Losing weight after COVID-19 lockdown: what if the answers are not where
you've been looking?
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
Knowledge Is Power:
See The Problem For What It Is
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.
Underweight
—
BMI 10.0-18.5
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.
Normal weight
—
BMI 18.5-25.0
The medical community recommends that you keep your weight within
this range.
Pre-obesity
—
BMI 25.0-30.0
* 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.
Obesity I
—
BMI 30.0-35.0
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.
Obesity II
—
BMI 35.0-40.0
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.
Obesity III
—
BMI 40.0-50.0
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.
Behaviour is simple. Weight is not
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.
Share
”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...
Share
“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.
How the “eat less, move more” mindset actually harms us
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?
Share
“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.
Time to change the narrative
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.
Share
“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?
Hope
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.
Share
“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?
References
Bray GA, Kim KK, Wilding JPH, World Obesity Federation.
Obesity: a chronic relapsing progressive disease process. A position
statement of the World Obesity Federation. Obes Rev Off J Int Assoc
Study Obes. 2017;18(7):715–23.
AMA resolutions. June
2012.
Food and Drug Administration. Guidance for Industry
Developing Products for Weight Management 2007;
Canadian
Obesity Network.
EASO: 2015 Milan Declaration: A Call to
Action on Obesity.;
Mechanick JI, Hurley DL, Garvey WT. Adipposity-based chronic
disease as a new diagnostic term: the American Association of
Clinical Endocrinoligy and American College of Endocrinology
Position Statement. Endocr Pract Off J Am Coll Endocrinol Am Assoc
Clin Endocrinol. 2017 Mar;23(3):372–8.
Waalen J. The
genetics of human obesity. Translational Research 2014;
164(4):293–301.
Kaprio J, Eriksson J, Lehtovirta M, Koskenvuo
M, Tuomilehto J. Heritability of leptin levels and the shared
genetic effects on body mass index and leptin in adult Finnish
twins. IntJObesRelatMetabDisord2001Jan251132-7.
2001;25(1):132-7.
Freedhoff Y; S AM. Best Weight: a Practical
Guide to Office-Based Obesity Management. Canadian Obesity Network;
2010.
Sharma AM, Bélanger A, Carson V, Krah J, Langlois M-F,
Lawlor D, et al. Perceptions of barriers to effective obesity
management in Canada: Results from the ACTION study. Clin Obes. 2019
Oct;9(5):e12329.
Caterson ID, Alfadda AA, Auerbach P, et al.
Gaps to bridge: misalignment between perception, reality and actions
in obesity. Diabetes Obes Metab. 2019;1–11.
Vallis M.
Quality of life and psychological well-being in obesity management:
improving the odds of success by managing distress. Int J Clin
Pract. 2016 Mar;70(3):196–205.
These ten questions can help to start a dialogue and take the first
steps towards understanding what treatment options for weight management
are available.
Obesity is a complex disease but treating it does not have to be.
Trained healthcare providers have the knowledge and tools to create a
treatment plan that works for you.
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