I recently came across a group of surgeons at a local hospital and spent a day with them observing bariatric surgery which included Lap Band insertion and Gastric Bypasses. This made me realise something important about the stigma attached to obesity, willpower and people’s perceptions.
Obesity is all around us and it is on the rise. We are now seen as one of the most obese nations in the world and epidemiologist are not foreseeing an improvement anytime soon. We have proposed a link between obesity and diabetes, cardiac failure, high blood pressure and certain cancers. Yet it seems that this link is largely being ignored on a public health level, or is it?
It is true to say that not much will change until we have an understanding into the behaviour of certain actions. So the first step in understanding the behaviour of overeating is to realise that the cause of obesity is multifactorial and NOT the cause of lack of willpower of the individual.
The Traditional Model
Eat less and exercise more! Simple. You get out what you put in. Right? Well, it’s a bit more complicated than that. I mean think about it. Diets, gyms and weight goals can only take us so far but now we know that there is more to obesity than meets the eye. Something that has to do with the regulation of eating behaviour, which may be out of an individual’s control.
Why it is so difficult to lose weight
Weight is controlled based on the following factors:
Survival – The genetic pool favours food consumption. The body receives impulses to eat in order to survive which at times may be out of our control.
Social factors – Food has been an expression of power, prestige and social status and in many cultures continues to be the case.
Environmental factors – Eating, prehistorically, used to depend on the availability of light. The technology has extended this availability and as a result we now have more time to eat. Therefore our surrounding has affected the amount of food we consume and ultimately affects our body weight.
Biological factors – Every one of us digests, absorbs and eliminates food differently and not one person is the same. Therefore, what we eat will affect each of us differently. There are many hypothesis as to what causes obesity ranging from viruses, intestinal bacteria and the processing of food has also been identified as a risk factor.
Genetic factors – Simply to say that genetic factors, most of which we do not yet understand, can make us more or less vulnerable to obesity.
Regulatory factors – Multiple messengers ranging from hormones, regulatory substances, and neurochemicals affect our eating patterns and body weight.
The treatment
The eating patterns are complex. There is no such thing as a quick fix. The treatment is multi-step process. Firstly if we are to get anywhere with the obesity problem we need realise that it is far more complex than simple lifestyle choices. Support is of great importance ranging from families, friends and general and specialist doctors.
Some specific options include:
– Long term diet and exercise interventions
– Behavioural and cognitive counselling
– Pharmacotherapy
– Surgical therapy
– Social change
Ultimately we need to recognise that obesity is not simply caused by individuals who do not care about their weight. As we have seen it is far more complex than that. As a society we need to acknowledge that and offer all the support that we can.
For more information please refer to Arthur Frank’s article “Why Is It So Difficult To Lose Weight?” published in the American Journal of Lifestyle Medicine (2014).
Wishing all our doctors.com.au Blog readers a safe and happy holiday season.
Until next time.