Dr. Mitchell Roslin is chief of obesity surgery at Lenox Hill Hospital in New York. He holds several patents for the treatment of obesity and designed a method for treating relapse after gastric bypass surgery. Roslin has expertise in laparoscopic obesity surgery, duodenal switch surgery and revisional bariatric surgery. He contributed this article to LiveScience’s Expert Voices: Op-Ed & Insights.
Recently, while driving to work, I heard a very sad story: Boy Scouts who were morbidly obese would be excluded from this year’s National Scout Jamboree, an event that occurs every four years and is considered a highlight for young scouts. Additionally, scouts with lower levels of obesity had to provide medical clearance before being allowed to participate.
But this story isn’t just sad because of the discrimination. Of course, I have empathy and compassion and hate to see any child excluded or hurt. But I understand that safety has to come first, and exclusions based on health are a sad reality. For example, the branches of the armed forces will not allow recruits who are overweight. But what I found so sad was that this problem has become so widespread that there had to be a policy to address it.
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American kids are rapidly becoming unhealthy. The impact will be devastating. Soon, there will be fewer eligible recruits to serve in the U.S. military. I’m concerned that more young people who have never worked will go on permanent disability for chronic diseases such as diabetes.
Several weeks ago, the American Medical Association (AMA) designated obesity as a disease. Some people questioned the decision, calling it financially motivated. For example, in an editorial in the Boston Globe, Alex Beam commented that “heredity, germs and viruses cause disease, not eating too much.” Really? I guess lung cancer is not a disease, as it often comes from smoking. What about heart disease? Aren’t cholesterol, hypertension, diabetes and smoking most responsible? Doesn’t what people eat cause or affect the risk of developing these conditions? A person’s behavior has an impact on every disease process, as do congenital conditions. Obesity and metabolic syndrome are related to heart disease, cancer, sexual dysfunction and early mortality.
Beam wrote, “What is this really about? Money.” He went on to say that the obesity epidemic was a conspiracy to get coverage for emerging pharmaceuticals and bariatric surgery.
My question to Beam and others is this: What were parents supposed to do if their son were one of the fat scouts excluded? After all, one of the reasons they enrolled their child in the Boy Scouts in the first place was to help make him more active and improve his self esteem. Now, he can’t even participate in the organization’s biggest event.
Some people think these young children want to be fat, or that they want to be excluded. No idea could be more absurd. What does Beam suggest? Enrolling the child in a weight-loss camp or a contest like “The Biggest Loser”? Unfortunately, that strategy is completely ineffective — virtually all the weight lost as a result of such activities is regained in a short period.
A better suggestion may be to see a pediatric endocrinologist, such as renowned doctors Dr. Robert Lustig and Dr. David Ludwig. Unfortunately, there are very few specialists with real expertise in pediatric weight loss — in my opinion, because there has been limited reimbursement from health-insurance providers. Because obesity hadn’t been considered a disease until recently, there are few training programs and limited opportunities for those hoping to specialize in pediatric obesity.
Though considered dubious by Beam, bariatric surgery is one of the few effective tools against obesity that doctors currently have. In the past year, I have had to operate on multiple teens who left school after being bullied and taunted. This is not about the money. It is about giving children a chance to be happy, and providing them with an opportunity to do things that I took for granted when I was their age.
Why should new or better tools be developed to address this problem if there is no health-insurance coverage for obesity-related issues? Beam feels everything has been “medicalized,” but shouldn’t we be searching for solutions for these young scouts? Certainly, the solution is not providing commercially marketed diets. Exercise reduces the risk of obesity, but it is not an effective weight-loss modality when children are already obese.
Of course, surgery isn’t the solution for everyone. The United States needs a national strategy to prevent obesity and metabolic syndrome. It will not be popular, but it is becoming necessary. The sadness of this story cannot be underestimated. Too many young children are now too heavy to be Boy Scouts or serve in the U.S. military. This trend must be stopped, and there needs to be treatment available for the children who have already been afflicted. I wonder what Beam’s suggestion is? Furthermore, I wonder what he thinks will happen if we do not help these children.
Roslin’s most recent Op-Ed was, ‘Yes, Obesity Is a Disease.’ The views expressed are those of the author and do not necessarily reflect the views of the publisher. This article was originally published on LiveScience.com.
