
”It has been estimated that about 40% to 70% of a person’s likelihood of developing obesity is due to genes.”
Many of us have put on weight during the COVID-19 lockdown simply because these were stressful times and we were close to our fridges. If you were already affected by excess weight and ended up with a few extra kilos after the lockdown, do you try yet another diet, sign up for a gym or consider reaching out to your healthcare provider?
By Dr. Michael Vallis, August 2020
Did you know that obesity is a chronic disease? Really. Turns out we had it quite wrong for quite a long time.
The cultural narrative has long maintained that weight can be controlled by simply tipping the balance between “calories in” and “calories out”. So, if you gain weight by taking in too many calories, simply cut back and you will lose weight.
Let’s not pretend weight control is simple
It turns out things aren’t so simple. Why? Because weight is not a behaviour. As a result, you cannot directly control your weight!
What an outrageous thing to say, eh? Here’s an example. If I asked you to eat 3 servings of fruits today, you could do that (provided you have access).
If I asked you to walk 30 minutes sometime between 8 am and 9 pm, you could likely do that, too. But if I asked you to gain 0.3 kg in the next 6 hours – wait, make that 5.5 kg – you couldn’t.
Being underweight could be a sign you're not eating enough or that you may be ill. If you're underweight, contact your general practitioner for further evaluation.
The medical community recommends that you keep your weight within this range.
* The term ‘pre-obesity’ was previously classified as ‘overweight’ by the World Health Organization (WHO)
People who fall into this category may be at risk of developing obesity. They might also be at risk of developing other health problems, or that their current health problems may worsen. The recommendation is to consult a healthcare provider trained in obesity management.
There are two recommendations for people who fall into the pre-obesity category, which are recommended by European and American clinical guidelines for obesity management in adults.
The recommendation for people with a BMI of between 25.0 and 29.9 and who do not have weight-related health problems (i.e. high blood pressure or high cholesterol) is to prevent further weight gain through healthy eating and increased physical activity.
For people with a BMI of between 27 and 29.0, and who also have weight-related health problems, the recommendation is to lose weight by combining lifestyle interventions and anti-obesity medications to achieve weight loss and improve health and quality of life.
People who have BMI equal or over 30 may have obesity, which is defined as an abnormal or excessive accumulation of fat that may harm health. Today a number of health organisations recognise obesity as a chronic, but manageable disease.
World Health Organisation and other health organisations distinguish three classes of obesity:
Obesity Classification |
BMI |
Class I | 30.0–34.9 |
Class II | 35.0–39.9 |
Class III | Above 40 |
The BMI ranges are based on the effect excessive body fat has on individual’s health, life expectancy and risk of developing diseases; as BMI increases, so does the risk for some diseases.
It is recommended that people with a BMI equal or above 30 consult a healthcare provider trained in obesity management for diagnosis, risk assessment and treatment of obesity and weight-related health complications.
The goal of managing and treating obesity is not simply to lose weight, but instead to improve health and lower the risks of other health complications. Losing even a modest amount of weight, such as five percent of body weight or more, and maintaining this weight loss, can improve overall wellbeing, while also reducing the risk of weight-related complications.
There is a range of scientifically proven treatment options for obesity that may be recommended depending on individual needs, health status and the presence or absence of weight-related complications. Treatment may include a combination of the following options**:
* Bariatric surgery is generally considered for people with a BMI of over 35 who also have weight-related complications. It is also generally considered for people with a BMI of 40 or above.
** Disclaimer: This information is not a substitute for the advice of a healthcare provider. If you have any questions regarding your health, you should contact your general practitioner or another qualified healthcare provider.
People who have BMI equal or over 30 may have obesity, which is defined as an abnormal or excessive accumulation of fat that may harm health. Today a number of health organisations recognise obesity as a chronic, but manageable disease.
World Health Organisation and other health organisations distinguish three classes of obesity:
Obesity Classification |
BMI |
Class I | 30.0–34.9 |
Class II | 35.0–39.9 |
Class III | Above 40 |
The BMI ranges are based on the effect excessive body fat has on individual’s health, life expectancy and risk of developing diseases; as BMI increases, so does the risk for some diseases.
It is recommended that people with a BMI equal or above 30 consult a healthcare provider trained in obesity management for diagnosis, risk assessment and treatment of obesity and weight-related health complications.
The goal of managing and treating obesity is not simply to lose weight, but instead to improve health and lower the risks of other health complications. Losing even a modest amount of weight, such as five percent of body weight or more, and maintaining this weight loss, can improve overall wellbeing, while also reducing the risk of weight-related complications.
There is a range of scientifically proven treatment options for obesity that may be recommended depending on individual needs, health status and the presence or absence of weight-related complications. Treatment may include a combination of the following options**:
* Bariatric surgery is generally considered for people with a BMI of over 35 who also have weight-related complications. It is also generally considered for people with a BMI of 40 or above.
** Disclaimer: This information is not a substitute for the advice of a healthcare provider. If you have any questions regarding your health, you should contact your general practitioner or another qualified healthcare provider.
People who have BMI equal or over 30 may have obesity, which is defined as an abnormal or excessive accumulation of fat that may harm health. Today a number of health organisations recognise obesity as a chronic, but manageable disease.
World Health Organisation and other health organisations distinguish three classes of obesity:
Obesity Classification |
BMI |
Class I | 30.0–34.9 |
Class II | 35.0–39.9 |
Class III | Above 40 |
The BMI ranges are based on the effect excessive body fat has on individual’s health, life expectancy and risk of developing diseases; as BMI increases, so does the risk for some diseases.
It is recommended that people with a BMI equal or above 30 consult a healthcare provider trained in obesity management for diagnosis, risk assessment and treatment of obesity and weight-related health complications.
The goal of managing and treating obesity is not simply to lose weight, but instead to improve health and lower the risks of other health complications. Losing even a modest amount of weight, such as five percent of body weight or more, and maintaining this weight loss, can improve overall wellbeing, while also reducing the risk of weight-related complications.
There is a range of scientifically proven treatment options for obesity that may be recommended depending on individual needs, health status and the presence or absence of weight-related complications. Treatment may include a combination of the following options**:
* Bariatric surgery is generally considered for people with a BMI of over 35 who also have weight-related complications. It is also generally considered for people with a BMI of 40 or above.
** Disclaimer: This information is not a substitute for the advice of a healthcare provider. If you have any questions regarding your health, you should contact your general practitioner or another qualified healthcare provider.
You have a lot of control (again within limits) over what you eat and how you exercise. But because weight is not a behaviour, our ability to alter weight as if it were a dial on a thermostat is very low.
Not only that, it turns out your genes count for a lot. It has been estimated that about 40% to 70% of a person’s likelihood of developing obesity is due to genes. Further, there is an association between your social environment and your weight.
Not to mention that our society has developed such that access to high-calorie, low-nutrition food is easy and the opportunities for activity are hard.
In other words, no matter how you slice it, scientific evidence clearly supports the case that weight is not a matter of choice and willpower, but the result of complex genetic, biological, sociocultural and psychological factors.
”It has been estimated that about 40% to 70% of a person’s likelihood of developing obesity is due to genes.”
Well, not the number of kilos on the scale but the impact of excess fat cells on health, ability to function and quality of life. Fat cells are not passive. They don’t just sit there doing nothing.
Fat cells secrete hormones and peptides that, when close to the heart, liver, pancreas, etc. (intraabdominal adipose tissue) can cause diseases.
Let’s go one step further. It’s crucial to understand that the body defends – yes defends – its highest weight! Our bodies have basic instinctual coping responses. Let’s look at a few examples.
Because overheating puts us at risk of having brain damage, we automatically begin sweating to bring our body temperature down. Another example: Freezing is not good for us; it can damage us which is why we automatically begin to shiver when cold to bring our temperature back up. So far, all well and good.
Well, in a similar way the body has been built to resist weight loss. In the distant past, when food was not easily found, we were often at risk of starving. So, when we lose weight, our built-in mechanisms would kick back in. Rather than shiver or sweat, our brain would increase hunger, shut down fullness and slow down metabolism. So those life-preserving mechanisms are still at work behind the scenes today...
“Somewhere between 3 and 6 months in, the weight loss stops and plateaus. This is biology taking over. Calling it a failure is too simplistic.”
There is a predictable weight-loss curve that almost everyone knows. Early in the weight-loss journey, the weight drops nicely. Then, somewhere between 3 and 6 months in, the weight loss stops and plateaus. This is biology taking over. Calling it a failure is too simplistic.
So why I am telling you this? Well, when people operate under the energy-in/energy-out model, their goals and expectations are based on this.
Someone persuaded to think this way might set a goal of 0.5 kg loss each week. 5 weeks: 2.5 kg. 10 weeks: 5 kg. 30 weeks: 15 kg. Awesome! Hook me up! Well, unfortunately, the chances of this actually happening are very, very slim. Because your body has a different idea for you and, well, you can’t fool mother nature.
There is a huge problem with the widespread “eat less, move more” mindset. When people go through the predictable weight-loss stages – initial success followed by inevitable stopping of weight loss they invariably blame themselves.
That sets people up for an unproductive sequence of events. If there is anything we know about people living with obesity, it is that they repeatedly make significant efforts to lose weight. But over time, their experiences tend to look like this: I try and I fail; I try and I fail; I try and I fail. Sound familiar?
“This pattern of try and fail results in giving up! This is called ‘learned helplessness’, and it is a very dangerous psychological state.”
As a psychologist when I see this pattern it really upsets me. Why? Because this pattern of try and fail results in giving up! This is called “learned helplessness”, and it is a very dangerous psychological state. It feels like depression. It interferes with most aspects of a person’s life. And it erodes a person’s self-esteem.
Recently a number of studies aimed to understand how to improve care for people living with obesity have been done. What we are learning is that people living with obesity do not actually view healthcare providers as sources of support but think that weight management is up to them and that they just need to focus harder on diet and exercise. Providers think they can help but also think that diet and exercise is the only way to go.
I have been working with people living with obesity since the late 1970s. I have seen time and again how incredibly infuriating it is for people with obesity when someone comes along and says, “Well, you just need to eat less and get more exercise.”
It is as if they expect the person with obesity to respond by saying, “Really? Wow, no one has ever said that to me. I had no idea eating less and exercising more would help”.
Having heard this story too many times to recall tells me we have the wrong script. It is time to change the narrative of what obesity means, how it develops and how it is treated.
When someone asks me to explain why obesity rates are rising, my response is, “Because the human brain is no longer adapted to the environment in which it lives.” There’s nothing wrong with the person and the brain. But in combination with the environment, problems can arise.
What would happen if you changed your narrative from obesity is a matter of eating less and moving more, which makes you a failure?
By the way, when one feels like a failure and gives up they stop taking care of themselves.
“It is time to change the narrative of what obesity means, how it develops and how it is treated.”
So, what is the alternative? Well, let me run something by you
What if obesity was a chronic medical condition that results from genetic, environment, biological (especially brain-based biology), social and psychological issues which are amplified in the context of the modern environment of over processed food, overburdened lives, with little time for self-care.
What if despite all of your past efforts, you’ve never actually been treated for this condition. As of yet, no one has approached your care from our current knowledge. Past attempts have centered around the eat less move more perspective.
If you could make this shift, I wonder what would happen?
Here’s my vision: I think this shift has the potential to reintroduce realistic hope into obesity management and to be a pathway to increasing self-esteem.
“This shift has the potential to reintroduce realistic hope into obesity management and to be a pathway to increasing self-esteem.”
My worry is that people living with obesity blame themselves – in fact, we know they do; it is called “internalized weight bias” – and don’t see healthcare providers as being there to help.
However, If we approach obesity similar to any other chronic disease, we can make a difference. Healthcare providers can use the skills they have learned supporting people living with other chronic conditions to help those living with obesity. After all, obesity management is about treatment approaches that improve health, function and quality of life more so than how much weight a person can lose.
I wonder if you’d be willing to reach out and seek help for your condition?