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Obesity is a Disease, Treat it Like One

Obesity is a Disease, Treat it Like One
10 November 2019 Laura Eggerichs

Stop Blaming Those who Struggle with Obesity and Start Treating the Disease

According to the WHO, obesity is a disease, but the society we live in has not accepted it as one. Instead, even the healthcare system often sees obesity as a burden they have to deal with rather than a disease state that deserves proper treatment and funding. This is because most people, including many healthcare professionals, think that all someone needs to do is eat less and move more and: Voila! Weight troubles are over! But this is is a huge misunderstanding. Sure, for short periods and smaller amounts of weight, that adage can help. But long-term, only 3-5%  of people maintain their weight loss after 5 years using standard methods. That’s because obesity is a complex disease, and the one-size-fits-all approach just doesn’t work.  

The Patient Didn’t Fail. The Treatment Did. 

The need for multiple treatment options for obesity was highlighted at a conference we recently attended in Stockholm that focused on caring for overweight and obese patients in a primary care setting. One of the lecturers, Dr. Carel Le Rouxe, compared how we treat obesity to how we treat other diseases.  Obesity is often treated as a character flaw, and other diseases are treated as, well, diseases. He drew a parallel to breast cancer. If a patient is treated with chemotherapy, and it doesn’t work, no one blames the patient. The doctor tries another treatment because different types of breast cancer respond to treatments differently without questioning the patient’s motivation to be cancer-free. On the other hand, if a patient doesn’t lose weight with diet and exercise, medication, or surgery, then it’s patient that failed, rather than the treatment. No matter how motivated that patient was and how hard he tried to follow the plan, he is often still seen as lazy, unmotivated, and noncompliant. Part of this is because it can be hard for people that have never had a weight problem or who have had long-term success with weight loss to understand why others can struggle with it so much. This is true even for people that have had weight loss surgery. 

Poor Responders after Bariatric Surgery

It’s not uncommon for people to look down on those who have not lost much weight after obesity surgery. Even those who have lost a lot of weight after surgery are not immune to having this negative view. After all, the operation worked for them, so why can’t these other people lose weight? This attitude also extends to those who have lost weight but then regained: How could you let that happen!? This is where we need to clarify something. As with other medical treatments, WLS does not work the same way for everyone. It is not as effective for everyone. I have had patients with a lot of motivation and desire to lose weight. They tried as hard as they could, but their efforts just didn’t show on the scale. They still felt hungry and didn’t have that hard stop when eating that many patients experience after obesity surgery. This is all despite them having the same surgery as the person who gets full after 3 bites. In healthcare, we call these patients”poor responders” because they don’t respond to the treatment as expected. Because poor responders are not very common, many will go back to pointing fingers at the patient rather than looking for other treatments. So what should you do if you are a poor responder? 

Options for Poor Responders

Before focusing on weight, it’s always important to take stock of the positive experiences you’ve had since surgery. Perhaps you are off medications that you’ve been on forever! Maybe your joints don’t hurt as much, giving you the freedom to move about more easily.  After taking an inventory of your non-scale victories, take a look at the treatment options you have. Start with seeking help from a dietitian who specializes in WLS to help you with your diet and exercise, and talk to a physician who can help you with weight loss medication to complement the surgery.  While the knowledge around how to care for non-responders is not incredibly extensive, more and more obesity specialists are learning how to use medications and other forms of intervention as complements to surgery for those who need it. If you are among those who haven’t responded well to weight-loss surgery, talk with your surgical center or other experts about what other forms of treatment might work for you.

 

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