Originally created 02/13/01

The morbidly obese



Lindy Chavis said she doesn't recognize herself in pictures anymore. And she is desperate to find the woman she remembers being.

She started gaining weight when she was in her 20s, after she began having marital problems. Depression set in, her self-esteem sank and the pounds started accumulating.

At first, Mrs. Chavis was able to work off the extra weight, but that was 20 years ago.

Now the 4-foot-10-inch tall woman weighs nearly 300 pounds, and she fears her life is in jeopardy.

The clinical term for Mrs. Chavis' condition is morbid obesity, or clinically severe obesity, and refers to people who need to lose 100 pounds or more to be at a healthy weight.

According to the Centers for Disease Control and Prevention, 97 million people in America are obese.

In a study conducted from 1991 to 1998, the National Centers for Chronic Disease Prevention and Health Promotion found that, nationally, obesity increased from 12 percent to nearly 18 percent of the population. Regionally, the South led the nation with a 67 percent increase in the number of obese.

The largest increase was in Georgia, with 101 percent.

"In the last 10 years, the number of people who have become morbidly obese has doubled. That's faster than any other state in the union," said Robert Martindale, medical director and surgeon of gastrointestinal surgeries at Medical College of Georgia.

Southern cuisine, which includes a lot of fried foods high in fat and calories, is one cause of the problem, said Donna Martin, senior dietitian at CSRA Partners in Health - a weight-management and nutrition center.

"Many patients say they don't know any other way to cook. It's just passed down through generations," she said. "Frying is a Southern thing. Where else would they fry tomatoes?"

Ms. Martin also sees many patients who use food to reward or comfort themselves. The staff counsels many people whose weight gain was caused by depression.

"Food is such a comfort for so many people. And it becomes a way to cope," Ms. Martin said. "It becomes a very vicious cycle. It can be totally discouraging."

A sedentary lifestyle also contributes to obesity. Exercising sounds like a simple cure, but taking a jog or even a walk can seem impossible for people who are morbidly obese.

"I am not lazy, but I am just about disabled," Mrs. Chavis said. "After 10 minutes in the grocery store, my knees, back and feet hurt so bad I am just about crying," she said.

Obesity greatly affects many of the body's organs and systems.

"It has a whole litany of side effects and risks. It has to be approached as a disease," Dr. Martindale said.

Mrs. Chavis' blood pressure is steadily rising. She has circulation problems, a hernia, degeneration of the spine, psoriasis and arthritis.

Obesity substantially increases the risk of morbidity from hypertension, diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and endometrial, breast, prostate and colon cancers.

In addition to trying every fad diet on the market, even hypnosis, Mrs. Chavis has attempted traditionally medical approaches to weight loss, such as a prescription medicines, aerobics classes and physical therapy.

Her only success was with the physical therapy, which she no longer attends because Medicaid stopped paying for it.

Most recently she considered bariatric surgery, an operation that limits the amount of food the body can hold by reducing the size of the stomach or bypassing all or part of it.

However, bariatric surgery poses life-threatening risks and must be taken very seriously.

"It's best to try all conservative measures first," said Dr. Martindale, who specializes in gastroplasty, gastric bypass and gastric banding operations. Typically, his patients have lost hope in traditional weight-loss methods and undertake surgery as a last resort.

Dr. Martindale said he spends several months making sure that his patients are serious enough to stick to the strict regimen required after surgery.

"After six months, if they are still serious, then we explain the risk of the operation," he said. "I ask them, are they willing to risk their life? Frankly, I try to scare them, to let them know how serious it is."

After speaking with her doctor in Aiken County, Mrs. Chavis decided not to have the surgery. She still wants to lose weight. But, like many, she doesn't know where to turn next.

"I need a push. I am tired of these two women hanging on my sides," she said.

Diane Smith, medical director at CSRA Partners in Health, said there is no quick fix and no magic bullet for weight loss. And you don't need all those silly little exercise gadgets.

"It's boring - but all it takes is persistent, consistent effort," she said. "If you settle for slow, steady progress, you'll do it."

After starting an exercise program, most people should expect to lose a pound or two a week.

"The good news is that even a 5 to 10 percent weight loss will greatly better their health," Dr. Smith said.

And most likely, the way they feel.

"When you have 100 pounds to lose, 10 pounds may not sound like a lot, but think about carrying around two 5-pound bags of sugar," Ms. Martin said.

"Some people can't walk to the mailbox, so that can be a goal. Every day just go a little bit further. Take small steps.

"Exercise ... should be a part of your daily life, then you don't make excuses anymore."

One of the first things patients are asked to do when they see Ms. Martin and Dr. Smith is to record a three-day diary of everything they eat. "Every single thing - food, drink and snacks," Ms. Martin said. "It's such an awakening."

What patients find are easy ways to cut fat and calories. Just changing from whole milk to skim milk - people don't realize how much the little things add up, Ms. Martin said.

"Change from Coke to Diet Coke, from sweet tea to unsweetened and stop having seconds."

Ms. Martin advises her patients to set goals and reward themselves with a movie, a manicure, or even a long, hot bubble bath instead of food.

For much-needed support in weight-loss efforts, Ms. Martin and Dr. Smith recommend attending meetings such as Overeaters Anonymous or TOPS (Take off Pounds Sensibly). Both groups meet in the area.

Weight loss groups

OVEREATERS ANONYMOUS:

Noon Mondays, 3670 Old Petersburg Road; 7:30 p.m. Tuesdays, St. Andrew Presbyterian Church, 3551 Wheeler Road; 6 p.m. Wednesdays, New Birth Missionary Baptist Church, corner of Ninth and Shadrack streets, Waynesboro, Ga.; 9 a.m. Saturdays, Wimberly House, 521 S. Liberty St., Waynesboro; 1:30 p.m. Saturdays, Covenant Presbyterian Church, Room 3, 3131 Walton Way

TOPS

(Take Off Pounds Sensibly): 5:30 p.m. Mondays, Burns Memorial United Methodist Church, 2372 Lumpkin Road; 10 a.m. Thursdays, Cokesbury United Methodist Church, 2005 Windsor Spring Road; 5:30 p.m. Thursdays, Grovetown City Hall; 9 a.m. Thursdays, Trinity Episcopal Church, North Louisville Street, Harlem.

Coming soon

Next week, we take a closer look at gastrointestinal surgery as an option for overcoming obesity. It's often seen as a last resort for people who've tried everything. For them, weight loss is a life-or-death issue.