Last month The Lancet Diabetes & Endocrinology, a respected medical journal, published "Treating obesity seriously: when recommendations for lifestyle change confront biological adaptations." This article advises how to “seriously” treat obesity. Because this article may unwittingly provide support for a defeated and discouraged attitude towards losing weight, I decided to weigh in.
From my experience, obese patients are all-too-quick to conclude “There’s nothing I can do about being obese” or give up an “I can’t help it” attitude. Medical journals should not be used to support such gloomy and false ideas. To avoid this, let’s clarify some statements made, “…improved lifestyle choices might be sufficient for lasting reductions in bodyweight prior to sustained obesity. Once obesity is established, however, bodyweight seems to become biologically stamped in and defended.” The implication here being, if you’ve been obese for a long time, “improved lifestyle choices” aren’t enough to help you lose weight. Frankly, this is absolute nonsense. If an obese individual changes how they eat and increases their activity levels, they can and will lose weight, period.
The journal continues: “Therefore, the mere recommendation to avoid calorically dense foods might be no more effective for the typical patient seeking weight reduction that would be a recommendation to avoid sharp objects for someone bleeding profusely.” Of course, merely recommending that someone eat fewer donuts is ineffective; they already knew that wasn’t a good idea before receiving such expert advice--no new insight or help there! As we have often said in my clinic, “knowing doesn’t equal doing.” The article appears to confuse recommendations with the behaviors themselves.
On a more balanced note, we read, “Thus, we suggest that few individuals ever truly recover from obesity; individuals who formerly had obesity but are able to re-attain a healthy bodyweight via diet and exercise still have ‘obesity in remission’ and are biologically very different from individuals of the same age, sex, and bodyweight who never had obesity.” There we have the admission that re-attaining a healthy body weight with diet and exercise is possible (and I have personally observed this in patients hundreds of times!) The claim is now made that once an individual has been obese for an extended period of time, certain biological adaptations never go away. If this is true, and it may be, this is not altogether different from what most have already figured out; namely, it is very hard to lose weight and keep it off, especially if you’ve been overweight for a long time. What I take issue with are the researcher’s conclusions. Instead of emphasizing accountability, the support of a caring family/community, and professional coaching, they want to see more anti-obesity drugs prescribed (phentermine, lorcaserin, liraglutide, etc) more surgeries, leptin-replacement therapy and nerve blockages. Several of which are more theoretical than proven, all of which have side-effects.
I couldn’t agree more with their suggestion to “obligate clinicians to go beyond mere recommendations to eat less and move more.” More than the recommendation is needed--how about referring them to a specific clinical resource with professionals that help take their behavior modification to the next level?
The last thing I want to mention here is how the article downplays the struggles with obesity. Obesity is a very stubborn risk-factor to treat, it’s certainly legitimate to put this in the same category as alcoholism or any other type of addiction. I am definitely not against bariatric surgery (far from it, I have referred dozens of struggling obese patients for surgery) nor am I opposed to all pharmacological interventions. What I am against is an unhealthy (pun intended) emphasis on those alternative methods to the exclusion of diet and exercise modification. Obesity is a serious battle, but it can be won. Even if you’ve been obese your entire life, you, your body and your decisions have the power to change!
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