Imagine Curing Obesity

Curing obesity is something hard to imagine. Because obesity is a chronic disease, finding effective ways to manage it is hard enough. If someone tells you they have a cure, hold onto your wallet. But it’s worth thinking about what a cure would be.

Mostly what we have are implicit assumptions on this subject. The most common assumption is that a cure might involve achieving an ideal weight. This assumption is implicit in the most common outcome measure used for obesity surgery: percent excess weight loss (%EWL). Using this measure, a patient who achieves a normal or ideal body weight is said to have reached 100% EWL.

A new study published in the journal Obesity demonstrates the limitations of %EWL for measuring the success of obesity surgery. Ida Hatoum and Lee Kaplan found that %EWL can be misleading when compared to the simpler measure of percent weight loss, because %EWL has a lot to do with someone’s starting weight. In other words, someone with a really high starting weight might lose lots of weight and greatly improve their health, even though their %EWL might not be so impressive.

And even more important, the notion of a standard for what is a normal or ideal weight is riddled with problems. The most fundamental problem is biological diversity. Most experts agree that BMI, by itself, is a poor tool for determining a healthy weight goal for an individual.

The fact is that people come in all sizes. Most people are born into this world weighing between 4.5 and 11 pounds, and such diversity in body size persists throughout life. A cure for obesity would be unlikely to change this fact. What a cure should do is fix the real problem of excess adipose tissue and the metabolic disease it causes.

So, when you think about curing obesity, consider abandoning the notion of an ideal body weight. Think instead about fixing the metabolic problem and achieving good health.

Click here to read the study by Hatoum and Kaplan, click here to read more about treating obesity from HealthPolicySolutions.org, and click here to read a perspective from author Lionel Shriver.

Dr. Pierce Cures It All, photograph © Great Beyond / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.