The Times…They are a Changin?
Addressing Important Issues To Beat Obesity

The past 10-15 years have been a period of dramatic change in the growing problem of obesity and the medical profession’s gallant effort to treat it. We have made dramatic positive strides from the development of minimally invasive and laparoscopic surgical approaches to the acceptance of newer surgical techniques such as the adjustable gastric band and sleeve gastrectomy. Recently, the FDA has also relaxed the indications and criteria for undergoing the Lap-Band procedure, making this option available to many who suffer from debilitating diseases such as sleep apnea or diabetes and giving them hope for a brighter future. Our understanding of the relationship between obesity and the medical afflictions with which it is associated has become stronger and clearer.

While it is indeed true that we have won some significant battles and made very real progress against our enemy, the war is far from over and we have much work to do. I would like to take this opportunity to reflect on some important agendas which still persist – issues which we must address if we are to go on ultimately to victory in our quest to beat obesity.

First and foremost are the many road blocks and detours which seem to be ever present and constantly growing. As time has gone on, insurance companies have fabricated new requirements, exclusions and onerous procedures and processes to make approval for medical treatment for obesity difficult and time-consuming. As a society, we must close the legal loop-holes by prohibiting exclusionary clauses in health policies and condemning unrealistic requirements. It baffles me how weigh loss surgery can legitimately be excluded from covered health benefits. I can’t imagine that cancer treatment ever would be – yet the two are responsible for a similar number of deaths each year. We must fight to keep the special interests of a few from affecting the happiness and health of the majority.

Secondly, we must demand that the purveyors of our wellness – our primary care physicians (PCP’s), become more familiar and knowledgeable not just about the various kinds of treatments available for obesity, but also of the many positive health benefits which they provide. I am sure that many of you are not surprised that there are a significant number of PCP’s that not only never offer a solution to their patients for their weight problems, but are ignorant regarding the long term health benefits which they offer. As a community, you can support those PCP’s and physicians who encourage their patients to seek surgical treatment as well as support their decisions to undergo these procedures. Patients must take part in their health care decisions, and as such physicians should provide them with the objective and unbiased information which is required to make such decisions.

Next, we must improve access to competent, quality care. A major step in the right direction was the initiative by the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS) to establish Bariatric Centers of Excellence (COE). These designated facilities provide comprehensive care to bariatric surgery patients and have demonstrated outcomes with minimal complications. Patients who have chosen surgery as their treatment of choice should seek out committed, dedicated bariatric surgeons who provide long-term care and follow-up. One of the most important components of this long-term care is assistance with life-style modification. As I see it, it is also the most neglected part of the process. We must promote and reinforce the concept that dietary and life-style modification is the cornerstone of ANY weight-loss program. Those who succeed will be successful for life. 

Finally, we must address access to care. With budgetary cuts and the Health Care Reform Act, weight loss surgery and weight management services potentially have a real possibility to suffer. Individuals should support those medical insurance plans that support these services. We must continue to organize and promote for the good of all who need this care.    One such organization is the Weight Loss Surgery Foundation of America ( This non-profit group raises money to help those who need weight loss surgery or reconstructive plastic surgery after weight loss surgery, but do not have insurance or the financial resources to obtain it. We must continue to support and participate in organizations such as this to assure the fight goes on, and eventually the war is won!

Paul Cirangle, MD, FACS, FASMBS, is the Director of the Bariatric Surgery Program at California Pacific Medical Center and Medical Director of the Surgical Weight Loss Center of Hawaii.

Article ID: WD191