57 Varieties of Obesity: Moving Past One Size Fits All

57 Varieties of ObesityOpening 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

4 Responses to “57 Varieties of Obesity: Moving Past One Size Fits All”

  1. June 03, 2016 at 6:40 am, Allen Browne said:

    Yup! I was there! As Kaplan said, obesity is like cancer – many varieties and each will need it’s own optimal therapy. We need to I.D. the types and determine which therapy works for which type – much to do.

    I hope today was as good as yesterday.

  2. June 03, 2016 at 10:01 am, Stephen Phillips said:

    Kudos to Lee Kaplan

    The American Association of Bariatric Counselors views obesities as a spectrum condition…..similar presentations with very different etiologies.
    All diseases and conditions require a diagnosis prior to a treatment plan or intervention..
    Development of diagnostic criteria for the full spectrum of obesities is long overdue
    Stephen Phillips
    American Association of Bariatric Counselors

  3. June 04, 2016 at 4:51 am, Mary-Jo Overwater said:

    So glad to see this elucidated more prominently. Let’s just hope that the insurance coverage for the various treatment options can somehow be sorted out to improve access to best care for folks who need the option that is most effective for them.

    • June 04, 2016 at 7:52 am, Ted said:

      Thanks, Mary-Jo. I hope so, too!