Reality Check: No Cure for Obesity

H.L. Mencken’s assessment is best: “For every complex problem, there is an answer that is clear, simple, and wrong.” Yoni Freedhoff, a prolific writer,  advocate, and obesity doctor, elaborated on this theme recently in U.S. News and World Report. “Despite what you may see in breathless advertisements, or read from the latest diet book guru, or hear from celebrity diet spokespeople, there simply is no cure for obesity.”

This points to the larger truth that obesity is, in fact, a prevalent chronic disease that lies at the root of many other chronic diseases. It’s a truth that everyone ignores. Right now, in the midst of implementing the Affordable Care Act, the U.S. Department of Health and Human Services is ignoring this truth as they finalize guidelines for health benefits that every plan must include if we are to call it health insurance. These plans must cover treatment for the chronic conditions that result from obesity, like high blood pressure, high cholesterol, diabetes, joint disease, and many cancers. But require coverage for the treatment of obesity? We’re just not ready for that.

We are ready to talk about mandating prevention of chronic diseases. So maybe certain kinds of obesity treatment, like intensive behavioral therapy, will be covered if we call it prevention. The case is especially strong because the United States Preventive Services Task Force has ruled that the evidence shows that it works. But if the same people who get “preventive services” need medicine to treat obesity, right now it’s mostly not covered.

It’s this same reluctance to deal forthrightly with obesity as a disease that sets up a flourishing market for quackery and false claims of miracle cures. The Internet, television, radio, and print media are full of an appalling array of miracle weight-loss solutions. Freedhoff sums up the flawed thinking that makes people susceptible to these frauds. He describes how most people mistakenly approach obesity as if a cure is possible:

In my experience working with thousands of people, the majority seem to believe that there are two phases to weight management — the weight-loss phase and the weight-maintenance phase — and that the losing phase will require far more restriction than the maintaining phase.

And therein lies the rub: if the ability to gain weight in our modern environment is considered the condition, it’s one that never goes away, which means weight-management efforts are treatments, and when treatments stop, conditions recur.

No doubt, we need aggressive research to make it possible to actually cure obesity. That would mean correcting the metabolic disease that is wreaking havoc on public health. But the means to do that is far off because our understanding of obesity is still very limited.

In the meantime, we have tools and skilled healthcare providers who can help people manage this chronic disease and maximize their health. The tools are under-utilized and the providers are too few, mainly because we’ve yet to get as serious about treating obesity as we are about treating the diseases it causes. We’ll get there after exhausting all the other possibilities. We’ll get there when it becomes unmistakable that prevention alone can’t can’t solve an epidemic that already affects more than half the population.

Click here to read Freedhoff’s commentary.

H.L. Mencken, image from Wikimedia.

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