Embryonic Stem Cells Forming Neurons

Biology? Not So Important in Obesity, Say PCPs

We have a new window into the thinking of primary care physicians (PCPs) about obesity. But the view is dismal. On the subject of obesity, physicians believe that that biology is not so important. Why do people with obesity tend to regain weight? Physicians say behavioral factors are more important than biology.

Likewise, they rated behavior modification as more effective than either surgery or obesity medicines.

The Biological Reality

These views rather directly contradict the biological facts of obesity and obesity care.

First of all, the biology of weight regulation is complex and potent. The body aggressively defends its stores of fat to increase a person’s odds for survival. Neuroscience research tells us that many overlapping biological mechanisms make this happen. But it boils down to two things: metabolic adaptation and an increased biological drive to eat.

Secondly, it’s indisputable that behavioral modification, by itself, is not adequate for treating obesity in most people. Behavioral strategies can reliably produce a sustainable five to ten percent weight loss in many people. On top of that, anti-obesity drugs can produce another five to ten percent.

But surgery produces sustainable weight loss and significant health benefits that behavioral therapy alone cannot match. Obesity medicine expert David Arterburn commented succinctly on Twitter:

Primary care docs rank bariatric surgery as less effective than behavior modification for obesity… Have they read the literature? Both are effective, but behavior change has never won a head-to-head comparison. Important study.

The Study

These findings come from a survey of physicians participating in continuing medical education programs. Adam Tsai and colleagues (including ConscienHealth’s Ted Kyle) surveyed both primary care physicians and physicians preparing for a certification exam in obesity medicine. Survey questions addressed beliefs about factors that contribute to weight regain and about obesity treatment.

Tsai  explained that these findings should be a call to action:

Physicians should educate themselves on the nature of obesity as a chronic metabolic disease. Organizations that provide CME and maintenance of certification should include more education about obesity specifically, to give physicians an incentive to learn more about obesity as a disease.

Closing this gap in medical knowledge about obesity will be critical for making more progress in reducing its impact.

Click here for the study and here for more perspective from Healio and Endocrine Today.

Embryonic Stem Cells Forming Neurons, photograph © NIH Image Gallery / flickr

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December 13, 2017

5 Responses to “Biology? Not So Important in Obesity, Say PCPs”

  1. December 13, 2017 at 6:26 am, Al Lewis said:

    I find it ironic that time after time wellness vendors and coaches give advice that starts “Talk to your doctor about…” and yet time after time studies come out like this one that say the doctor is wrong as often as right.

  2. December 13, 2017 at 6:54 am, Ted said:

    You’re right, Al. The best advice for someone concerned about obesity is to look for a provider who is board-certified in obesity medicine. It’s no guarantee, but it helps the odds for getting good, evidence-based care.

  3. December 13, 2017 at 2:16 pm, Allen Browne said:

    Ted, your data is very useful.

    It’s amazing how stigma and bias have an effect even on curriculum committees and educational projects for health care providers. Numerically obesity is an overwhelming problem. The effect of obesity is devastating on lives and our economy. Yet, education about the science and physiology of obesity is a very hard sell. I guess we just have to keep trying to break this log jam.

    The root of the problem for doctors, nurses, PT’s, OT’s, RT’s, health coaches, NP’s, PA’s, etc is their lack of education and background. Without education and training they are just products of our very biased, stigmatizing society and culture. Much work to do.

  4. December 13, 2017 at 6:32 pm, Kate said:

    Thank you for this.

    The evidence for those of us working in surgery speaks clearly, yet primary care continues to choose not to engage with the complexity of obesity. Obesity is an adaption to our current environment and continued victim blaming aids and abetts further decreased mental health.

    This is an important study and tool for further education.

  5. December 17, 2017 at 6:16 pm, Lizanka Marinheiro said:

    Great post and comments.