the doctor every two months, and in a year’s time has lost 60 pounds. 

The routine of the program is what made the difference for O’Connell, who before experienced short-lived successes in commercial weight loss programs. 

“If I know I have appointments with the doctor or dietitian, it makes me feel more accountable,” she says. 

Having seen her mother battle over her weight and eventually develop and lose her life to pulmonary hypertension over the use of Phenphen, O’Connell was determined to take a medically supervised route to her weight loss. 

And if she hadn’t sought help when she did?

“For me, it would have turned into a medical issue,” O’Connell says. 

Medical issues are the reason most people seek this treatment. They are looking for relief of the associated conditions including sleep apnea, back and joint pain, and an increased risk of many kinds of cancer, such as breast, colon, uterine, and more, Smith says. 

Making News in the Field

Gastric balloons are somewhat new as a non-surgical option, but still a relative unknown for its long-term help. 

In the process, a balloon is inserted down the throat and filled with fluid once inside the stomach, giving the patient a sensation of fullness. The maximum implantation is six months. 

“Because of the expense, potential complications, and minimal expected sustained benefit, at St. Elizabeth we believe it is in the best interest of patients to avoid these devices,” Smith says.