Our expert is Fatima Cody Stanford, MD, MPH, MPA, FTOS, Obesity Medicine and Nutrition, Massachusetts General Hospital and Harvard Medical School, American Board of Obesity Medicine Diplomate.
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OBESITY HAS MORE IMPACT THAN ANY OTHER CHRONIC DISEASE
Obesity has enormous impact, partly because it is so widespread and partly because it exacerbates so many other disease states. In the US, there are 93 million Americans with obesity, and according to the McKinsey Global Institute, obesity is responsible for about 5% of all deaths each year worldwide. The global economic impact of obesity is roughly $2 trillion annually, which is nearly equivalent to the impact of smoking or of armed violence, war, and terrorism.
WE HAVE BEEN USING THE WRONG MODEL FOR TREATING OBESITY
Unfortunately, we’ve been using an inaccurate and archaic model when trying to deal with obesity. Up until recently, we were all taught that a simple combination of diet and exercise is the answer to weight loss. Our job was to follow the “calories in, calories out,” model and encourage people to eat less while exercising more. Today we know that obesity is a multifactorial disorder, and each of the following play a role: genetics, the environment, development, and behavior. Treatment plans need to be individualized, and blaming patients for their obesity is both unfair and inappropriate.
CHANGING MEDICATIONS SHOULD BE CONSIDERED EARLY ON WHEN TREATING OBESITY
A large number of the medications we routinely prescribe result in weight gain as a side effect. Examples include antidepressants, antipsychotics, sleep agents, beta-blockers, steroids, insulin, and hypoglycemic agents. Weight gain can occur with medications even when an individual’s diet and exercise remain nearly the same. Medications can increase an individual’s appetite and/or reduce her desire to exercise. Medications can also influence whether the calories from the food consumed are stored or not. If your patient is on a medication that may cause weight gain, check if there are substitute medications that don’t have the weight-promoting side effects.
FOCUS ON QUALITY, NOT CALORIES
Instead of focusing on the caloric value, have your patient focus on improving the quality of the foods she is consuming. We know that she can consume the same number of calories in a pepperoni pizza or in a meal of quinoa with roasted pepper, but the results will not be the same as far as weight gain. Unlike the quinoa meal, the pepperoni pizza consists of highly processed foods, and she is likely to store and retain more of the pizza calories than the less processed quinoa. The brain naturally adjusts in a healthier way to the less processed foods.
WITH EXERCISE, ENCOURAGE HER TO DO WHAT SHE IS MOST LIKELY TO DO
What she will do and what is ideal are two different things. Find out what she is willing to do for the rest of her life, as opposed to what you would like her to do. Ideally, she should get some kind of weekly moderate exercise such as walking for 150 minutes or 75 minutes of vigorous exercise. Help her manage her expectations to avoid having her become discouraged about exercise. Let her know that while exercise is excellent for maintaining her weight and her health, in most cases it will not by itself do much for weight loss.
ENCOURAGE WOMEN WITH OBESITY TO LOSE WEIGHT BEFORE BECOMING PREGNANT
The intrauterine environment has a strong influence on her child’s likelihood of having obesity. We know from women who had children both before bariatric surgery and then afterwards, that the children born to the mothers when they were obese are much more likely to struggle with weight than those born after their mothers achieved a healthier weight.
DON’T STIGMATIZE OR MAKE ASSUMPTIONS ABOUT YOUR PATIENT
Just because a woman weighs 300 pounds, don’t assume she’s unmotivated. Factors outside her control, such as heredity or her own epigenetic development may mean that in her case weight loss without help is not possible. She may need bariatric surgery or lifelong medication to control her weight, the same way others may need lifelong medication for blood pressure or cholesterol. Every single clinician is treating patients with obesity, and stigmatizing them impairs our ability to deliver optimum care.