Friday, August 14, 2009

Questions for Dr. Edward Hixson:Weight and the North Country

Dr. Hixson is medical director of Adirondack Medical Center’s Bariatric and Weight Loss Program, based in Saranac Lake, which has facilitated loss of 100,000 pounds over the past ten years. The Adirondack Almanack sat down with him to discuss a Centers for Disease Control report that found Northern New Yorkers are heavier than their counterparts elsewhere in the state.

AA: Please tell us about the bariatric/weight program’s history and its goals.

EH: This program was founded in 1999 and is devoted to weight loss, no matter how you do it, surgically or not. We have two thoracic surgeons, a bariatric nurse/nurse practitioner/coordinator, a physicians assistant, plus we have two doctors, David Merkel and myself, who started the program, and we do administrative work and see patients. We also have a nutritionist and we developed a weight-loss program that is potentially as effective as surgery for those who stick with it — one of our previous operating room nurses is running that.

We’ve done it now for ten years and have had over a thousand people have surgery. Our surgical doctors have been responsible for more than a hundred thousand pounds of weight loss.

A year and a half ago we were designated as a Center of Excellence by the Society of Metabolic and Bariatric Surgery, which is the gold standard in the country today.

We are dealing with a chronic disease, treatment for life, and it really demands commitment and a lot of effort. The reward, when you see somebody lose 120 pounds — it’s a big difference. The average weight loss among people who have had the surgery, we found, is 117 pounds. Not everybody reaches their desired weight, but most people become healthier and less susceptible to weight-related diseases like diabetes, high-blood pressure and high cholesterol.

AA: When you founded the program, were you responding to a need in the community?

EH: Yes, Dr. Merkel and I had been talking about it. Weight was becoming a problem. We knew the need. When we became aware that there was a good solution for it, then we felt that it should be available up here, and that of course was surgery. We started with a few patients in 2000, and now we get about a hundred a year.

AA: Are they all North Country residents?

EH: We have a few from Canada, but most are from here. And there’s a basic premise of any critical treatment for weight anywhere, and that is: if you’ve got the problem you need treatment for life, whether it’s medical or surgical. There is no cure. The goal is control. And if you get control you have to make sure you keep control. Our rule from the beginning is follow-up for life.

AA: Were you surprised to see the Centers for Disease Control statistics that North Country residents are on average heavier than those elsewhere in the state?

EH: Well, I knew that, I had preached this ten years ago. The statistics are there. They’re not really new. We know that two-thirds of Americans are overweight, and half of those are morbidly obese. And this has been a problem of increasing magnitude for ten or twenty years. The fastest growing group of those who have a weight problem are children, which is discouraging because very heavy children grow into heavy adults. The other rapidly growing group are the morbidly obese. This is worrisome too because they are the ones with the most severe problems. About 4 percent of the country are morbidly obese; in Franklin County it’s 7 percent— there may be newer numbers than that, but that was a few years ago.

The heaviest state in the country is Mississippi, and the best state in the country as far as weight is Colorado.

AA: I was going to ask, is there something about the rural way of life that encourages weight gain?

EH: No not really. If anything it’s good for you. To a certain extent the rate is related to your population mix; obesity is more a problem among Native Americans, for instance, but really it’s related also to poverty and income level. It’s more of a problem to the people who can least afford to get out of the problem. This is not an affluent area, and I think that’s largely responsible.

AA: Do you see any signs the trend is reversing?

This is getting a lot of publicity. But on the other hand look at the huge amounts of money spent by the food industry on advertising. Then you look at the amount of money that is spent on health in schools or advertising; you are talking thousands-to-one.

The morbidly obese generally live a decade or decade and a half less than their normal-weight counterparts. The problem is getting worse quicker than we are solving it. More people are becoming obese than we are helping.

Shakespeare really hit it right on the nail: “Diseases desperate grown are by desperate appliance oft relieved, or not at all.” And that often applies to obesity. Surgery is often the most effective tool for controlling weight. And that’s why we started the bariatric surgery program.

My goal was, hey, can we do what a major medical center has trouble doing, in a small community hospital out in the woods, and I think we’re the smallest most rural place in the country that has this certification.

[He pulls a framed photograph of a woman on top of Hough Peak off the shelf.] This is one of our patients. She just gave me that the other day. She was morbidly obese, and here she is completing her 46 [High Peaks]. She doesn’t look like she’s unhealthy or heavy, does she?

If there’s a goal, we have a lifestyle up here that’s active physically, and there’s a movement to buy local food. Our environment is great, it’s healthy. If we could go from a 7 percent morbid obesity — one of the highest in the country and the highest in the state — if we could turn that around and be right up there doing better than Colorado, and to do it in a rural area, with very little monetary resource, if we do it on our own, grass-roots work, then that to me is a good goal.

I don’t think we’d do it with everybody having surgery, but if we can change things for the kids, time will change that. You can correlate the weight problem with the kids to the number of hours they spend in front of a computer and a television set. Chances are if you can drag kids away from a computer, there’s something outside they like to do.

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Mary Thill

Mary Thill lives in Saranac Lake and has worked alternately in journalism and Adirondack conservation for three decades.




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