Confronting Obesity: Biology, Destiny, and Persistence

Tom Wadden and Rudy Leibel made compelling presentations about confronting obesity at the Blackburn Course in Obesity Medicine Friday. Together they brought a sharp focus on the tension between biology, destiny, and persistence that goes with facing this chronic disease.

A number of headlines this week have suggested that keeping excess weight off is “scientifically almost impossible.” Delivering the prestigious Blackburn Lecture, Rudy Leibel certainly explained why some people might think so.

Leibel, who played a central role in mapping the ob gene and discovering leptin, described in exquisite detail how our bodies vigorously and relentlessly work for years (perhaps forever) to restore the weight we lose, protecting us from starvation. Like a computer run amok, the body never gives up its quest to restore the weight it lost. He also described the neurobiology that adapts to a higher set point when you gain weight. That high water mark becomes the new weight your body protects.

After listening to all of this, Tom Wadden delivered a perfectly gentle and compelling counterpoint. Reviewing landmark data from both the Diabetes Prevention Program and the Look AHEAD study, he made the point that behavioral strategies can do much to improve the health of people with excess weight or obesity. Blood pressure, lipids, blood sugar, sleep apnea, physical function, quality of life, and risk of depression can all be improved.

In obesity, we have a chronic metabolic disease for which we have treatment strategies. Those treatments can do quite a bit to improve the lives of people affected, even though they offer no cures. So we have to apply all the tools we have to do the best we can with this chronic disease (or diseases) we cannot yet cure.

While providing care to people affected, we must also keep working to build the knowledge base that will make all the different forms of obesity more treatable, and ultimately, curable.

Click here for perspective from Yoni Freedhoff on why obesity treatment is far from futile. Click here for more from CBC and here for more from the New York Times.

Persistent, photograph © Sharon Drummond / flickr

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