Obesity: A Chronic Disease

Traditional medicine has viewed obesity or excess adiposity as an acute disease of “laziness” where patients are simply told to eat less and exercise more. If it were that simple, we would not be in an obesity epidemic right now! The reality is that obesity, for many individuals, is a chronic disease that will need lifelong management, and in many cases, medication. This is evident in patients who indicate that they spent years losing weight only to gain it back plus additional weight. Patients spend many years yo-yoing between restrictive diets and exercising only to regain the weight over and over again.

When we treat obesity as an acute illness we severely underscore the complexity of this disease and the many variables that are in play that contribute to excess adipose tissue. For example, when a patient presents with a sinus infection, we give them a course of antibiotics, the infection clears up and the patient goes on with life! This is not how we should be managing obesity! In fact, we now know that for many individuals the hunger hormone ghrelin actually increases when weight is lost, and it does NOT return to normal levels. What this means is that losing weight can trigger intense feelings of hunger in some individuals making it harder to maintain weight loss over time.

Older weight loss medications (which are highly effective) focused solely on appetite suppression via stimulants such as phentermine. Newer drugs such as the GLP-1 agonists (Wegovy and Saxenda) address hunger hormones such as GLP-1 which increase satiety without the stimulant effect. These drugs have been proven to be effective in helping patients lose up to 20% of their body weight!! In addition, they can also be used long-term for weight maintenance.

Understanding the bio-chemical processes involved in obesity is essential to provide evidence-based remedies for effective management. Healthcare providers who specialize in obesity medicine can provide patients with the support and foundation to better understand this chronic disease while implementing evidence-based plans to help patients lay the foundation for good health!