2013년 11월 25일 월요일

About 'obesity management'|Gastronomic Integrated Pest Management: Childhood Obesity and Diabetes







About 'obesity management'|Gastronomic Integrated Pest Management: Childhood Obesity and Diabetes








We're               seeing               two               new               trends               today.

The               first               one               became               noticeable               a               couple               of               years               ago:               kids               are               getting               fatter.

No               one               has               a               clear               idea               of               why;               some               blame               it               on               video               games               and               televisions,               others               on               fatty               food               habits               picked               up               in               school               lunchrooms               and               home,               and               still               others               on               a               relatively               indulgent               and               often               absent               parenting               style.

The               second               trend               is               obesity               surgery               for               teens.

With               the               drastic               rise               in               teen               obesity,               it's               easy               to               see               why               this               has               become               a               trend.
               Which               Teens               Get               Obesity               Surgery?
               According               to               published               guidelines               in               the               magazine               Pediatrics,               teens               who               want               obesity               surgery               should:
               *               Have               failed               at               least               a               six-month               organized               weight               management               program               (or               series               of               them)               under               the               care               of               their               pediatrician               or               family               doctor.
               *               Be               fully               physically               mature,               or               nearly               mature.
               *               Be               severely               obese               with               a               minimum               body               mass               index               of               40               and               obesity               related               disease               -               or               have               a               BMI               of               50               or               more               with               or               without               disease.
               *               Have               medical               and               psychological               evaluations               both               pre               and               post               procedure,               and               show               no               signs               of               addictive               behaviors               or               binge               eating               behaviors;               approach               to               food               should               be               normal               and               healthy.
               *               Promise               not               to               get               pregnant               for               at               least               a               year               post-surgery.
               *               Be               motivated               and               able               to               follow               the               specified               diet               post-procedure.
               *               Be               mature               enough               to               make               decisions,               and               capable               of               providing               an               informed               consent               to               surgery.
               *               Have               a               supportive               family               that               is               motivated               to               help               the               teen               follow               a               diet               and               exercise               plan               post-procedure.
               The               Quick-Fix               Society
               So               why               the               sudden               turn               to               surgery               rather               than               the               tried-and-true               methods               of               diet               and               exercise?

We               live               in               a               quick-fix               society,               and               it's               getting               worse.

Teens               today               have               less               patience               than               I               had               at               that               age,               only               twenty               years               ago.

If               diets               don't               help               them               drop               five               pounds               right               away,               they               switch               to               another.

Physical               exercise               is               taxing               to               the               body,               and               many               aren't               fit               enough               to               start               any               kind               of               exercise               program               without               some               weight               loss               first.
               A               pill               can               fix               some               things.

But               obesity               is               only               quickly               treatable               with               pills               that               also               harm               the               body,               or               with               surgery               that               alters               the               size               and               shape               of               the               stomach.
               Side               Effects               of               Obesity               Surgery
               The               death               rate               due               to               complications               from               obesity               surgery               is               low,               about               one               percent;               complications               ranging               from               stomach               leakage               to               infection               are               at               about               ten               percent.

Teens               who               have               bariatric               surgery               are               less               likely               to               die               or               suffer               from               side               effects,               probably               because               they               are               young               and               have               not               had               time               to               develop               diseases               like               high               blood               pressure               or               diabetes.
               However,               over               the               long               run               obesity               surgery               may               lead               to               malnourishment.

This               doesn't               mean               the               patient               starves.

Rather,               the               ability               of               the               digestive               tract               to               absorb               essential               nutrients               is               lessened.

This               means               that               a               variety               of               complications               related               to               vitamin               or               mineral               deficiency               can               arise.
               Infections,               too,               can               be               a               problem.

The               digestive               system               affects               the               immune               system               in               ways               we               can't               understand               yet,               and               infections               at               the               site               of               the               surgery               as               well               as               other               generalized               infections               may               be               a               problem               later.
               There               may               also               be               psychological               effects               if               the               patient               later               fails               to               maintain               a               healthy               weight,               not               an               uncommon               occurrence.

Many               patients               don't               follow               the               exercise               and               diet               plan,               assuming               that               having               a               smaller               stomach               is               going               to               take               care               of               things.

Some               patients               have               even               overeaten               to               the               point               of               bursting               their               staples,               making               emergency               repair               surgery               necessary.
               Long-Term               Effectiveness               of               Obesity               Surgery
               The               effectiveness               of               obesity               surgery               over               time               depends               on               the               patient.

Both               my               aunt               and               my               mother               had               this               surgery               done               in               their               late               30s.

My               aunt               did               well.

She               dropped               at               least               half               her               starting               weight               and               changed               her               eating               habits,               focusing               more               on               vegetables               and               healthy               meats               than               the               fatty               Southern               cooking               she'd               been               raised               to.

She's               heavier               now,               but               still               maintained               her               loss               pretty               well.
               My               mother               didn't               do               so               well.

She               dropped               a               lot               of               weight               at               first               too,               but               was               unhappy               because               she               couldn't               eat               as               much.

Instead               of               sticking               to               the               diet,               she               started               eating               a               little               more               each               meal.

She               tried               Lean               Cuisine               style               meals               -               and               they               didn't               satisfy               her.

Eventually,               she               was               eating               several               meals               per               day.

Soon               enough,               the               part               of               her               stomach               that               was               accepting               food               expanded,               and               she               put               all               the               weight               back               on               in               just               a               couple               of               years.
               Part               of               the               difference               was               their               exercise               habits.

My               aunt               is               a               restless               person,               and               has               always               looked               for               active               jobs.

My               mother's               job               involved               sitting               at               a               desk               up               to               twelve               hours               a               day.

But               part               of               it               was               also               differing               motivations.

They               both               wanted               to               keep               the               weight               off,               but               my               aunt               was               more               willing               to               make               those               critical               changes.
               In               the               end,               if               the               patient               is               not               willing               to               make               serious               permanent               changes               in               his               or               her               lifestyle,               obesity               surgery               will               not               matter.

The               weight               will               come               back,               and               it               will               bring               all               the               original               health               problems               back               with               it.
               How               Well               Has               This               Been               Studied?
               So               far,               no               one               is               certain               what               the               long-term               effects               of               obesity               surgery               are               likely               to               be               for               teens.

Weight               gain               is               very               complex,               involving               diet               and               exercise               habits               as               well               as               genetics,               social               pressures,               the               environment,               finances,               and               many               other               factors.

Teen               obesity               has               been               a               minor               problem               for               decades,               and               little               study               has               been               done               on               it.

And               even               though               obesity               surgery               for               teens               has               tripled               over               the               last               few               years,               it               is               still               rare,               with               fewer               than               one               percent               of               obesity               surgeries               performed               on               people               aged               14-19.
               The               few               studies               that               have               been               done               on               this               operation               at               this               age               suggest               that               risks               outweigh               benefits               for               all               but               the               most               morbidly               obese               teens.

For               those               who               have               had               surgery,               little               study               has               been               done               on               how               well               they               maintain               their               weight               loss,               how               fit               they               work               to               become               afterward,               and               how               it               affects               teens               psychologically               with               identity               issues               and               social               situations.

For               instance,               a               young               girl               who               is               slender               for               the               first               time               in               her               life               will               probably               react               differently               from               a               thirty-year-old               man               who               has               attained               the               same               success.
               But               what               I               find               more               disturbing               than               anything               is               how               many               of               the               bariatric               surgery               studies               are               funded               by               companies               that               have               a               vested               interest,               like               Johnson               &               Johnson,               which               sells               lap               band               kits               and               other               obesity               surgery               tools.

Without               unbiased,               long-term               studies,               we               can't               know               the               true               risks               and               benefits               of               this               serious               procedure.






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