Dr. Darren Tishler
I’ve spent my entire career studying and treating obesity. I have found that obesity, like many other diseases, is extremely complex and there is no single treatment that will work for everyone.
In our practice, we have been fortunate to follow patients for many years after they’ve had weight loss surgery. In fact, we followed some patients for close to 15 years, including time before and after surgery which that helped us understand the natural course of this disease.
In trying to wrap my hands around the complexities of obesity, I’ve concluded that obesity behaves, in many ways, similar to a cancer. Overall, it is a highly debilitating disease that both affects quality-of-life as well as shortens overall life expectancy, very much like a cancer.
When considering the natural course of cancer in simple terms we can think of cancer prevention and treatment in several phases. First and foremost, we want to prevent people from ever getting cancer. Smoking prevention, healthy living and avoiding exposure to certain carcinogens are some of the keys to preventing certain cancers. But prevention is not always possible.
When a cancer does occur, the best treatment outcomes usually come with early detection, aggressive treatment to patients who can tolerate it and long-term monitoring when someone becomes cancer-free. Of course, even with the very best cancer treatment, some disease spreads or comes back — leading to a dreaded diagnosis of metastatic cancer. At that point, sometimes all we can do is control the disease, not cure it. In rare cases, unfortunately, there is no treatment to cure the disease.
As with cancer, the best treatment of obesity is a good prevention program. Through advocacy, early intervention and education, we are making advances in the prevention of obesity in the United States. Because I deal mainly with adults, most of the time it is too late for prevention when someone comes to see me with obesity.
In fact, we are seeing people at a younger and younger age with obesity and severe related health issues such as diabetes, high blood pressure, high cholesterol and infertility. To this end, we have fostered a partnership with Connecticut Children’s Medical Center to help create a seamless transition from the treatment of obesity in children, through their teenage years, and into adulthood.
Recommended Obesity Treatment
1. Prevention
2. Early identification of obesity
a. family history
b. lifestyle
3. Early Intervention
a. at a younger age
b. at a lower weight / Body Mass Index (BMI)
c. before serious side effects of the disease (like stroke, heart attack, or poor mobility)
When it comes to evaluating a patient with obesity, just like cancer, we look at family history and patient lifestyle. This helps us determine specific risk factors for obesity and related health conditions and their severity. For example, when I see a young patient with mild obesity in my office who comes from a family with a longstanding history of obesity, diabetes and heart disease, I don’t need to wait for her to gain more weight to see if she also develops the same severe health issues as her family members. Looking at her family history is basically my crystal ball to look into the future.
Like cancer, the best outcomes for the treatment of obesity occur the earlier it is detected. By earlier, I am referring to several things: early in the course of the disease, at a younger age and at a lower weight. When patients reach a BMI of 35 or more (about 50-75 pounds overweight), we do not need to wait for them to gain additional weight before starting treatment for obesity.
Like cancer, we can be more aggressive with our treatments before there are serious, detrimental effects of the disease. In general, health and mobility decline with age, increasing weight and once serious obesity-related health conditions occur. Patients who increase cardiac or aerobic exercise and also have surgery have the most success.
Please do not misinterpret my last points. I am not saying that we shouldn’t offer treatment of obesity for those with serious obesity-related health issues. We feel very strongly that there are treatment options for most people with obesity. But treating obesity earlier and before serious health and mobility issues has significant advantages. I have found that just about every patient with obesity at some point starts to wonder about their ability to move and do everyday things. That is yet another indication it is time to treat obesity.
In yet another analogy to cancer, we are often very successful in treating obesity and its related health issues. But our work is not done. Long-term surveillance is needed so that early intervention can take place if the patient regains weight or has other obesity-related health issues.
I sometimes use the term metastatic obesity because, like a cancer, sometimes the disease has spread and it is too late to treat obesity. There is unfortunately a point of debilitation where the burden of the disease of obesity is just too great to overcome. This doesn’t necessarily mean that the weight is too high, just that the damage from the disease is done and nothing can cure it. Fortunately, this only represents a small percentage of patients we see in our practice.
Overall, we need to look at obesity like cancer or any other serious disease. From both an individual patient and population standpoint, we will make the greatest impact on obesity by increased prevention, more vigilant surveillance for the disease, and offering potentially life-saving treatments to our patients earlier in the course of their disease.
Dr. Darren S. Tishler is director of Metabolic and Bariatric Surgery at Hartford HealthCare.
To learn more about Hartford HealthCare’s weight loss services, click here.