Dr. Alan Wittgrove performed the world’s first laparoscopic gastric bypass in 1993. He established the Wittgrove Bariatric Center at Scripps Memorial Hospital in La Jolla.

San Diego is dropping points while residents gain pounds. America’s Finest City was once the nation’s fittest community, but as residents packed on weight, the 2004 ranking dropped to No. 14, a new low. For local businesses, this trend could be costly on many levels.

The Centers for Disease Control reports obesity increased by more than 50 percent in adults and 100 percent among children and adolescents in the past 15 years. More than 44 million Americans are considered obese and many more are overweight. (To be classified as obese, a person must be at least 30 percent overweight.)

As obesity rises so does the number of people with diabetes, heart disease and cancer. In California, about 2 million people have diabetes, and in the United States one out of every three children will develop diabetes as a result of excess weight. The best prevention and treatment for diabetes is weight loss, moderate exercise and proper meal planning.

Behavior and personality traits are not the primary reasons for obesity, says Dr. Ken Fujioka, medical director for the Scripps Clinic Center for Weight Management. Fujioka, who has studied nutrition and metabolism for 20 years, says race and genetics play a big factor.

“Some people really do have the genetics to gain weight easier or to use calories more efficiently,” says Fujioka. Humans evolved from a harsh environment that required exertion. Not only is it no longer necessary to hunt or forage for food, but with online grocery shopping and home delivery, it’s not even necessary to walk down grocery aisles.

Adult obesity is doubling about every 25 years. For children, that number triples. “Our environment is not good for kids,” Fujioka says. “They don’t have great food choices. Many families eat fast food or eat out at least once every other day, and some families every day. If you look at the portion size and fat content of the meals, it is clear that when you go out and eat, you eat more than you would normally and you eat more calories. At home we do better, we make fairly good choices.”

Conventional wisdom says San Diego is more health conscious than other places, “but we’re not always putting our efforts in the right direction,” Fujioka says. A recent survey indicates that more than half of San Diego’s residents are taking some sort of supplement with no proven ability to promote weight loss. An estimated $40 billion a year is spent on weight loss approaches. This includes nutritional supplements, weight-loss programs, exercise equipment or gym memberships.

No pill or quick fix exists for obesity. And San Diego’s car-dependent culture does not promote exercise. Fujioka is a fan of San Diego’s resurgent Downtown. “You can walk to the ballpark, stores, restaurants, things of that nature. So that is going to help.”

Working Toward Being Overweight

Dr. Ken Fujioka is medical director for the Scripps Clinic Center for Weight Management. ‘Some people really do have the genetics to gain weight easier or to use calories more efficiently,’ says Fujioka, who has studied nutrition and metabolism for 20 years.

Many San Diegans work so many hours they don’t have time to exercise. Instead of doing physical labor, they spend their days in front of a computer screen. Fascinating researchers, Fujioka says, is a phenomenon called “grab stations.” High-tech companies get their employees to work longer hours by providing them with snacks. “They make food available so workers can go to these stations where they find brownies, pastries, chips — salty, snacky things — and they will eat those during the day,” Fujioka says. “Then at lunchtime they realize they’ve eaten all this stuff and forego lunch and work through it.”

Also more prevalent are meetings that offer lunch but don’t present enough healthy choices for a meal. To keep employees after hours, these companies may provide fast food meals with a high fat content and greater portions. Fat doesn’t signal the brain the body had enough to eat, and it’s easy to keep eating later into the day. Protein is best for telling the brain the body is fulfilled. A better choice for a working meal is a salad with grilled chicken and low-fat dressing. “We work too many hours and our food choices aren’t great,” Fujioka says. “It’s a slow death.”

Medical Assistance In Weight Loss

Promoting healthy living, San Diego hospitals stress nutrition and physical activity. At Scripps Hospital, registered dietitians work individually with patients on meal planning and exercise programs. An obese person with diabetes may be prescribed a regimented diet that includes meal replacement. “Humans don’t do well with a lot of choice, so meal replacement works,” Fujioka says.

Research shows obese people are genetically disposed to gaining weight. Gluttony is less than one-third the cause of obesity; genetics and environment are leading factors in this chronic disease. If it’s in the genes and the body isn’t fed well and exercised, the weight creeps on. Once it’s on, the body fights to keep it on. Fat cells have memory; they lower their metabolism to regain weight. It’s tough to find a balance between high fat and low fat in low-carb diets, Fujioka says, and people who keep the weight off for five years eat lower fat diets.

But the battle is worth it because obese people end up in nursing homes earlier with more physical complications. About 400,000 Americans die each year from overweight and related diseases, says Dr. Albert Ray, Southern California regional physician coordinator for preventive care and health promotion at Kaiser Permanente. “Smoking and obesity are the two most common causes of death in the U.S.”

Kaiser offers a variety of health education classes including weight management, exercise, nutrition and positive choice wellness center programs, including bariatric surgery preparation and counseling. Kaiser provides written handout materials in English and Spanish and an online program called Balance. Information about weight management, health improvement, exercise and other health and wellness topics can be found online at kp.org/healthylifestyles. All programs are available to Kaiser health plan members and many are open to the public, either free or at nominal costs.

The most recent addition to Kaiser’s health education is the 10,000 Steps Program, at http://kp.10k-steps.com. But, Ray says, “The latest and greatest is the advice your mother gave you: Eat a balanced diet, exercise regularly and get enough rest.”

Obesity Leads To Diabetes

Palomar Pomerado has a self-management diabetes education program that instructs patients on behavior change and assessment, a core class to take care of their disease, nutrition, exercise, carbohydrate counting and basic meal planning. “We are also in the planning stage of developing a weight loss class to help patients deal with stress eating and hyperlipidemia education,” says Susan Lessani, program manager of DiabetesHealth at Palomar Pomerado. “Diabetes is a disease that must be dealt with on a daily basis — it doesn’t go away.”

As the body gets heavier it needs more insulin hormone. At some point the insulin cannot keep up and the body develops diabetes. About 20 years ago, 5 percent of the population was diabetic; that number has doubled. Diabetes can result in functional loss of feet and kidneys. It used to hit the senior population, now it’s being seen in women and men of all ages who are obese. “It’s scary seeing it in people that young,” Fujioka says. “That means their next 20 years are going to be rough. And then it gets really bad after that.”

When diets fail and people become morbidly obese — two-times normal weight — there’s surgery. San Diego has one of the highest numbers of surgeons per capita in the world for bariatric surgery. The Wittgrove Bariatric Center, located at Scripps Memorial Hospital La Jolla, but not affiliated with the hospital, was established by Dr. Alan Wittgrove. Wittgrove performed the world’s first laparoscopic gastric bypass in 1993 and may best be known for performing singer Carnie Wilson’s gastric bypass surgery in 1999.

“Weight is always on everybody’s mind,” Wittgrove says. “Although San Diego seems to be home to some of the fittest people, it is not immune to obesity.” One measure of obesity is body mass index. A rating of 35 or more means a body is morbidly obese. To qualify for surgery the patient has to have a BMI of 35 with severe medical conditions. A BMI of 40 is acceptable regardless of medical problems. “This means the person is 100 pounds above their normal weight,” says Dr. Charles Callery, attending surgeon for Palomar Pomerado Health. “About two-thirds of the population is overweight, one-third is obese and 4 percent have clinically severe obesity making them candidates for surgery.”

Most surgery candidates tried and failed at least five documented diets. Medical conditions related to obesity include diabetes, hypertension, heart disease, sleep apnea and arthritis of weight-bearing joints. A gastric bypass rearranges the gastric intestinal tract, leaving patients with smaller stomachs. With a capacity of about a tablespoon, eating is restricted to mostly protein and nutritional supplements. “The key is you take less in but you don’t feel cheated,” Wittgrove says. “You feel satisfied with small amounts.” Last year about 120,000 procedures were performed on only about 1percent of those at risk. “The surgery is not a cure,” Wittgrove says. “It gives patients a tool. At the center there is a team to help them with the tool.”

Researching For A Cure

Inactivity is the leading cause of weight gain in both children and adults. Adults in the corporate world spend hours in front of computer screens; children sit up to 13 hours a day, much of it in front of the television and video games. “We’re actually having to work with people on how not to sit in front of the TV or video games,” says Dr. Kevin Patrick, a professor in the department of family and preventive medicine at UCSD.

“In the area of weight loss, we know that to lose weight it is more important to restrict calories than it is to just burn energy through activity,” Patrick says. “We also know that if you’ve lost weight and you want to keep it off, it’s more important to do activity than it is to restrict calories. The people who are most successful in terms of keeping weight off, if they’ve gone through a program, are those who have really adopted new behaviors. It’s an important thing because it is a structural change often in their behavior patterns.”

To calculate your body mass index and for tips on dieting and nutrition, visit the National Heart, Blood and Lung Institute online at http://nhlbisupport.com/bmi/bmicalc.htm. It might be the next step at improving both your health and career.