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Surgical Options

An increasingly common treatment for severe obesity is bariatric surgery, such as "stomach stapling" in which the size of the stomach is surgically reduced. It's gotten a high profile as some obese celebrities and public figures have undergone the procedure with dramatic results. It's even becoming more common among teenagers. While bariatric surgery is necessary and life-saving in some cases, is it a reasonable treatment for obesity in America?

"Surgery is an effective last resort," says Dietz, "and many people are so obese, with a body mass index over 40, that they're at the last resort stage."

However, if obesity continues to worsen, so many people will require surgery that it will become impossible to operate on all of them. "It's difficult for me to see how we'll be able or willing to perform surgery on 100 million Americans," says Hill. Instead, the only real answer is in preventing people from getting to the point of surgery in the first place.

The Problems With Prevention

As with other public health campaigns, such as the efforts to get people to stop smoking or to practice safe sex, results of the campaign against obesity will come gradually. But Dietz sees reason for hope.

"I think that in the last three years, we've seen a dramatic shift in the attitudes of policy makers toward obesity," Dietz tells WebMD. "There is now a huge amount of attention being paid to the condition," he says, and that's an important first step.

But analogies to other public health efforts can only go so far, and obesity looks to be a difficult opponent. "Personally, I think that obesity may be the toughest social issue that we have ever faced," says Hill, "even more so than smoking."

Part of the problem is that the message about eating well is necessarily more complicated than the messages of other health campaigns. The recommendations for preventing tobacco-related illnesses are pretty straightforward: Don't smoke. But given that "don't eat" is not an option, there isn't such a concise recommendation for eating well and staying fit. It's more like, "Eat plenty of these, and not so much of that or those, and remember to exercise a lot."

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