Editorial Message—Worldwide Obesity Rates Doubled Over Past Three Decades: Dietary Habits and Physical Activity Partly to Blame

| February 11, 2011

Dear friends, colleagues, and readers of Bariatric Times:
As I opened Google news this morning, I found an article in the healthcare news section entitled “Worldwide Obesity Doubled Over Past Three Decades.”[1] What a great start for my monthly editorial. The article comes to the conclusion that changes in both dietary habits and physical activity are partly to blame for the rise in the worldwide obesity rate. Publicized in February 2011 issue of The Lancet, the article states that in 1980, 4.8 percent of men and 7.9 percent of women were obese. Those percentages jumped to 9.8 percent of men and 13.8 percent of women in 2008. In addition, their results show that overweight and obesity, high blood pressure, and high cholesterol are no longer Western problems or problems of wealthy nations. Majid Ezzati, the study’s lead author from the School of Public Health at Imperial College, London, United Kindgom, concluded that these problems have shifted toward low- and middle-income countries, making them global problems. As I mentioned in previous editorials, the obesity epidemic is not only the result of evolution of human kind and our predisposition to gain weight in order to fight starvation, which is mainly controlled by our genotype. Our lifestyle, or phenotype, is another major factor, and it is the only one we can control. Modifying our diet and degree of physical activity are the only ways we can fight our genes.

Relevant to addressing the need to modify our diet and physical activity, this month we have an excellent article by Dr. Peirano on exercise physiology and physical activity. This is a great article to print out and give your patients to read.

In this issue, we also have an interesting article on single-incision laparoscopic surgery (SILS), focusing on the sleeve gastrectomy, by Drs. Park, Afthinos, McGinty, Koshy, and Texeira. I am sure that by now everyone, including Dr. Julio Teixeira, who is a dear friend of mine, knows my personal opinion on the SILS approach. In my opinion, the conclusions of this article continue to be misleading and lack scientific evidence. The authors conclude that SILS is “safe, feasible, and it has the potential for better cosmesis and decreased pain.” I am still waiting for the data to prove these conclusions are true!

Dr. Duperier’s article, “Implementing an Electronic Medical Records System into Practice,” is a must read. For those of us who are in full swing adjusting to electronic medical records (EMR) systems, this article is no news. However, I would like to emphasize an issue on which no article on this topic has ever commented: Most of the EMR programs available depend on a security system that needs login codes, passwords, and signatures in order to access, open, and close a file. Unfortunately, these systems are not always available due to technical issues, and in some occasions, they are slow to react. One of the situations that has bothered me the most when implementing EMR into my practice is that when patients are in my office, I have to look at the computer screen and not at my patients in order to enter data. Though I agree with Dr. Duperier on all of the advantages of EMR systems, there is a price to pay when implementing this new technology. One of the disadvantages is the loss of visual communication with our patients. I challenge the EMR companies to come up with a video recording of consultations that allows a “screen free” and direct dialogue with the patient.
We are pleased to include an article this month by Sarwer and Dilk’s entitled, “Overview of the Psychological and Behavioral Aspects of Bariatric Surgery.” This article reminds us that patient follow up using the entire multidisciplinary team is of utmost importance.

Finally, on a disappointing note, I am sure that by now everyone has learned that the seemingly promising procedure transoral gastroplasty, or TOGA, has discontinued its United States Food and Drug Administration (FDA) trial. The main reason for the discontinuation was that patients treated with TOGA did not achieve significant weight loss when compared to controls. Specific issues that need extensive debate in the future are 1) how to measure outcomes in bariatric procedures and 2) how to define a control group. I believe that it is our obligation to help our partners in the industry design these studies in such a way that they can achieve their goals when it comes to safety and efficacy.

I hope you will enjoy reading this issue of Bariatric Times.

Sincerely,

Raul J. Rosenthal, MD, FACS
Editor, Bariatric Times

References
1.    Carollo K. Worldwide obesity doubled over past three decades. ABC News Medical Unit. 2011. http://abcnews.go.com/Health/global-obesity-rates-doubled-1980/story?id=12833461 Accessed February 4, 2011.

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