All Posts tagged obesity

Is surgery really the best option to treat obese diabetics?

In 1993, MTV’s new hit reality show The Real World: Los Angeles was in its second season.  During that season Tami Akbar Roman famously had her jaw wired shut in an attempt to lose weight.  From her perspective it was a simple enough idea, if she can’t eat food, then she should lose weight, right?  It was one of the first of a long line of reality show TV stunts that are all too familiar today.  Twenty three years later, I’m sad to say that a panel of international experts on diabetes has recommended something very similar as their preferred treatment for obesity in diabetics.  They go on to extend these surgical recommendations all the way down the line to diabetics with class I obesity (BMI of >30kg/m2) who have poor glycemic control.  That means a 222lb man standing 6 ft tall with poor blood sugar control on medications should consider bariatric surgery as his next best option.

Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations

Even in 1993, long before I started my medical training, I understood that physically preventing food from entering the body was a poor way to lose weight and become healthier.  It must start with a change of heart and an improvement in understanding.  A point that Tami was happy to prove for me as she attempted to take all her normal foods and puree them through a blender.  I seem to remember a cheeseburger slurry showing up during one of the episodes.

That’s the story with so many patients who undergo surgical weight loss.  Without the change of heart and change of understanding, the recidivism rate is quite high.  Lest you think I’m pointing a finger, let me explain that I understand their dilemma all too well.  I teach nutrition.  I treat diabetes.  I see the heartache and pain associated with blindness, kidney failure, amputation, and neuropathic foot pain and yet I still really like Double Stuf Oreos. “Like” is too soft a word.  I long for Double Stuf Oreos.  Every summer I’m tempted mightily by these wonderful little chocolate promises of happiness.

Don’t give up what you want most for what you want now

What are we to do?  How do we change?  How can we go from surgically altering our bodies in an attempt to irrevocably force limited food consumption to choosing life-giving options that promote our wholeness physically, emotionally, and spiritually?

For me, I believe it starts with a change of my heart and a change of my understanding.  I’ve learned more about nutrition in the last 15 years then any other medical topic.  My understanding has been refined through trial and error in my own life as well as when I work with patients through their struggle.  This self-education was fostered by friends as early on as medical school and continues to this day as my fellow Trinity physicians and clinicians challenge me with new research.  I love being part of a practice culture that works so hard with individual patients in their understanding of how nutrition shapes health.  The continual education and re-education of nutrition has been the easy part for me.

Love… faithfulness, and self-control

As Paul fought against Jesus’ calling in his life so too does my heart still kick against the goads of my soul.  I am coming to believe more that for us to truly change our behavior in nutrition, among many other areas of lives, we must first change our heart’s desire.  I recently heard it said that you “Don’t give up what you want most for what you want now”.  Similarly, in Galatians 5:22-23 Paul pens the fruit of the Spirit as love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self-control.  I believe that if my love is rightly fix on something worthy of that love, if what I want most in my life is the growth of that love relationship, then the natural outcome will be the fruit of the Spirit including faithfulness and self-control.  Faithfulness in choosing well when someone else’s interests are at stake (ie, how I parent, how I practice medicine, how I treat my neighbor, etc…) and self-control in choosing well when only my own interest’s are at stake (ie, what I eat, how I exercise, my personal time, etc…).  (Notice that fruit is singular not plural.  That’s important because the fruit comes as a single unit not multiple fruits from which we get to pick and choose those that taste good while avoiding those that are unpleasant to us.  We produce these traits as a collective whole.)

So that begs the question, “What should I love?”  If the direction of my heart’s affection changes the choices I make and how I live my life, then what should be my heart’s desire?  There is only one thing worthy of your love and worship.  It isn’t health, or your family, or your self-image, or even the promise of less pain in your life.  It isn’t the hope of a cured cancer or the re-opening of clogged arteries that is worthy of our utmost desire.  Only God is able to receive worship properly.  Paul writes to the Corinthian church, “whether you eat or drink, or whatever you do,  do all for the glory of God.”  When our first thought at every intersection of our lives is “how do I glorify God in this situation?”, then we fundamentally start changing the things we do.  Our choices are now informed by a true and perfect set of guidelines that lead to our ultimate good.  They very often lead to our physical good, a healthier or more functional body, but that isn’t their goal.  The goal of our actions is to glorify God.  In that power, we can choose well the foods we eat or avoid.

Biblical counseling is nutritional counseling is Biblical counseling.

However, the fruit of the Spirit isn’t the fruit of my spirit but the fruit of THE Spirit.  It is God’s Spirit dwelling in me to grow in faith and love of God Himself.  It is much deeper than following a 12 step program of reform.  It is much more fundamental than even just adhering to the 10 commandments of scripture as though they are highway guard rails that keep us pointed in the right direction hopeful that we might finish the race before we screw up too badly.  Instead, we are to be driven by the hope within us in Christ’s finished accomplishment.  As God works in our lives, His fruit is produced.

Trinity’s Biblical counseling program was built on this foundation so that we can help our patients understand what their heart’s desire should be.  We saw the need to help our patients understand the hard moments of their lives in the light of God’s worthiness to receive worship.  It was only natural for us with this counseling mindset to extend our help for patients into the area of nutrition and exercise with our VitalSigns program.

I urge you as we all walk together through your life to reach out to us and begin to understand the choices that will truly fulfill you.  Please call us at 539-0270 to set up an appointment with your physician or clinician to begin this discussion.  Call and set up an appointment our Biblical Counselors or our Medical Nutrition Management clinicians to start addressing the fundamental issues that shape our lives.  Don’t let another set of superficial, hollow medical guidelines lead you further away from the truth.



The luxury of obesity

Ever thought about the fact that some people always assume that other people who are overweight are worse off than someone who isn’t? Have you ever thought that yourself?

I hear from patients all day long about how they feel okay about their health even when they have an awful diet and no exercise habit. Most of the time they feel this way because they aren’t overweight or at least aren’t as overweight as someone else in their life.

Society judges health based primarily on weight. It’s just not that simple.

I’ve come to believe that obesity is a luxury. It’s one extra (and very powerful) mechanism the body has to protect us from the outcomes of a less than perfect nutrition plan. Sometimes those choices are voluntary and sometimes they aren’t.

Think about it this way. A simple 7 inch banana has enough sugar (ie, glucose) stored within it in various carbohydrate forms to raise my fasting blood sugar from 85 mg/dL all they way up to 351 mg/dL. If my body didn’t protect me, then a simple banana would make me instantly diabetic.

Thankfully my body is better at protecting me than sometimes I am at choosing my food. All that sugar is moved from my blood stream into my cells. My brain uses some to do math and write a sentence. My heart and lungs use some to beat and breathe. My muscles use some to walk down the sidewalk or ride a bike. In the end, almost after all other cells have used as much of that sugar as they can, the body must still get rid of the rest of it. If it doesn’t, bad things like blindness, Alzheimer’s, and kidney failure can occur. So where does that sugar go?

That’s were adipose (the five dollar word for fat or storage cells) comes into play. Adipose takes up the extra sugar and stores it. As that happens these cells grow larger. So they really are a protective mechanism for keeping too much damaging sugar out of the blood stream. But not everyone has adipose cells that are good at taking up the extra sugar. Some people lack virtually any ability to grow their adipose cells in response to a bad diet. Nearly 20% of diabetics have a normal weight.

So why is obesity a luxury? When you need protection from less than ideal food choices it’s nice to have that extra place to store your bad decisions. The alternative is to let loose all those extra sugars into the blood stream and allow them to cause havoc on your system.

We tend to consider cars with more airbags and safety features as better vehicles. We should be thankful we get our own safety features for our bodies. Better yet though, let’s not live a life dependent on our safety features protecting us from the consequences of our choices. Let’s eat and exercise in such a way as to not stress, strain, and overwhelm our body’s plan to be healthy and strong.


The end comes from the beginning

Being board certified in Internal Medicine and Pediatrics and working in a full spectrum primary care practice I get to see all types of people every day. Yesterday, for instance, I took care of a two week old and then went across the hall to care for a 99 year old. I absolutely love that part of my job.

That age difference also allows for me to gain a unique perspective on the choices we all have to make. I literally will walk out of one room having told a middle aged woman she has lung cancer to the next room only to find out a teenage girl had her first cigarette recently. I’ll counsel a diabetic on starting insulin then go meet a sixth grader who is 85lbs overweight.

When you can see the end of every new beginning it impresses upon me the urgent need to change our destiny. We must learn to choose differently and to choose wiser.

Watch this video and see what I mean. I warn you though it doesn’t pull any punches. I have seen a patient at every stage portrayed in that man’s life even the last one. At each stage we can choose differently and avoid the ending.

Come see us and learn about our wellness program and our nutritional counseling. This doesn’t have to be your destiny or the destiny of your child.

How does this happen?


Adolescent Obesity

Adolescent Obesity and Overweight


“That was awesome!” OK, admittedly that is not a phrase that is usually uttered as a patient exits one of my exam rooms. This was an 11 year old boy, Sam, who had just heard some very encouraging news. Some five months earlier he had come in with abdominal pain and frequent episodes of diarrhea. In the midst of examining him and working this up, several additional facts came to light. Sam was obese, being well above the 95% for BMI (body mass index) for his age. Connected to his obesity were several common complications:

  • High blood pressure
  • High cholesterol
  • High triglycerides (a fatty substance that also increases risk for heart disease)
  • Fatty liver with elevated liver enzymes in the blood indicating damage
  • A low HDL (the “good cholesterol” that helps protect against the plaque in the arteries that can lead to eventual heart attack or stroke)
  • He was not yet diabetic or pre-diabetic but certainly was at risk for this

As we reviewed this with his mom and him, they (especially his mom) registered concern.

She was well aware that Sam’s family history, besides obesity, included heart disease, stroke, diabetes, high cholesterol, high blood pressure, and several kinds of cancer. These are the very things that Sam’s obesity put him at risk for, and they were already beginning to emerge.

Childhood obesity has more than tripled in adolescents in the past 30 years, increasing from 5% to 18%. In 2010, more than one third of children and adolescents were overweight or obese. Besides the major diseases that rise with obesity, there are the stigmas and teasing and lack of energy and involvement in physically demanding activities that often are the further unwanted baggage of obesity and overweight.

We got Sam and his mom scheduled with one of our nutritional counselors as well as our wellness nurse who helps put together a lifestyle of movement and exercise that will work for a given person. Sam and his mom both got on board with a number of healthy changes. Sam had begun to get in some walking and then running, partly through school activities. He had gone from frequent giant sweet teas to less frequent small ones. He halved the portions of a lot of the carb-heavy snacks he was having. All in all he didn’t feel deprived but was learning to make better choices, and his mom was making sure that his available choices at home and in his lunch were healthy.

The result was that Sam, in four months had dropped about 18 pounds (roughly a pound a week). His liver enzymes had gone back to normal along with his triglycerides. Sam’s total cholesterol had dropped, his good cholesterol went up and his bad cholesterol went down. Blood pressure had completely normalized. Beyond that, Sam’s digestive problems had nearly resolved, his energy was back, and he felt great about it all. What’s more, he was putting in place habits that would serve him well for a lifetime.

These are some of the most satisfying visits for me as well – to identify habits that are feeding into several disease processes, especially when this can be done early on, and to then help to effect real change. We can only put tools in people’s hands; it is the Sam’s and Sam’s moms (and dads!) who do the real work of using those tools to make things happen. And of course that doesn’t always happen. But every time that it does, to quote Sam, it’s “awesome!”

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835