57 Varieties of Obesity: Moving Past One Size Fits All

Opening the Blackburn Course in Obesity Medicine in Boston Thursday, Lee Kaplan presented a compelling rationale for moving past thinking that one size fits all in obesity prevention, diagnosis, or treatment. Kaplan started with a simple definition of obesity – excessive fat accumulation that presents a risk to health – and presented an expansive overview of the wide variety of ways that an unhealthy fat mass can become the set point for different individuals.

To make his point, Kaplan listed 57 potential varieties of obesity and then explored distinguishing characteristics of some of them.

Different pathologies mean that different people respond to different therapies very differently. In bariatric surgery, for example, the average response might be losing about 30% of body weight in a given population. But some patients will lose as much as half of their initial body weight. A few will lose very little and eventually regain it.

For every obesity treatment, we see a wide variety of responses. Medical nutrition therapy can bring dramatic responses in some people, alongside minimal responses in other people who initially seem very similar. A drug like liraglutide, which typically causes a loss of 5-10% of body weight, produces a loss of up to 30% in a few outliers.

The reasons for this diversity is only partially understood. Genetics, epigenetics, environmental factors, and behavioral factors all play a role. The one thing that is clear is that thinking one size fits all in obesity is simply wrong.

No one treatment works for everyone. No one prevention strategy will be adequate to prevent obesity in the next generation. Dogged pursuit of understanding the complexity of this disease is the key. It’s key for developing targeted strategies that will actually work for preventing obesity’s diverse causes. It’s key for developing targeted treatments to relieve the suffering obesity causes in so many forms.

Click here and here for more on the diverse types of obesity we are confronting.

57, photograph © Thomas Hawk / flickr

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June 3, 2016