Written by Jennifer Brown, MD
Jenna has struggled with her weight for most of her life. She has tried multiple “fad” diets over the years. She usually loses some weight, only to regain it when she reverts to her old eating habits.
She’s understandably frustrated with her yo-yoing weight and her inability to keep weight off over the long term. She isn’t sure what to do about it. Jenna has developed high blood pressure and sleep apnea because of her weight, and she feels like her weight has cost her job promotions and relationships. Worse, she is starting to feel like a failure.
I’m a family doc who specializes in obesity medicine, and Jenna is a new patient of mine. She suffers from obesity, which is a complex, chronic disease caused by excess fat deposits. The old advice of “eat less and move more” doesn’t work. Jenna needs a different approach to weight loss — one that focuses on obesity as a medical disease, rather than a lack of willpower.
Obesity is characterized by too much excess fat that leads to significant health issues. Obesity is typically diagnosed using the body mass index (BMI), a calculation based on a person’s height and weight. You can determine your BMI using this free online calculator.
If your BMI is over 30, you are considered to be obese. However, there are some caveats. BMI doesn’t account for individual differences in people, such as:
For example, a person who is physically fit with a lot of muscle mass may have a BMI over 30 yet not be at risk for health problems. Experts are starting to understand that obesity is more than just a BMI number.
According to the CDC, around 42% of US adults have obesity, and that number is expected to grow. Obesity has serious health consequences; it contributes to the development of over 200 diseases. Some of the most significant health risks include:
In the past, obesity was thought to be caused by a lack of willpower, poor lifestyle choices, or inadequate exercise. It was viewed as primarily a cosmetic issue that a person could easily correct with the proper diet or exercise routine.
Experts now realize that obesity is a complex, chronic disease that is caused by a mismatch between our modern diet and the way our bodies naturally function. In 2013, the American Medical Association, the largest physician group in the US, designated obesity as a chronic disease.
Diets high in ultra processed food and limited physical activity have caused a short circuit of normal hunger cues. Genetics, gut hormones, and brain signaling pathways all play a role in the development of obesity.
Just like high blood pressure and diabetes, obesity is a serious chronic disease that requires lifelong management with lifestyle changes and medical treatments.
As knowledge about obesity has increased, healthcare providers now have a much better understanding of the condition. Instead of telling patients with obesity to just “eat less and move more”, doctors now have evidence-based treatments that can help patients lose weight and keep it off.
There’s been a shift towards more individualized, compassionate care that focuses on realistic goals and expectations. If you suffer from obesity, even losing 5% to 10% of your body weight can help reduce your risks and improve your health.
Lifestyle changes remain the cornerstone of obesity treatment, but they rarely work if used alone. Other tools can help people lose excess weight, including intensive behavioral therapy, medications, and surgery. Most people suffering from obesity require at least one of these tools, in addition to lifestyle changes, to lose excess weight for good.
Intensive behavioral therapy from a dietitian is a crucial component of effective weight loss. Dietitians help people with obesity make changes in their diet by setting small, realistic goals. They can also help in creating an exercise program that meets the physical activity recommendations, which include 150 minutes of aerobic exercise and two days of strength training weekly.
Effective medications are now available to help people manage their weight. These include:
Bariatric surgery is also an option for treatment of obesity. There are different types of surgeries, such as a gastric sleeve or a gastric bypass, that are effective and have a lower complication risk than standard gallbladder surgery.
Obesity care should be based on a foundation of trust and open communication with your doctor. Here are some tips to help make the most of your weight loss journey.
Obesity, contrary to a once-popular belief, is not caused by a lack of willpower or a moral failing. Instead, obesity is a treatable chronic disease. With a combination of intensive behavioral counseling, lifestyle modifications, medications, and/or surgery, achieving long-term weight loss and improved health is possible.
Why is obesity considered a chronic disease?
Obesity is a lifelong, complex disease that tends to get worse over time, just like high blood pressure and diabetes. It’s not a short-term problem that can be easily fixed.
Can obesity be cured?
Obesity, because it is a chronic metabolic disease, can’t be cured; it can only be managed. Once a person successfully loses weight with treatment, they will most likely regain it if they stop taking their medication or adhering to lifestyle changes.
What health risks are associated with obesity?
Obesity is associated with over 200 diseases, including heart disease, stroke, type 2 diabetes, sleep apnea, and certain cancers.
How can obesity be prevented or treated effectively?
Choosing whole foods instead of ultra processed foods and getting the recommended amount of physical activity can help prevent obesity. Once obesity develops, it can be effectively treated with intensive behavioral counseling, medications, and/or surgery.
