|
EATING disorders and obesity have become so prevalent that they have
given rise to new medical specialties and procedures.
Anorexia nervosa was first identified in 1874 by
Sir William Gull, a British physician, but the term entered common
speech only in 1970, according to the Oxford English Dictionary
(1993). The antonym, bulimia nervosa, gained currency at about the
same time when many people were obsessed with their diet and body
shapes.
The World Health Organization (WHO) tells us
that today obesity is “epidemic” due mainly to bad nutrition and
a sedentary way of life.
On Oct. 31, 2008, the Philippine Supreme Court
released its decision on a 20-year-old case on obesity.
The high court upheld the ruling of a lower
court that the latter’s decision on the termination of the
contract of employment by Philippine Airlines (PAL) against an
overweight flight steward was just and correct.
Armand Yrasegi argued that his being fat was a
“sickness and a physical abnormality” that were beyond his
control. The courts found that Yrasegi “ignored” PAL’s
suggestions to “trim down” as a steward’s “ideal” weight
for a person of his size was 75.30 kgs. He weighed, at the time of
the suit, 98.42 kgs. He was too big for the narrow passages of an
airplane.
Much has been written about anorexia, bulimia
and obesity in the popular press but relatively little about
surgical interventions to suppress the desire for and intake of
food. These are admittedly extreme measures; in the case of the
morbidly obese they work better than diet, exercise and drugs.
For the morbidly obese—meaning people whose
body mass index (BMI) is at least 40—bariatric surgery is probably
the better way. However, even the merely overweight (BMI25) are
beginning to consider elective surgery to bring down their weight.
Bariatric surgery is invasive.
The most common procedures are gastric bypass or
gastric banding.
Gastric bypass involves shrinking the stomach
either by cutting off or stapling a portion of it and rearranging
the intestines.
In gastric banding a loop is inserted around the
top of the stomach which is then tightened to form a small pouch.
The purpose of both procedures is to reduce the
stomach’s capacity for food.
The risk of dying from bariatric surgery is
small although it could cause hernias and leaks in the digestive
tract.
However the risk is still too high for many
morbidly obese persons.
For this reason, a non-invasive procedure is
being tested.
A natural opening, rather than cutting open the
abdominal wall, is used to get at the stomach.
Such a technique has been successfully used to
remove the appendix through the mouth or the gall bladder through
the vagina.
Over the past three years, about a hundred
persons in Mexico and Europe have undergone this experimental
procedure (The New York Times, October 23, 2008). It’s called
Toga, the acronym for transoral gastroplasty. The subjects were
reported to have lost an average of 40 percent by their excess
weight.
Toga is neither simple nor painless. The patient
is given general anesthesia. Then the surgeon pushes a dilator down
his throat. A 60-centimeter long tube containing staples is inserted
into the distended esophagus while the subject’s stomach is
inflated with CO2 to create space to work in. When the tube is in
place (as shown by a camera) the staples are attached with a
mechanical tool to prese-lected spots in the stomach.
For several months after surgery, the patient is
on a liquid diet. It could take a whole year before the patient’s
body adjusts to this type of nutrition.
Is Toga safe and effective?
It will take many years of clinical trials to
answer this question. Furthermore, the staples have not yet been
approved by the US Food and Drug Administration (FDA).
In the meantime, the invasive procedures are
available at select hospitals for those who might need them.
This is my last column until the first Sunday of
2009.
Happy holidays to one and all!
opinion@manilatimes.net
|
