Despite the many recent breakthroughs in obesity medicine, misunderstandings about the disease of obesity persist among patients, clinicians and insurance providers.
The disease of obesity is a complex, relapsing condition that requires multimodal therapies. It is not a personal choice or a failure of willpower.
And yet people with obesity can be blamed and shamed for having a chronic disease they’re trying to manage.
Imagine if patients with diabetes or cancer were treated as such.
In this blog, I address 3 OBESITY MISUNDERSTANDINGS head-on to refocus our efforts and improve obesity care:
Misunderstanding #1-Obesity is a Lifestyle Choice
Obesity has been deeply rooted in healthism, the belief that health can be attained through personal responsibility and lifestyle choices, all within the individual’s control through the use of willpower.
When one develops a health condition, healthism promotes the idea that the person didn’t try hard enough.
Healthism is harmful because it leads to victim blaming.
It stigmatizes those with chronic illness, suggesting their conditions are a result of character flaws.
This couldn’t be further from the truth.
This belief ignores the multiple and diverse causes of obesity including genetics, biological drivers of obesity, metabolism, our environment, economics, and psychosocial and behavioral factors.
No one chooses to have obesity.
Similarly, no one chooses to have diabetes, heart disease or cancer.
Misunderstanding #2-Obesity is Caused by Overeating
We now know that faulty appetite regulation is primarily responsible for the excessive weight gain that leads to obesity.
When biological signals from the gut and fat tissue that govern appetite do not reach the brain, hunger can linger without the normal sensation of fullness – leading to overconsumption of food.
This appetite dysregulation leads to excessive weight gain among genetically predisposed individuals when living in an obesogenic environment.
Through no fault of their own, individuals with these biological determinants experience increased appetite, increased hunger and reduced satiety.
Instead of overeating causing obesity, having the disease of obesity causes individuals to overeat.
Misunderstanding #3-Obesity Treatment is Short-Term and One-Dimensional
Once individuals understand that obesity is considered as a chronic progressive disease like diabetes, then it is easier to grasp the view that long-term treatment is needed.
Multiple cycles of weight loss followed by weight regain that are experienced by many people living with obesity are not due to lack of motivation or laziness.
Rather, it is the body’s metabolic machinery resisting further weight loss and restoring weight back to where it started.
Through multimodal therapy that may include lifestyle modification changes, obesity medications or bariatric surgery, the biological forces of the disease that make sustained weight loss difficult can be controlled.
And long-term weight loss is the means to the ultimate goal of obesity treatment – gaining improved health.
Changing hearts and minds about obesity takes a collective effort. We have a lot of work to do.
The problem with these misunderstandings is that they negatively affect obesity care directly – through limiting treatment access and delivery.
I encourage you to share this blog with clinicians, patients and others interested in obesity care.
I’m also hoping my new book for healthcare professionals, Patient-Centered Weight Management, will help clinicians better understand and treat individuals with the disease of obesity.
This requires respecting each patient’s right to evidence-based, compassionate care free of stigma.
RK
Robert Kushner, MD
