AOPA Pilot Magazine - December 2013 - 26

FLY WELL

Fifty weighs to lose
your blubber

BY DR. JONATHAN M. SACKIER

Stop wasting 100LL on your weight

DR. JONATHAN SACKIER

is a private pilot
and British-born
surgeon living in
Virginia.

WEIRD AL YANKOVIC PARODIED two Michael Jackson
songs; Beat It became Eat It, celebrating copious consumption, while Bad morphed into Fat, mirroring what
is happening in America-our mutation into a fat nation.
Many obese people, while acknowledging their
size, deny being unhealthy; this is delusional. Obesity
among the young will ensure the next generation has
a shorter lifespan than their parents for the first time
ever. Carrying excess weight causes heart, lung, brain,
joint, skin, and other diseases; predisposes to cancer and social isolation; and wastefully burns 100LL
to ship unnecessary freight. Pounds pack on through
poor eating and exercise behaviors. Periodic dieting
does not work; without fundamental behavioral change,
slimming down inevitably is followed by expanding waistlines-the "rhythm method of girth control."
With commitment to change, physician supervision,
and certain medications, a svelte you can be attained
by acknowledging the problem and a desire to address it.
As a surgeon, I am pleased to report that there are
options, especially for those with morbid obesity. Obesity
means there is so much of a person that his premature
death is inevitable. One calculates body mass index (BMI)
by dividing body mass (weight) in kilograms by height in
meters squared. Ideal BMI is between 18 and 25; overweight is 25 to 30; obese 30 to 35; above 35 is severe
obesity; and above 40 is morbid obesity. If one cannot
lose weight with a physician-supervised program, most
insurance companies cover surgical approaches when
BMI is above 40 or when obesity-induced physical problems-co-morbidities-have developed.
If you are interested in pursuing a surgical solution,
choose a surgeon experienced in bariatric discipline, like
Dr. Shawn Garber who many moons ago was one of my
trainees. He told me, "Our field is constantly evolving
and has moved from major operations with large incisions down the center of the belly, to minimally invasive
laparoscopic procedures ensuring swifter recovery. Now,
through one tiny incision, we insert a video-equipped telescope providing a view of the inside of the belly, and three
to four other little cuts allow us to insert grasping, cutting,
stapling, and suturing instruments." Talk to prior patients;
many doctors either host or encourage support groups.
You would not add new avionics to your airplane
without doing thorough research, so do not rearrange

26 | AOPA PILOT December 2013

your insides until you know the skinny; operative
choices abound and most can be performed under laparoscopic guidance, so get well-informed.
A relatively easy option is an adjustable, inflatable
band placed around the top of the stomach, thereby promoting earlier satiety. This works for some people and
is also used with lower-BMI patients to treat diabetes.
Gastric stapling and Roux-en-Y bypass, a widely-practiced operation, partitions the stomach into a small
pouch and bypasses some small bowel. In good hands,
weight loss can be dramatic, but postoperative complications merit consideration. Sleeve gastrectomy limits
how much one can eat and carries good results.
Other operations are occasionally offered and two
fairly recent developments merit mention. Singleincision laparoscopic surgery (SILS) is becoming more
widespread; through one small cut inside the umbilicus, doctors place telescope and surgical devices into
the abdomen, reducing pain, improving cosmesis, and
delighting patients and surgeons alike. Some surgeons
use robotic assistance to perform these operations,
allowing for very precise procedures with three-dimensional vision. Another new approach undergoing clinical
trial evaluation places an inflatable balloon inside the
stomach to limit the desire to eat. Although this was
tried long ago with limited success, time will tell if the
new generation of balloons is better. Additionally, a
number of impermeable liners have been developed-
placed via the mouth with a flexible endoscope, they
allow food to pass but prevent absorption. Early results
promise weight loss and reduced severity of diabetes,
which frequently accompanies obesity.
New technology also allows specialists like Dr.
Garber to revise prior operations by adjusting the rearranged anatomy via flexible endoscopes. So many new
inventions reflect the impact that obesity is having on
our country-companies are investing in finding solutions because so many people are so heavy.
I am reminded of Paul Simon's iconic song Fifty
Ways to Leave Your Lover. If you are unhappy with
your body mass, do some research and talk to your
doctor-because there really are fifty weighs to lose
your blubber.
AOPA
EMAIL jonathan.sackier@aopa.org

AOPA Pilot Magazine - December 2013

Table of Contents for the Digital Edition of AOPA Pilot Magazine - December 2013