Director of Nutrition and Metabolic Research
Diabetes and Endocrine
La Jolla, California
Ken Fujioka, MD, has disclosed that he has received fees for non-CME/CE services from Novo Nordisk and consulting fees from Amgen, Boehringer Ingelheim, Gelesis, Janssen Global, Novo Nordisk, Phenomix, and Sunovion.
In the relatively recent past, modern medicine has debated whether obesity is a disease.
To some, obesity might seem obviously a disease: It has obvious signs and symptoms, and it impairs normal function, especially given its many comorbidities. But it was not until 2013, fewer than 10 years ago, that obesity was designated as a disease by medical associations and societies and world and national health organizations.
Resetting the Disease
What made this designation possible? Science showed very impressive biological changes—metabolic adaptation—that often make weight gain permanent.
The concept of “metabolic adaptation” showed that the body resets to stay at the highest weight it has ever attained. Even though that higher weight now makes the person diabetic or hypertensive, that individual’s biology is set for life to try to maintain that higher weight.
This outlook was a change from the past where scientists, healthcare providers, the media, and especially patients all thought that obesity was temporary. Everyone thought that this “set point” would adjust down to a “healthy weight” with simple diet and exercise.
The scary part is many healthcare providers and patients still think of obesity as temporary. Almost daily I hear from patients, “if only I could get my weight down, I will be fine.”
It’s true that if patients get their weight down, their health will improve, but getting it down and keeping it down is not a question of mind over matter—it’s a fight against biology.
Armed with this knowledge, it’s time for us to reset our expectations on typical amounts of weight loss. Patients often want to lose 25% to 30%, but to achieve that degree of weight loss would require very aggressive treatment such as bariatric surgery, for which fewer than 10% of patients qualify.
The good news is that only 3% to 10% weight loss confers tremendous health benefits, which is easily attainable with proper treatment. As little as 3% weight loss has been shown to improve A1C and dyslipidemia, and as little as 5% weight loss has been shown to improve hypertension.
The other good news is that this level of weight loss—3% to 10%—is achievable and sustainable, especially with tools such as antiobesity agents. And a simple trial can help evaluate if an antiobesity agent is a good fit for the patient.
Resetting the Future
Obesity is associated with numerous other diseases: diabetes, cardiometabolic disease, nonalcoholic fatty liver disease, and certain cancers to name a few. Although healthcare systems have generally done a great job of treating and preventing cardiometabolic disease, this is not so with obesity-related cancers.
Cancers not associated with overweight and obesity have been declining in the United States, but apart from colorectal cancer, other cancers associated with obesity are on the rise, correlating with the increasing prevalence of obesity itself.
It’s time for us to take action, in part by recognizing and treating obesity as the treatable disease it is.
How do you think the designation of obesity as a disease will (or will not) help clinicians and patients? Answer the polling question and join the discussion by commenting below.