Medical Daily had the chance to talk to Dr. John Morton, Director of both Bariatric Surgery and Surgical Quality at Stanford Hospital and Clinics and has performed over 1,500 bariatric surgeries. He is also Associate Professor of Surgery at Stanford University, serving as Section Chief of Minimally Invasive Surgery. Dr. Morton weighed in on the proposed soda ban in New York as well as obesity in America. 

What is your take on the proposed soda ban in New York City?

Dr. Morton: I think what's going on with the soda ban in New York is the recognition that obesity is a very severe public health crisis; it's probably our leading health problem. We have roughly 60 million in this country who are obese and that number's only going to grow over time. We haven't had much luck with over prevention methods and I think the soda ban is a reasonable approach for a variety of reasons.

One, if you want to look at foods that are not good for you, the one that really stands out are sodas. They really have no nutritive value and they are directly correlated with increases in weight and increases in cholesterol and resulting in increased rates of cardiac death. So, all of those are reasons to approach the soda ban to start and I think the actual ban is actually a very reasonable compromise.

If you want to have more soda, there's 16 ounces which is the amount that's allowed, you can always get more and then you'll get up and walk and move a little bit. But it shows there is a clear and present danger in obesity and I think it's recognition by the mayor that you have to do something. If we don't do something, we are all going to pay for it. Not only in the sense that we are going to get heavier but in the sense that we are going to have increased healthcare bills and that's something we all pay for, not just obese patients but all of us who pay taxes.

"It seems like diet sodas are a way of paying off your food sins, if you will, it makes you feel better but probably didn't accomplish much."

 

Do you think the soda ban will happen across America or in just select cities?

Dr. Morton: I think for now it's going to be pockets of major cities. New York has led the way, quite frankly, on having public health prevention measures. They were the ones who started out by requiring restaurants to label foods with calorie counts; they were also the first ones to banning smoking in restaurants. So they've really kind of led the way here. I do envision the soda ban to different cities.

My hope and desire is that soda companies wake up and see what's going on here and make efforts to limit the portions that are associated with sodas. Part of the problem is right now, sodas are extremely cheap and so the way they demonstrate value to the consumer is by just giving more of them. Sodas should be considered a treat not a daily sort of food intake and even the diet sodas are not really healthy for you either.

Diet sodas are lacking nutrients that are inside of them, they also fool your sense of satiety. When you consume a soda that is made with artificial sweetener, your body is simply not full. You may believe you are cutting back on calories but there are studies that show that when you consume a lot of diet sodas you make up for it by eating other foods.

I think you see that every day, right? You go into a McDonald's and you see somebody order a Big Mac and fries and then get a diet coke. You have this belief like in the old days like papal indulgences. In the old days you could just kind of just pay off your sins. It seems like diet sodas are a way of paying off your food sins, if you will, it makes you feel better but probably didn't accomplish much.

Might there any consequences to the soda ban? Would people choose different food?

Dr. Morton: I don't think there will be any unintended consequences to the soda ban. Just because people can't have more soda, I don't think they are necessarily going to end up making it up in other directions. Again, if you are looking for "bad foods," anything in moderation is okay; it's getting down to portions. And again, the exception to this are sodas, there is just no real nutritive value to them at all and I think it's one place we can very closely tie consumption of this particular food item to increased health risk. It's a very, very clear relationship.

With increased rates of obese Americans, what procedures are available to the morbidly obese?

Dr. Morton: I think there are different approaches to the obesity crisis, prevention is obviously one of them, but prevention takes time. It will take about 18 or 20 years before you see a difference, so what do you do for people that have problems now? You have to treat them and right now for people who are very obese, with Body Mass Index's over 35, there are options and there are surgical options primarily. Surgery is a very potent tool in the right patients and in the right hands and anybody seeking bariatric surgery should go to accredited centers where they have the expertise to deal with them.

With that being said, there are options for those patients and in the realm of surgery, is very safe and very effective. There are things like gastric banding, sleeve gastrectomy and probably the most common of them all is gastric bypass. All of those work very well for patients with appropriate education, selection and treatment.

Recent studies have associated gastric surgeries with an increased risk of alcohol abuse, what is the reason for this?

Dr. Morton: I actually wrote the first study showing that after gastric bypass surgery your metabolism of alcohol changes. In other words, you become a lot more sensitive to the effects of alcohol. So it is possible that after surgery, patients are unaware of that increased sensitivity and overindulge. I think it points out the need for education around consumption of alcohol after surgery. There are two components to it, one is to be careful with it and two - there are calories in alcohol, empty calories that don't give you a lot of nutrition.

With the recent study that came out is interesting in that they found the strongest predictor of who was going to have an alcohol problem after surgery were those who had an alcohol problem before surgery. It points out the need for patient selection and patient candor, in being very open and straight-forward in relating what issues they have so we can help those patients afterward.

Again, this does not detract from all of the benefits of gastric bypass surgery and other bariatric surgeries do, it just allows us to be more thoughtful about our pre-operative education and post-operative care.

"We don't have a national weigh-in day, and make people aware of "you're this height and that's your weight, you're doing well or you're not doing well" but we have to raise awareness about the health risks of carrying extra weight, no question about it."

 

Do patients who have bariatric surgeries, regain weight after surgery?

Dr. Morton: Obesity is a chronic disease and even though you have a very powerful tool in surgery, there is potential for weight regain, it's probably in the order of five to 10 percent and there are a variety of reasons why people regain weight but most of them are not following the rules after surgery. In other words, they forget to keep their portion sizes small, or they snack too frequently, or they consume high calorie liquid foods. Liquids will go right through so there is nothing you can do to help prevent that, so they have to be careful with it. Stress, people will go back to bad habits when they get stressed.

What it points out is that it's just like any other medical therapy, correct? No therapy is 100 percent foolproof, if you have cancer and get chemotherapy or surgery, there is no guarantee it will be 100 percent effective. What it calls for is vigilance, surveillance and dedication to taking care of those patients long-term.

What about people who are in flux or are trying to live healthier? The recent Centers for Disease Control and Prevention report showed that more Americans are exercising. What could Americans do to help curb obesity?

Dr. Morton: I think the physical activity increase is great, it is a start, but we have to work on the diet side of things even more so. You have to do a lot of exercise to burn a pound; you have to burn 3,500 calories. So if you are on the elliptical and doing great, you might burn 300 calories and that is nowhere near enough to keep weight down. The best place people are going to make a difference is when it comes to their diet and even a little bit of change will make a big difference.

For example, if you consume an extra 150 calories a day you will gain 10 pounds. So the opposite of that is if you can curb your calorie intake by a very modest amount, anywhere from 100 to 300 calories, you can have substantial weight loss by the end of the year.

One thing I would like to see happen is we've done okay when it comes to decreasing smoking and one of the interventions they have for smoking is awareness days, like a national smoke out day where everyone gives up smoking. We don't have a national weigh-in day, and make people aware of "you're this height and that's your weight, you're doing well or you're not doing well" but we have to raise awareness about the health risks of carrying extra weight, no question about it. If we don't, we'll have a big toll to pay down the road.

In regards to weight, and in particular BMI, how accurate is that measurement for obesity?

Dr. Morton: BMI is actually a pretty good measure people and obesity. There are questions out that like "Can you be fat and fit?" and I'll say it is rare. If your BMI is over 35, the likelihood of you being in good physical condition is low. I think the comment of "fat and fit" is more of a myth than a reality.

What role has the internet played in raising awareness of obesity or promoting weight gain?

Dr. Morton: I think the internet's obviously been a culprit when it comes to weight gain. People are in front of the computer way too much, they are not up and about doing things. The information is fantastic but the ability to act on it would be better. I would much rather see people going out for a walk than being in front of a computer looking up different obesity treatments or prevention strategies.