To understand the complexity of both the origin and treatment of obesity you first have to understand the terminology. Obesity is a clinical diagnosis based on various guidelines, the most common being the Body Mass Index, or BMI. Using this scale a person is considered either normal, overweight or obese based on their height divided by their weight. There are problems with this standardization, as there are with all scales, but suffice it to say for this discussion that there is a difference between being overweight and obese. Most of the medical complications due to excess body fat arise in those folks who fall into the obese category. Granted it is a continuum, with a steady rise in problems as BMI and percent body fat rises, but understand that I am not talking about the middle aged woman who puts on an extra ten pounds. She is not obese and doesn’t have this disease. That is a simple but important distinction.
For those who would challenge this characterization of obesity as a disease I offer the following. The most recent statistics from the American Cancer Society report that:
80% of type II diabetes is related to obesity.
70% of cardiovascular disease is related to obesity.
42% breast and colon cancer diagnosed among overweight individuals.
30% of gall bladder surgery related to being overweight.
26% of overweight people have high blood pressure.
100,000 new cases of cancer a year due to obesity.
The reality is that this is simply the tip of the iceberg as it applies to chronic illnesses and obesity. Any other physical condition that created such a list of maladies would probably have its own telethon by now!
And any who suffer obesity understand clearly that it is a chronic problem. When you consider the physiologic changes that happen in the body - in the endocrine system, brain, and metabolism - you quickly realize that the duration of the problem is often lifelong. Considering the increasing role genetics plays in obesity, one can easily surmise that this is a chronic problem.
Unfortunately, the treatment of obesity has suffered greatly due to the lack of understanding of the origins of the disease. Many if not most approaches are focused on simply one aspect of obesity. For example, many so called treatments simply restrict calorie intake. This is largely based on the fallacy of the energy balance equation that says to lose weight you simply take in less than you burn off. Not only is this a complete oversimplification of the problem, but it can actually worsen the situation. Studies are abundant now that illustrate very low calorie diets that result in rapid weight loss actually alter a person’s metabolism such that once they return to a life sustaining “normal” dietary intake, they gain back all their lost weight and even more. Any therapy that focuses on only one factor is doomed to failure.
That brings me to another important consideration in the treatment of this disease. It would be rather ludicrous for someone with diabetes, for example, to get treatment from a celebrity spokesmodel on a TV infomercial. Yet that is what happens all the time with obesity. Most of the commercial products and diet plans don’t make a distinction between the person who is 10 pounds overweight and the person with clinical obesity, they just lump them all into the category of “folks we can sell stuff to.” Yes, you may be able to lose a few pounds by drinking some shake or eating a prepackaged meal (but 98.6% of the time you won’t keep it off) but understand this is not a treatment for a disease. It is marketing hype and often bad science.
As you can surmise from the preceding rant, treating obesity is not for one size fits all. Not every plan works for everyone…but everyone needs a plan. Here is a quick way to tell if the plan you hope to use is worthwhile. It must meet these basic criteria or I would look elsewhere:
Is it healthy?
Is it meant for the long term?
Does it involve exercise?
Can you learn from it?
Are there ways to hold you accountable?
Is it flexible?
Is it easy to follow?
Does it meet the “smell” test?
If your approach falls short, so will your weight loss.
The only reasonable approach to treating a chronic disease is to first have a qualified and knowledgable doctor evaluate your individual situation and understand what factors are contributing to your specific condition. There is absolutely no room for a cookbook approach to weight control. Next, you need a multi pronged management plan that looks at all factors including nutrition, genetics, lifestyle, associated medical conditions, activity level, social and economic factors, and psychological influences. Just as every person with diabetes has a detailed plan of differing medications and lifestyle changes, so the person with obesity should have an approach to treatment that is individually tailored.
The final critical factor in treatment is understanding that this is a lifelong issue. Once a person reaches a goal weight, their treatment plan has to include ways to maintain and persist. Reaching a goal is certainly reason to celebrate, but understand that this treatment process is a marathon, not a sprint. You are setting yourself up for failure if you don’t have a plan in place to maintain your success.
