Eight Invisible Facts of Obesity

Eight invisible facts of obesity get in the way of a more rational health policy to deal with this pernicious chronic disease. Without coming to grips with these facts, policy makers will keep making dumb mistakes and tripping over them.

1. Obesity is more than one disease. For people who have barely come to terms with the notion that obesity is a disease, not just a bad choice, accepting that obesity comes in many different forms makes their heads hurt. They’ll have to get over it. Someone who is a high insulin secreter needs very different treatment than someone with a binge eating or food addiction problem. We have much more to learn about this. Read more here.
    
2. Weight loss is not the same thing as obesity treatment. Weight loss is a big industry that meets a real need some people have for short-term weight control. Obesity treatment is very different. Obesity treatment is about long-term metabolic health. It’s chronic disease management for a condition that we can’t really cure, any more than we cure hypertension. But a skilled obesity medicine professional can certainly help someone with obesity greatly improve their health for better, longer life. Read more here and here.
    
3. Prevention and treatment are really the same. Public health advocates and policymakers hold up the goal of obesity prevention without stopping to think. How do you prevent something that already affects two-thirds of the population to a greater or lesser degree? A good start would be to acknowledge that prevention and treatment are really inseparable. Preventing childhood obesity most often requires adressing obesity for the whole family. Effective treatment for adults often yields less obesity for the children those adults care for. Read more here.
    
4. Only a few thousand physicians seriously treat obesity. Under the Afforable Care Act, health plans will have to cover screening and intensive behavioral treatment for obesity. But primary care physicians most often provide provide only superficial care for obesity. For someone significantly affected, they would do well to seek out a skilled obesity medicine physician. The trouble is that only about 500 physicians will have passed the new, stringent board exam from the American Board of Obesity Medicine by early next year. Perhaps another thousand physicans practice obesity medicine with a high degree of competence. Other health professionals who can be helpful are dietitians with certificates in weight management, certified bariatric nurses, clinical psychologists and fitness professionals with training in obesity, and bariatric surgeons practicing in a center of excellence. The Obesity Action Coalition is a key resource and advocate for elevating and empowering people with obesity to maximize their health. Read more here and here.
    
5. Cancer is an important complication of obesity. When most people think about the diseases associated with obesity, it’s all about cardiovacular disease, diabetes, and maybe joint disease. Cancer seldom makes the list, even though obesity is responsible for the growing prevalence of many cancers. Read more here.
    
6. Blaming people for obesity is a waste. Any good clinician knows that blaming a patient for their health problems simply shuts down the conversation and discourages people from improving their health. It doesn’t happen so often when the subject is cancer, heart disease, or diabetes. We need that same focus on improving people’s health in obesity. Read more here. 
    
7. We pay for obesity even if we don’t pay for treating it. Health plans, even under the Affordable Care Act, continue to delude themselves by thinking they can avoid the costs of obesity by simple excluding treatment coverage for obesity. Wrong. Bills for heart disease, joint disease, cancer, diabetes will show up regardless. Smart health plans know that investing in chronic disease management for obesity saves money by cutting the burden of other chronic diseases that results from untreated obesity. Read more here.
    
8. Obesity is often complicated, not caused by lifestyle. A glib, false assumption that often goes unchallenged is the assertion that obesity is a “lifestyle disease.” No doubt, lifestyle complicates obesity. Better diet and more physical activity can provide substantial benefits for many with obesity. But they are hardly a dependable cure. The fact is that obesity has its roots in a complex web of biological mechanisms. And the root cause can be very different — if we can even figure it out — in different people. Read more here.

 
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Pier Lights, photograph © Denis Collette / flickr

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