Feature article on weight loss
By: Dawn Mulkern, MBA, RD, LD
Baptist Health, Patient Educator, Health Management Center
MD Issues Challenge to RD's: 
"Put Me Out of Business"
Who is this physician and why would he ask us to put him out of business?
First the Who: John W. Baker, M.D., F.A.C.S. is Co-Director of the Bariatric Surgery BAPTIST HEALTH, Medical Director of the BAPTIST HEALTH Weight Loss Program, and Secretary-Treasurer, American Society for Metabolic and Bariatric Surgery ASMBS.
And now the Why: Because he cares tremendously about helping overweight and obese people achieve better health. And because in his own words, "I would like to pose a challenge to the dietitians. WE have failed to better educate the residents of our state and our nation about the problems with obesity. WE need solutions to the Obesity Epidemic such that I go out of business."
Huh? This is not what you'd expect a doctor to say, right? However Dr. Baker is not your usual doctor -- he is exceptionally devoted to helping his patients. And part of that started when he was a boy in Louisiana.
Dr. Baker had a friend growing up who gained more and more weight as they went through school together. There was no help for his friend and he did not get better. No matter what he did, he could not lose weight and improve his health. Before age 40 his friend would be dead of obesity-related disease.
His friend's early death affected Dr. Baker profoundly. He saw how excess weight could kill. And he has made it his mission to help obese people help themselves. One way he does this is employ a full-time RD to work with his patients both before and after surgery. Another way is through the BAPTIST HEALTH Weight Loss Program, a rapid weight loss meal replacement program where he is Medical Director. And yet another method is through bariatric surgery.
Local RD Dawn Mulkern works with Dr. Baker in the BAPTIST HEALTH Weight Loss Program and recently interviewed him about weight loss, including his thoughts on the new OTC weight loss drug Alli.
Q - What are the characteristics of your most successful weight loss patients, both in bariatric surgery and BH Weight Loss Program?
A - Successful patients have learned to change their lifestyle. They have learned to incorporate an exercise program into their daily routines. They get sufficient sleep. They learn to take care of themselves first. They have learned how to EAT TO LIVE, not live to eat.
Q - What holds people back from losing weight?
A - There are a multitude of factors. They may be cultural, environmental, and societal. For example, a patient who successfully loses forty to fifty percent of their excess weight in the first six months after a gastric bypass may encounter sabotage from family or friends. Another example would be the patient who “hides” behind their weight. They may have a disturbed self image or low self esteem. It’s important to teach them they can say “thank you” when someone pays them a compliment. Counseling for changes in self image or dealing with past emotional trauma is an important adjunct to care for some patients.
Q - What are some of the medical conditions that can be improved when someone loses weight?
A - The most significant impact we can have is on the reversal of diabetes mellitus with surgery. Twenty percent of patients who have a gastric bypass or duodenal switch will go home from the hospital off of their medication with normal blood sugars. In fact, an international Diabetes Surgery Summit was held in Rome in March of 2007. The consensus statement will propose a significant change in treatment of diabetes especially in patients with a BMI greater than 35. Other chronic diseases that can be corrected or their side effects improved include obstructive sleep apnea, hypertension, urinary stress incontinence, infertility, psuedotumor cerebri, dyslipidemias, and intertriginous dermatitis to name a few. What’s more significant is the reduction in cost of care and improvement in survival long term after surgery. Several studies have shown a reduction in cardiac complications in patients who have undergone weight loss surgery.
Q - What is your opinion on Alli, the new OTC weight loss drug? Do you think it will help people lose weight on their own? If not, why not?
A - I don’t think consumers will be returning to the stores to purchase this after they encounter the side effects for the first time. The package insert recommends that patients reduce their fat intake to 15 grams daily in order to reduce the soilage and other unpleasant side effects that will occur with the fat malabsorption. I have not seen information regarding potential fat soluble vitamin deficiencies with long term use.
Q - Are there any weight loss drugs that you believe are effective?
A - They are tools just as the surgery and medically supervised diets are. Medications alone do not offer long term sustained weight loss.
Q - Should people always start out with an RD or weight loss class before getting bariatric surgery? Why? 
A - I think it is important for patients to meet with a dietitian to assess for potential problem areas in their diet. We also need to adjust for cultural influences and regional influences on food purchasing and preparation. Additional instruction on purchasing and preparing low calorie dense foods is important. It’s sad that $1 will purchase 2500 calories of pasta yet 3.4 calories of raspberries. I incorporate an eating disorder inventory as part of information gathering that is obtained about each patient.
Q - Explain about the "me" concept you've taught in class several times. What does taking care of "me" have to do with getting to a healthy weight?
A - Most of us have been taught to take care of others at the expense of ourselves. Individuals can be better stewards with their time if they take care of themselves. We need to take out time in our busy schedules for ourselves.
Q - Some sources use < 28 as a healthy BMI for women, not < 25. What are your thoughts on this?
A - Why allow for bracket creep? Actually there may be some chronic diseases that demonstrate better survival with some degree of being overweight. I don’t have the reference readily available, but I read this in the past week (June 25, 2007)
Q - Anything else you'd like people to know about weight loss options, etc?
A - I would like to pose a challenge to the dietitians. WE have failed to better educate the residents of our state and our nation about the problems with obesity. WE need solutions to the Obesity Epidemic such that I go out of business.