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Expanding Care for a Growing Population


Over 78 million adults and nearly 13 million adolescents. These staggering numbers represent the number of Americans who are obese. With these individuals making up nearly one-third of the country’s population, many of whom live here in the Philadelphia area, the need for effective, durable, and safe obesity treatment—like bariatric surgery and other weight management programs—is greater than ever.

Earlier this fall, Philadelphia magazine reminded us that Philadelphia has the second highest rate of obesity among the 10 counties with the nation’s largest cities. The story shared a newer set of maps put together by the nonprofit RTI International that showed spots where obesity is most prevalent—you can’t miss the shaded red areas in parts of Center City and West Philly nor the ones in the suburbs. The numbers are equally as sobering. According to a U.S. Centers for Disease Control and Prevention report, in North Philadelphia, 70 percent of kids are overweight or obese and are more likely to stay that way into adulthood. And in the surrounding counties, adult obesity rates are also high: 23 percent in Chester County; 26 percent in Bucks County; and 27 percent across the river in Burlington County, according to the Robert Wood Johnson Foundation 2015 PA and NJ data.

Battling the epidemic is multi-pronged, but one way to help alleviate the rates is improving access to care.

 “By making information sessions and clinical visits available to patients in the areas surrounding Philadelphia, we’re able to help more of those who are battling obesity,” said Noel Williams, MD, FRCSI, director of the Penn Metabolic and Bariatric Surgery Program. “More than 30 percent of Pennsylvania’s adult population is obese, so the more patients we can get in front of, the more we can help – with bariatric surgery, or any one of our other weight loss and weight management programs.”

George Crowding, 44, of Chester County, is one of those patients. He struggled with weight gain over the years, but was never impressed with results he had seen from others who underwent bariatric surgery. “But last year, at my highest weight, I knew I had to do something about it,” said Crowding.

Crowding first came to Penn Medicine for care at the Abramson Cancer Center in the early 2000’s, and, now cancer free, he continues to get his medical care here.

Having spent years making the drive to Philadelphia, which in traffic can take upwards of two hours, when Crowding was able to make appointments outside the city, he added, “I was really very happy.”

For those dealing with obesity and facing the daunting road of weight loss, many may not even know where to begin, particularly if they are interested in bariatric surgery like Crowding. Understanding whether someone is a candidate is key.

A qualified patient is someone who is more than 100 pounds over their ideal bodyweight or someone who has a Body Mass Index (BMI) greater than 40. BMI is the measure of body fat based on a patient’s weight and height. For example, if a patient is 5’ 9” and weighs 270 pounds their BMI would be almost 40. Though, in some cases, patients with a lower BMI – around 35 – who also have an obesity related condition such as high blood pressure, type-2 diabetes or sleep apnea, can be considered for surgery to help treat their related problems.

Patients also need a documented history of weight management and weight loss attempts with supervised diets and exercise program to show their efforts and to support their need for surgery. And as with any elective procedure, a candidate cannot be have any current drug or alcohol abuse, or  an untreated psychiatric disorder.

Most importantly, bariatric surgery isn’t considered for cosmetic weight loss, or to lose a few pounds before beach season. Rather it’s a surgical therapy for obese patients who have truly tried everything else. Obesity can cause a myriad of other, very serious, health problems, such as heart disease, type-2 diabetes and arthritis. Excess weight impacts the body’s ability to produce insulin and process sugars, which is the main cause of type-2 diabetes. This insulin resistance also impacts the body’s ability to process bad cholesterol in the bloodstream, which builds up in the arteries and can cause a heart attack. And, it has been reported that every one pound of excess weight exerts about four pounds of extra pressure on the knees, which can cause arthritis.

 “I was 443 pounds when my journey first started, so I knew I was definitely a candidate for the surgery, provided everything checked out,” Crowding said.

Patients don’t just meet with the surgeon to discuss the procedure; they also work with dietitians and nurse practitioners to ensure they have all the tools and knowledge to lead a healthy lifestyle, following the surgery.

“Patients are put on an initial weight loss plan designed to encourage behavior and lifestyle modifications prior to surgery,” Williams added. “This helps patients lose weight leading up to the procedure, and makes for a smoother post-operative transition.”

Everyone’s experience is different, but on average, patients experience a 30 percent weight loss in the first 12 to 15 months following surgery, Williams added.

“I’ll actually be coming in at the end of the week to meet with Dr. Williams and Colleen [Tewksbury, MPH, RD, LDN, bariatric surgery program manager]. I had my surgery in March 2015 and I have already hit my target,” Crowding said. “I’m excited to see what’s next and to talk about my plan for keeping the weight off.”

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Views expressed are those of the author or other attributed individual and do not necessarily represent the official opinion of the related Department(s), University of Pennsylvania Health System (Penn Medicine), or the University of Pennsylvania, unless explicitly stated with the authority to do so.

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