Take this quiz.
Imagine you are obese. For a chunk of the population, that is not much of a stretch. Your physician has warned you of the perils: every extra pound raises your risks of heart disease, diabetes, arthritis and some kinds of cancers.
Cowed by the statistics, you decide to lose weight. How? Choose one answer:
* You slash your caloric intake to subsistence, substituting fruits and vegetables for the large quantities of sugary carbohydrates you used to gulp
down.
* You jog, cycle, swim, power-walk. You join a gym, working out on Marquis de Sade machines. You substitute hours of physical activity for hours of sedentary spectatorhood.
* You undergo bariatric surgery, where surgeons staple your stomach into a shot glass-sized receptacle. Physically unable to eat vast quantities of anything, you spend the rest of your life munching on tiny portions.
Which do you choose?
Astoundingly, an increasing number of Americans are opting for surgery. In 1998, 13,386 Americans went under the knife to lose pounds; in 2004, 121,055 did – a nine-fold increase. Patients stayed an average of 3 days in the hospital and cost their insurers an average of $10,000.
The risk of dying from the procedure, which requires general anesthesia, has dropped from 0.89 percent to 0.19 percent.
Yet this is no simple panacea. Patients are at risk for vitamin deficiencies (food doesn't just make us fat – it gives us nutrients), flabby pouches of skin (calling for cosmetic surgery), and rehospitalizations. On the plus side, patients may be quickly freed from type 2 diabetes, joint pain, sleep apnea and cardiovascular problems. On the negative side, patients can no longer take joy in eating. And of course, for long-term success, patients still must modify their lifestyles to eat healthier foods and exercise regularly.
The intriguing question is: Why the popularity of an inpatient operation, one that may keep a patient out of work for up to six weeks – and one with little data on long-term effects? Diet and exercise have no calamitous side-effects, cost little, nor keep a person out of work.
For severely obese patients who have tried diet and exercise, the surgery is the last resort. Yet the soaring statistics suggest that more people are embracing it not as the last resort, but as the best resort. Why?
One plausible explanation points to an avaricious industry. Federal researche-rs calculated the total cost last year of bariatric surgeries at $1.26 billion, up from $147 million in 1998. For most patients, insurers pay.
Yet it is too tempting to blame an industry. Perhaps clever advertising can convince consumers to buy high-definition televisions, but the patients who sign up for this surgery sign "informed consent" papers that spell out the risks.
As Cassius told Brutus, "the fault … is not in our stars, but in ourselves."
Judging by the populace's expanding girth, few people are avidly dieting and exercising. The reason: They don't want to. Call it the self-denial-is-not-fun theory. Carrots don't taste as yummy as chocolate mousse, and it is hard to give up the latter for the former.
It is equally hard to forego watching the home team play its penultimate game for an afternoon jogging. Surgery offers an easy way out: You can lose the fat quickly, without going through the rigors of a strict regimen.
Dieting and exercise generally work. But they take time, and require lifestyle changes. We are a populace unaccustomed to sacrifice. And now it seems we want to slim down without stepping on a treadmill or giving up doughnuts.
Joan Retsinas is the managing editor of Medicine & Health/Rhode Island, a monthly journal of the Rhode Island Medical Society.
