Weight a minute

Dr. Kent Sasse is a surgeon, an author, and the founder of the Western Bariatric Institute. He came to Reno 11 years ago. He’s also a frequent blogger at www.sasseguide.com/blog/about-dr-kent-sasse, but most relevantly, he’s a weight-loss expert who sees his primary career, surgery, as simply one tool to be used to help people reach more healthful weights. The WBI can be reached at 326-9152.

What are the risks with being overweight?

They’re a lot more serious than most of us realize. The risks of being overweight or obese, for starters, are a huge increase in the risk of developing Type 2 diabetes. That risk doubles very quickly with just a modest amount of extra pounds, but it quickly becomes 10-fold, 20, 30-fold higher as one becomes more overweight and into the obese category. That one is very serious and leads to things like kidney failure and blindness and amputations, but really it’s just the start of the long list of health problems that are associated with excess weight gain. Probably all if it together is summarized in the dramatic reduction of life expectancy and quality of life that people report and is documented in our health statistics. Every organ system is adversely affected. The rates of several types of cancer go up, heart disease and then just things we think of as aches and pains in life that become more serious when there is real wear and tear on joints. So degenerative joint disease becomes incapacitating due to obesity.

You’re a surgeon, so I presume you primarily focus on surgical things, but do you talk diet first?

When I started, I approached it from the surgical weight loss perspective. I had a skill set from some very advanced training in laparoscopy for gastrointestinal surgery. But as a little time went on, I realized that much of our effort needs to be directed toward helping people make personal change in their lives, and directed toward changes in what they eat and drink, and how they think about food and health and activity and exercise.

Is there a single factor that has contributed most to the obesity epidemic?

We can point our fingers at more than one thing, but the biggest factor is a net overconsumption of calories that has occurred primarily due to the excessive availability and consumption of carbohydrate calories: sugars, starches, high-fructose corn syrup, most of the snacks that we all like. And just the fact that any of the routine foods and drinks that a generation before us enjoyed are now packed with far more calories than they were 30 years ago. This has been documented by some other authors, but for example, the calorie content of a lot of things like a regular old fast food burger, or a soft drink, all have dramatically more calories and mostly net carbohydrate calories than they did 30 years ago. That’s really the number one factor.

Is surgery the last option?

I think that we certainly used to think that way. I think that it is clear from the clinical-outcome evidence that we need to think about the role of surgery earlier in this disease process. So I guess I would say that we need to be focusing on all treatments and all strategies that have a chance of success. I think that the two that are most likely to succeed are efforts aimed at childhood-obesity prevention and secondly, a program that has surgical weight loss as an option. The Food & Drug Administration recently expanded the approved criteria for weightloss surgery using the lap band system to include people with a Body Mass Index of 30 or greater. Many, many more tens of millions of Americans now meet the criteria. The FDA is doing that because they look at the alarming statistics of what happens to a person’s health if they don’t undergo weightloss surgery at a BMI of 30. And it’s disturbingly, clearly worse for them if they don’t. I would say we’re broadening our understanding and expanding when we think weightloss surgery should play a role.