Is Obesity a Life Sentence?

Last week, commentary published in the journal Lancet Diabetes and Endocrinology made the media rounds, filling consumers with dread and hopelessness that obesity is incurable and we’re all doomed. Well ok, maybe I’m being a little hyperbolic. But the discussion on my Facebook page belied an uneasiness that maybe we’re doing all this work to change our habits in vain.

First off, it’s important to understand that this paper was not a study. It’s a commentary, the purpose of which is to educate healthcare providers about the mechanisms of obesity and provide recommendations for treating it. The media made it out to be a statement that ‘obesity is incurable! eat less move more doesn’t work! OMG WE’RE ALL DOOMED’, but the authors made several very reasonable recommendations for the treatment of obesity and the support of a healthy (or at least healthier) body weight once it is achieved.

The paper is short and readable, you can access it for free by registering at the site I linked above. The authors outline some research that suggests that weight loss produces metabolic adaptations that prime the body for regain (but we already knew that), and the fairly dismal statistics on weight loss and maintenance (short story: most people regain the weight they lose). They discuss the treatment options we currently have available, their strengths and limitations.

Then they lay out some recommendations for healthcare providers. These recommendations include:

– encourage patients with obesity to consider treatment
– consider biological treatments like surgery and medication in addition to lifestyle interventions
– create a treatment plan that uses multiple interventions if necessary
– recommend bariatric surgery if appropriate
– monitor progress and adjust treatment when necessary
– educate patients about the realities of weight loss and it’s metabolic effects – namely that they may need to eat roughly 300 less calories (or burn 300 more) per day than someone their height and weight without a history of obesity

All in all it was actually a pretty boring paper, with little in the way of new information or groundbreaking interventions. We already knew most of this stuff. This paper simply put the information together and provided some evidence based recommendations for healthcare providers.

We know that it is possible to lose weight and keep it off. Check out the National Weight Control Registry. It isn’t easy. No one has ever claimed it is easy. And sometimes it requires more than ‘eat less and move more’ – I’d argue that one of the recommendations missing from this paper is treatment for those struggling with binge eating disorder and other forms of disordered eating.

Lasting weight loss requires a permanent change in behavior. Sometimes it also requires medication, or therapy, or surgery (or all of those things!). Every obese patient will need a personalized treatment plan, and a compassionate and knowledgeable treatment team. This paper is a good step in the right direction by providing recommendations for health care professionals who might not understand all the biological issues a patient may present with.

More research, and better treatment options are necessary. I hope that more and more health care professionals begin to recognize the psychological issues at play, and the need for any treatment plan to address a patient’s mental and emotional health as well as their physical health. When we address all these aspects of health, we’ll see progress.

Sorry this post is so boring. This is the reality of the paper in question. It’s pretty boring. But you’ll notice how the media hyped it up into something it really isn’t (OMG WE’RE DOOMED FEAR FEAR FEAR). That’s what the media is best at.

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