Is obesity incurable?

In an article recently published in the journal The Lancet: Diabetes and Endocrinology, which hit the popular media by way of The Los Angeles Times (“Diet and exercise alone are no cure for obesity, experts say”) four well-respected weight-management physicians (from Mount Sinai Hospital, the University of Colorado, Northwestern University and the University of Pennsylvania) challenge the common assertion that obesity can be reversed by the common prescription to “eat less and exercise more.”

Perhaps their most alarming statement was that, once obesity has taken hold (which they define as two or more years at a BMI of more than 30) it becomes nearly impossible to turn around. The doctors observe that the body’s natural “set point” becomes elevated and then the “eat less, move more” advice doctors typically give their patients becomes meaningless. They note that, even if a patient manages to lose weight, formerly obese people must remain “at war” with their bodies because they are “biologically very different from individuals of the same age, sex and body weight who never had obesity.” The doctors refer to it as “obesity in remission.”

This idea of a “set point” is not new. Anyone who has ever dieted, or whose weight has fluctuated much, knows from experience that our bodies seem to reach a comfortable plateau and then just settle in there. And it’s maddening that even though we reduce our caloric intake and / or increase our activity, the pudge doesn’t budge.

When I posted this article on Facebook, asking for feedback, I got an earful! For those who commented, this was overwhelmingly their experience. They were doing everything “right” by all measures, but still couldn’t lose weight. Their bodies had found a comfortable set point and no amount of dieting or exercise seemed to make a bit of difference. Their frustration and desperation were unmistakable, and completely understandable.

But as frustrating as the doctors’ conclusion was, three things came to my mind immediately upon reading the article:

• The number on the scale isn’t necessarily the best barometer of health. I’m a big believer in the DXA body scan as a way to test body composition. A body composition analysis will give you your percentages of lean muscle mass, essential body fat and excess body fat. It will tell you bone density and waist to hip ratio. (For a do-it-yourself waist to hip ratio calculator, click here.) These numbers, along with other markers your doctor can test you for (cholesterol, triglycerides, blood sugar, and blood pressure among them) may be better indicators of overall health than weight alone.
• Nobody’s stopping us from eating better and moving our bodies to improve our health, whether it moves the scale or not. Yes, it would be great if our jeans were a little looser, but honestly the ultimate goal is improved health. Even though I know it can be discouraging to do all the “right” things and see no improvement on the scale, making good food and exercise choices means that all the right things are happening inside our bodies. There’s tremendous satisfaction to be found there!
• Forgive my indelicate language, but what the hell are we teaching our children??? How have we abandoned any effort to educate them about proper nutrition? The best way to avoid a lifelong struggle with obesity is to never become obese in the first place! The way we achieve that is to educate our children about proper nutrition. It is not a political issue, nor is it an infringement on anyone’s rights to say that both schools and parents have a responsibility to teach children the importance of caring for their bodies.

The doctors’ paper concluded by saying that their peers needed to do a better job advising their overweight patients how to turn around their habits before obesity set in. And they acknowledge that bariatric surgery may be the only way that many obese patients will ever find any success at weight loss.

But I believe there is another answer that they failed to mention, one that my own readers pointed out from their own experience: hormonal imbalance may be at least partly to blame. Hormones are responsible for telling us that we’re hungry, or that we’ve had enough. They’re integral in the way we deal with stress and how we experience contentment. Until I began seeing a naturopath a few months ago for severe menopause symptoms, my own understanding of how my hormones affected my weight and my health was rudimentary. I believe that conventional medicine’s understanding of how hormones affect our weight is in its infancy. There is mounting evidence that the bath of chemicals most of our Standard American Diet is awash in messes with our hormonal regulators. And though it sounds rather cynical and possibly even conspiratorial of me to say so, there are powerful, big money forces at work to uphold the status quo.

Is obesity incurable? No, I don’t think so. But I do think it’s going to take a groundswell of activism on the part of us stakeholders (aka the American public) to turn this around. It’s my hope that someday processed foods will be as stigmatized as cigarettes are now, exposed to be the tremendous threat to public health that they are.

Also, we need to stop screwing around with our children’s health. As a nation, it is imperative that we take our responsibility to them seriously by teaching them proper nutrition in schools, and by offering assistance and education to their families. Government agencies, doctors and insurance companies, non-profits and private community organizations (YMCAs, Boys & Girls Clubs, etc.), with our support, need to band together to teach healthy cooking classes, offer family-oriented exercise classes and create inviting, accessible activity centers where people can experience wellness in a social and supportive environment.

And finally, doctors need to step up and find more effective ways to reach out to their patients who are teetering toward obesity. I’m guessing that the four doctors who wrote that paper were right; once obesity sets in, it takes on a life of its own and reversing it is next to impossible without medical intervention. But what if that medical intervention was quicker in coming? What if doctors acted proactively with patients, and what if they asserted a unified voice about children’s health and the disgrace that is our nation’s diet?

It’s fair to say that this article got under my skin. People are suffering, and no matter how they got there, they need help getting out. It’s clear that obesity will not go away by telling people to “eat less and exercise more.” We’re all touched by it; we all pay a price for it. We all have a stake in finding solutions.