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In this month's cover story, Ambinder, who underwent bariatric surgery a year ago, explains his - and the nation's - battle with obesity:

Stigma might be more bearablean unpleasant way station on the path to a thinner, healthier lifeif diet and exercise, the most prescribed solutions to obesity, worked. But they don’t. Qualification: if you eat less and exercise more, you’ll lose weight. But the chances that you’ll stick with that regimen are slim, and the chances that you’ll regain the weight, and then some, are quite high. A systematic review of weight-loss programs, by Thomas A. Wadden and Adam Gilden Tsai of the University of Pennsylvania, found that the evidence that commercial and self-help weight-loss programs work is “suboptimal.” People who diet often regain more weight than they lose.

On bariatic surgery:

For young adults who cross a certain weight threshold, bariatric surgery can be an effective preventive step. Its incidence among all adults doubled over six years, to 220,000 surgeries in 2008. And it seems to be increasingly prevalent among obese teenagers: one study suggests that from 2000 to 2003, the number of teens resorting to the procedure tripled. But it’s major surgery, and specialists aren’t comfortable doing it as a preventive measure. Moreover, many insurance companies (including mine) refuse to pay the $30,000 cost, reasoning that any economic benefit they would recoup is years down the road.

Surgery for, say, 1 million of America’s most obese might cost no less than $30 billion, and probably much more. While the total cost of surgery for everyone who is obeseperhaps as many as four out of 10 Americans by 2015may well be less than the financial burden of the diseases associated with obesity, surgery still seems inordinately expensive, unwise, and unfeasible as a hypothetical mass solution. But the treatment does inform how we ought to approach the problem. The only way to cure obesity is to radically rewire the relationship between the stomach and the brain. Diet and exercise can’t do that as quickly or as well.

If we can't easily cure obesity, we’ve got two choices: we rely on medical science to ameliorate its effects, in which case we consign the obese to a miserable life waiting for that one pill or Nature article that solves it all; or we get serious about helping to prevent people, and especially children, from becoming overweight and obese in the first place.

Marc describes his first principles for "an enlightened, realistic approach to beating obesity" over at his blog.

(Photo: Matt Cardy/Getty.)

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