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What Exactly Is Well-Controlled Obesity? Does It Matter?

A chronic disease is a medical condition that stays with you. Doctors don’t have a cure, so the goal is to control it. To come as close as possible to living a healthy life despite whatever chronic condition might trouble you. Diabetes? By carefully controlling your blood sugar and your body’s response, most people can keep its complication at bay. Hypertension? Keep it under control and you’re less likely to have a stroke or a heart attack. Obesity, too, is a chronic medical condition. But what exactly defines a state of well-controlled obesity?

Bruno Halpern and Marcio Mancini tell us in a new commentary that this is a question we should be spending time to answer. Because COVID-19 makes well-controlled obesity an especially important goal.

Not So Easy as Hypertension

Dealing with obesity as a chronic disease is new to most people. Some are still stuck on thinking of obesity (absurdly) as a health behavior. Others still think of it as a bogus diagnosis. “I’m just a big person. Don’t try to medicalize my body.”

But for folks who are serious about metabolic health, that debate is over. COVID-19 has made it clear that the altered physiology of obesity puts people at risk for bad outcomes, including death. The struggle remains, though. Obesity is a very heterogeneous condition. Patients encounter this disease in many different ways. Some were seemingly born with it and can never remember anything but being the biggest person among their peers. Others might develop it later in life, as a result of any of a number of triggers. It might be mild and relatively stable. Or it might be severe and relentlessly progressive.

Thus, defining the goal of well-controlled obesity is not as simple as hypertension. For that disease, definitions of good control might vary a bit, but if blood pressure is less than 140/90, you’re probably in a good place. For well-controlled obesity, one size simply does not fit all. That’s because BMI does not define health. So providers and patients must set individual goals according to individual needs and health status.

Body weight is not the only factor to consider. Sometimes it’s beside the point.

Why Does It Matter?

Good control over obesity is rarely easy. But it does matter, especially in the midst of a pandemic in which obesity raises the risk of death if a person gets the infection. We have some very preliminary data to suggest that obesity treatment might reduce that risk. Likewise, we have data to suggest that better control of blood sugar correlates with better outcomes in COVID-19. And of course, with successful obesity treatment, patients with type-2 diabetes often enjoy better control of blood sugar.

So we have every reason to believe that well-controlled obesity is especially important when COVID-19 is a risk for us all. But we have quite a bit of work to do – defining it and measuring the benefit in terms of outcomes. Let’s get on with it.

Click here for the commentary by Halpern and Mancini and here for more on the interaction between obesity and diabetes outcomes..

Traffic Control, photograph © Scott Stewart-Johnson / flickr

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September 14, 2020