HARRISBURG, PA—Pennsylvanians love good food—and what's not to love in a state brimming with cheesesteaks, soft pretzels, chocolate, and beer? The problem is, we may love these foods just a little too much as indicated by the unsettling local and national trends towards obesity, fast becoming the leading cause of preventable death. That's where the Pennsylvania Medical Society says awareness, vigilance, and sometimes medical intervention can go a long way in saving lives and cutting health care costs. The key is determining which approach is right for you.

Pennsylvania's obesity rate has jumped 49 percent since 1991, with 21 percent of our population afflicted by this health problem. Our love of funnel cakes and shoo-fly pie, perhaps coupled with less active lifestyles, has catapulted us into the top 20 states suffering from obesity, according to the Centers for Disease Control and Prevention (CDC).

As Pennsylvania's obesity rate continues its upward climb, the Medical Society warns that weight-related health problems soon could surpass smoking as the leading cause of preventable death. Nationally, medical care costs associated with obesity already top smoking, a more widely recognized health risk.

According to Crozer-Chester Medical Center bariatric (obesity) specialist and Pennsylvania Medical Society member physician Christopher Hannum, MD, obesity is a major public health concern in the United States. "Almost 300,000 Americans die every year from weight-related health problems," says Dr. Hannum, also on the Board of Directors of the Delaware County Medical Society. "Only smoking causes more preventable deaths. And, if the current trend continues, obesity soon will be number one."

The CDC estimates that more than 44 million Americans are now obese. Approximately 6 million of those are considered morbidly obese, which is generally defined as being 100 pounds over ideal weight or as having a body mass index (BMI) greater than 40. (Note: BMI is a popular tool for defining an individual's degree of obesity. It is calculated based on the individual's weight and height. A BMI of 30 or more is considered obese.)

If left untreated, obesity could lead to a number of related health problems. "Obese patients are at high risk for certain cancers, including breast, colon, prostate, esophagus, uterus, and stomach," cautions Dr. Hannum. "Additionally, high blood pressure, heart disease, diabetes, respiratory problems, sleep apnea, and acid reflux can be attributed to a patient's weight."

A recent study published in the health policy journal Health Affairs found that spending on hospital and outpatient care is 36 percent higher and medication costs are 77 percent higher for obese people than for people in a normal weight range. Comparatively, the study also found that health care service costs are 21 percent higher and drug costs are 28 percent higher for smokers than for nonsmokers.

University of Pittsburgh Medical Center-Shadyside's director of bariatric surgery Anita Courcoulas, MD, a Pennsylvania Medical Society member physician, attributes the increasing obesity rate to generational changes in dietary and exercise habits.

"Our culture focuses less on physical activity than in the past. And, with today's increased food portions, the calories we ingest are not proportionate with the calories we expend," explains Dr. Courcoulas. "In addition, liquid calories play an increasing role in the escalating number of obese patients. People should drink more water and fewer sodas and sugared fruit drinks."

The Medical Society advises individuals to work with their physicians as they consider options for maintaining and/or losing weight. People likely will see significant improvement in their health after losing only 5 to 10 percent of their weight. Most people will benefit from one or several of the following weight control methods:

• Diet modification and nutrition. Healthy eating can help reduce body weight, high blood pressure, and high cholesterol.
• Increased exercise. Just a little exercise can make a difference. For example, taking vigorous 10-minute walks twice a day will help burn calories.
• Changed eating behavior. Lifestyle changes (such as addressing stress-related eating), family meal planning, and controlling snacking can help an individual lose unwanted pounds.
• Doctor-approved medication. Physicians may prescribe medications that either suppress appetite or absorb fat.

Another, more drastic, option is gastric bypass surgery, which is proving successful in helping morbidly obese individuals control their weight. Garnering significant media attention as a result of surgery performed on the likes of television weatherman Al Roker and pop singer Carnie Wilson, this procedure was tried by approximately 60,000 Americans last year.

"The surgery involves sealing off the upper portion of the stomach, leaving only a pouch the size of a hard-boiled egg, and bypassing a portion of the small intestine," says Dr. Courcoulas. "As a result, the patient becomes full more quickly and absorbs less of what is eaten."

The majority of gastric bypass patients lose 60 to 80 percent excess body weight within the first two years and maintain 50 to 65 percent weight loss more than five years after surgery. However, the operation has its risks, which must be considered before deciding on such a drastic treatment. Side effects can include bleeding, pneumonia, infection, and vomiting due to over-eating. Also, a blood clot may travel to a patient's lung, causing a pulmonary embolism, and possibly death, though this is rare, occurring in just one-half of one percent of cases.

Whichever course of action chosen to lose weight, the Pennsylvania Medical Society reminds patients to work with their physicians in order to maintain overall good health. As Dr. Courcoulas says, "Trends, such as the upswing in obesity, are social markers indicating a cultural change. At times like this, doctors and patients should work together to avoid negative medical consequences and achieve healthy outcomes."