The medical profession has no cure for obesity. While many people will diet, exercise, and thus, lose weight - keeping that weight off is where the real struggle lies.
Below is an article and a video in which Dr. Sharma, who-is-one-of-the-medical-obesity-experts-that-I-admire-and-respect, explores the complex biology behind weight loss and regain, and gives his medical opinion as to why obesity should be managed as a chronic disease rather than as a personal failure.
The Three Clinical Faces of Obesity
by Dr. Arya Sharma M.D.
In my experience, patients presenting with obesity tend to fall into three categories, each of which requires a distinct management approach. They are:
1) Active Gainers
2) Weight Stable
3) Post-Weight Loss
Active Gainers are patients currently at their lifetime maximum and continuing to gain significant amounts of weight – i.e. more than the usual 0.5 to 1 lb/year. Patients in this category require immediate attention – if nothing happens, their weight will most likely just continue to increase.
The good news is that in almost every patient in this category, there is an identifiable reason for the ongoing weight gain – this can be psychosocial (e.g. depression, binge-eating disorder, etc.), due to a medical comorbidity (arthritis, chronic pain, etc.) or medications (e.g. atypical antipsychotics, hypoglycemic agents, etc.).
From a management perspective, the sooner we identify and address the underlying problem, the sooner we can slow or even halt the rate of weight gain – in this patient – gaining less weight than before is the first sign of success. There is really no point trying to embark on losing weight as long as the underlying problem driving the weight gain has not been addressed, as this is likely to make sustained weight loss even more unlikely that it already is..
Weight Stable patients are those that present with excess weight but are relatively weight stable. Even though they may be at their lifetime maximum, they have been pretty much the same weight (perhaps a few lbs up or down but nothing drastic) for several years (sometimes even decades). By definition, a patient who is weight stable is in caloric balance, and thus, by definition is not eating too much. In fact, these patients are eating the exact number of calories needed to sustain their bodies, which is why they are weight stable. (Remember, even if you are weight-stable eating 4000 Cal a day, you are technically not “overeating”.)
These patients of course have experienced significant weight gain in the past (historical weight gain), but whatever it was that caused them to gain weight is no longer an active problem (e.g. pregnancy, past depression, etc) – and therefore, probably doesn’t need to addressed (although, I always find it of interest to find out what caused the weight gain in the first place). With these patients, we can determine whether or not their weight is affecting their health, and if it is, we can jump right into discussing treatment options (behavioural, medical and/or surgical).
The third group of patients, Post-Weight Loss, are those who are not at their lifetime maximum, or in other words, have already lost weight (by whatever means).
These patients generally present either because they want to lose even more weight (Doctor, my diet has stopped working! = “weight-loss plateau“), or are experiencing weight regain (Active Regainers).
In case of the patients experiencing a “weight-loss plateau”, one needs to determine if there is in fact any medical indication for further weight loss – many of these patients may already be at their “Best Weight”.
If there is indeed a medical indication for further weight loss, it generally means adding therapeutic options that may include anti-obesity medications and/or surgery. (In my experience, patients who have been maintaining a significant amount of weight loss on their own, generally leave little room for further behavioural intervention).
On the other hand, there are the post-weight loss patients who are actively regaining weight. These tend to fall into two groups:
1) The first group of Active Regainers are those, who have lost a significant amount of weight with a strategy that is in fact unsustainable (e.g. a very low-calorie diet, an excessive exercise program, or whatever else desperate patients will try just to drop their weight).
As the strategy they were on is not one that they can sustain (for good reasons), some weight gain is inevitable and the best we can do is to offer a weight management strategy that is sustainable in the long run (and may include medication or surgery) .
2) The other group of Active Regainers, are those that were on a more-or-less sustainable management plan (behavioural, medical or surgical) and have for some reason “fallen off”.
Here one needs to determine what exactly they have stopped doing (e.g. no longer keeping their food journal, stopped their anti-obesity medications, etc.) or what additional weight-gain promoting change has occurred that has thrown them off (again, reasons can be psychosocial or medical).
Here one needs to determine if the patient can in fact go back to doing what was “working”, which may require addressing the new problem that has arisen or add additional therapeutic options (e.g. medications or surgery).
Thus, as each type of patient needs a somewhat different assessment and management strategy, I find this approach to thinking about each patient most helpful.
About Dr. Sharma:
Dr. Arya M. Sharma, MD/PhD, FRCPC is Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program.
Dr. Sharma is founder and Scientific Director of the Canadian Obesity Network, a network of over 10,000 obesity researchers, health professionals and other stakeholders.
He is also the Past-President of the Canadian Association of Bariatric Physicians and Surgeons.
His past appointments include positions as Professor of Medicine and Canada Research Chair (Tier 1) at McMaster University (2002-2007), Professor of Medicine at the Franz-Volhard Klinik – Charité, Humboldt University Berlin (2000-2002) and the Free University of Berlin (1994-2000). His research focuses on the evidence-based prevention and management of obesity and its complications.
He has authored and co-authored more than 350 scientific articles and has lectured widely on the etiology and management of obesity and related cardiovascular disorders. Dr. Sharma is regularly featured as a medical expert in national and international TV and print media and maintains a widely read obesity blog at www.drsharma.ca.
Video Below: How to Lose 50 Pounds and Keep Them Off
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