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Wednesday, August 17, 2022

Blacks and weight loss: Why so few go under the knife

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Within the last few weeks, Dalelynn Bradshaw-Settle, 28, did something she never thought she would enjoy–hiking.

“Come on, let’s go,” she screamed to her husband below as she made her way on Rattle Snake Trail in Black Mountain, N.C.

From her enthusiasm and physical state, no one would know Bradshaw-Settle sat at just over 300 pounds one year ago. Today she weighs in at about 210 pounds thanks to her recent bariatric lap band surgery.

Why Black Americans aren’t going under

In August of 2013, The American Journal of Gastroenterology released a study titled, “Inpatient Bariatric Surgery Among Eligible Black and White Men and Women in the United States, 1999–2010,” which discovered “a higher percentage of Black than white women and of Black than white men were eligible for bariatric surgery. But a higher proportion of eligible white women and men than Black women and men received bariatric surgery.” The study concluded this may be due in part to differences in insurance coverage for various races.

Dr. Steven Clark, medical director and bariatric surgeon at Community Bariatric Services – South says although African-Americans are eligible for bariatric surgery based on the National Institute of Health guidelines, they aren’t the individuals going under the knife as often. About 80 percent of Community Bariatric Services – South’s patients are women and about 10 percent are African-American. Clark disagrees that insurance is a major barrier for patients.

“The thing I find very odd is, out of all the patient population, Black women suffer the most from obesity,” said Clark. I wonder if it’s (lack of) education, more in terms of people not recognizing that it’s available. Some of it is also cultural and I don’t think it’s as accepted in the Black community as in others.”

Bradshaw-Settle said she knows of African-Americans who have had surgery but refuse to admit it.

“A lot of people are ashamed to say they’ve had surgery,” mentioned Bradshaw-Settle. “I don’t know what there is to be ashamed about but I think it’s because a lot of people believe surgery is the easy way out so we let naysayers persuade our judgment. I’ve had people ask, ‘Oh, you didn’t do it on your own?’”

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), between 2011 and 2013, the number of bariatric surgeries performed in the U.S. grew by nearly 15 percent. In 2011 over 158,000 people received the surgery and in 2013 that number increased to 179,000. Among those procedures in 2011 were sleeve gastrostomy utilized at 42.1 percent followed by gastric bypass at 34.2 percent and gastric band at 14 percent.

“The good news is cases are growing again. The bad news is, this still represents less than 1 percent of the eligible patient population for surgery,” said Dr. Jaime Ponce, immediate past president of the ASMBS.

In the gastric sleeve procedure, about 60 percent of the stomach is removed laparoscopically, leaving behind a sleeve of the stomach. Gastric bypass works by laparoscopically reducing the volume of the stomach. The intestines are rerouted and a small stomach pouch is created by stapling off the main body of the stomach. Gastric banding involves placing a silicone gastric band with an inflatable inner collar around the upper stomach to restrict food intake.

Cultural factors aid in obesity

Bradshaw-Settle, who lost over 100 pounds thanks to lap band surgery, said her family’s eating habits and cultural traditions contributed to her rapid weight gain.

“It’s called ‘eating good.’ My family has big dinners every Sunday and we cook like it’s Thanksgiving year round,” she said. “We eat for any and all occasions with big, hearty meals, then nap.”

Experts say because eating traditions such as these aren’t uncommon in the Black community; this minority group has a high risk for obesity-related health issues. Meals considered “soul food,” which may include starchy vegetables; cornbread and collard greens with bacon fat have contributed to the overall downfall of Black Americans.

The American Diabetes Association finds type 2 diabetes among African-Americans is 1.6 times higher than that of the total U.S. population.

After losing her 34-year-old sister to a sudden aortic aneurysm in January 2014, Bradshaw-Settle became more aggressive with her weight loss plan.

“A mechanic was working on her car when she collapsed right outside of her home. Some of the contributing factors to her death were stress and high blood pressure and because it went untreated, it exploded,” she said. “I had a panic attack after she died and went to the doctor to find out I weighed my heaviest at 302 pounds.”

Paying out of pocket, on March 3, 2014, Bradshaw-Settle began the process to undergo lap band surgery and March 17 was her official surgery date.

The day of surgery she experienced flashbacks of a thinner physique before she gained over 100 pounds in a year and a half due to depression and other factors.

“I started to cry because I’m the mom of two children and I thought back my daughter’s childhood when she would ask, ‘Mommy why are you always so tired?’ or “Why don’t you want to play?”

Clark at Community Bariatric Services – South said those with no prior diabetic health conditions and a body mass index (BMI) over 40 are eligible for bariatric surgery. Those with health conditions should have a BMI over 35 to have surgery. Currently 12.2 percent of African-Americans have a BMI over 40, with over 16 percent being women. Next steps in the process involve in-office appointments to become aware of the types of surgeries offered, a one-on-one with a medical provider to help patients apply for surgery and if approved they move on to an educational component. This step explains foods to avoid and the importance of vitamin supplements. Patients are then given a brief test to ensure their knowledge of the procedure, seen by a doctor to clear them for surgery and then a date is selected.

At the Community Bariatric Services – South facility, over 40 percent of surgeries are sleeve gastrostomy, 34 percent are gastric bypass and lap band procedures fall just under 14 percent. About 75 surgeries occur throughout the year.

Within an hour and a half, Bradshaw-Settle’s procedure was complete and she rested in recovery for a little over an hour. Following she was dressed and taken home the same day.

Regulating the system

Feeling accomplished, Bradshaw-Settle said she was “blessed” to have been approved for the surgery as this was her third attempt. Her first try to go under the knife, doctors said she wasn’t heavy enough and the second time her health insurance wouldn’t approve the procedure.

Clark frequently notices some insurance companies forcing perspective patients to participate in six months of medically-supervised weight loss programs.

“To me it seems as if it’s a way for insurance companies to eliminate people from the process, it’s a barrier in a sense,” said Clark. “Obviously, if you’re put in a structured program and are able to lose the weight, then go ahead, there is no need to have the surgery. I also understand if you’ve tried for three months and haven’t lost any significant weight, what’s going to change in the next three months?”

He continued, “Many studies have shown the six-month time frame hasn’t helped people lose weight, it has resulted in fewer and fewer going through with surgery. On the other hand, to defend insurance companies, not everyone can receive bariatric surgery because you can’t operate on that many people per year. You have to find some way to regulate it.”

Insurance isn’t the only barrier standing between individuals and the average $25,000 surgery. Some experts believe primary care physicians choose not to recommend bariatric surgery for safety reasons. This may be due to reflections on past days when surgeries were extremely unsafe and the risk of death sat at a peak. Today the risk of death is 1-in-500 said Clark.

Being held accountable

Those who are approved and receive the surgery are instructed to visit the doctor every couple of weeks after the procedure but Clark finds 10 to 15 percent of patients relapse.

To stay on track, Bradshaw-Settle visits her doctor often to receive meal plans and nutrition information. She has completely changed her eating habits and exercises at least three times per week.

“(Weight loss) wasn’t instant but after 25 pounds down I took a picture in a pink blazer I like to wear to church and I remember it being so snug on my arms it used to hurt,” she said. “The size 18/20 jacket sleeves could now be rolled up.”

In addition to her clothing fitting looser, she is able to do several activities she always dreamt of doing, such a racing in the field with her children, fastening a seat belt on an airplane, swimming laps around the pool and carrying groceries up to her third-floor apartment from her vehicle.

“I’m proud of a lot of things in my life, but this is one thing I am truly proud of. Yes, there is a band around my stomach to tighten it but I still have to watch what I put in my mouth and exercise,” commented Bradshaw-Settle. “It’s really helped my confidence. Having a husband that loves you obese or where I am now is a great feeling, but when you love yourself, there is nothing better.”

To hear Bradshaw-Settle give her three tips for those wanting to undergo bariatric surgery, visit IndianapolisRecorder.com.

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