Obesity is a disease—and it’s treatable

Obesity is a disease—and it’s treatable

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With Covid-19 in the rearview mirror (hopefully), it’s time to address its ramifications. One of them is the large number of people who gained weight over the past two years. Many were forced to admit—possibly for the first time—that obesity put them at greater risk for health complications such as type 2 diabetes, heart disease and polycystic ovarian syndrome. Coronavirus may be waning, but the obesity pandemic and its impacts are still very much with us.

As an obesity medicine specialist, I find it disheartening that so many in the public eye are telling people they simply need to get back to their pre-Covid bodies, or worse, take part in dangerous crash diets. Obesity doesn’t work that way; obesity is a disease, and America’s healthcare providers and hospital systems must be part of changing how we treat it. That means many of us in the health ecosystem must reexamine how we view patients with excess weight.

Encouragement of body acceptance is a positive counterweight to the relentless stigma faced by people with obesity, but it can’t supplant treatment. Thankfully, this isn’t an either/or situation. In doctor’s offices and hospitals, we should promote both acceptance and treatment; that effort starts with rejecting the mistaken beliefs that obesity is simply a lifestyle issue or a consequence of lack of willpower. People with obesity do care about their health and have tried to lose weight (often several times), but they run into the brick wall of biology.

Weight loss is not, as many imagine, a simple matter. Our bodies have evolved numerous mechanisms that resist and counteract any effort to lose weight, including hormonal and metabolic changes that desensitize the brain to normal appetite signals, increase food cravings and store fat more tenaciously. These complex adaptations mean most people with obesity are unable to lose clinically significant amounts of weight on their own, no matter how strong their willpower.

This is where obesity medicine comes in.

A relatively new domain, obesity medicine considers the wide range of factors contributing to the disease, including a person’s genetics, health conditions, medications, socioeconomic circumstances, sleep patterns and weight-loss experience. The diversity of causes means there is no one-size-fits-all solution. Every individual’s situation is unique, calling for a personalized treatment plan that comprehensively addresses all factors contributing to weight gain or creating barriers to weight loss.

The good news is that even a relatively small amount of weight loss (5% to 10% of body weight) can measurably improve long-term health and well-being. Success requires not only identifying lifestyle changes that work for each person and can be maintained over time (a diet that doesn’t feel restrictive, physical activity that’s enjoyable), but also addressing undiagnosed or untreated conditions, adjusting medications as needed, and providing a supportive, multidisciplinary care team to keep patients on track and help overcome inevitable challenges and setbacks.

Most major medical organizations, including the American Medical Association, have designated obesity a chronic disease, but a massive care gap still exists. Less than 2% of the 130 million Americans with obesity are being treated with an evidence-based medical approach, compared to 86% of people with diabetes who are treated according to guidelines.

Most healthcare professionals receive little to no specific training on managing obesity. As a result, they often hesitate to initiate uncomfortable conversations about weight or see no middle-ground treatment options between lifestyle-only interventions, which have limited effectiveness, and bariatric surgery.

To address America’s obesity epidemic, we need to recognize it as a disease, not a moral failing. Obesity treatment needs to be incorporated into training for health care providers, especially in hospital systems. Doctors must become familiar with treatment guidelines, educational resources and technologies for creating individualized care plans for their patients.

Accepting your body starts with feeling good and healthy in it. If providers and patients are willing to accept and treat obesity like the disease it is, we can make progress against this epidemic. We can give people hope instead of leaving them to fight a daunting battle on their own.

Photo: puhimec

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