Why You Should Treat Obesity as a Chronic Disease

Experts have come to recognize that viewing obesity as a failure of willpower is not only unhelpful but also medically inaccurate. Today, major health authorities agree that obesity is a complex chronic disease with multiple causes, including genetic factors and hormonal dysfunction, that generally require lifelong medical treatment.

As health authorities have come to understand obesity, they have shifted treatment focus away from blaming the individual, says Samar Hafida, MD, the vice president of the Obesity Association, a division of the American Diabetes Association, and an assistant professor at Boston University Chobanian & Avedisian School of Medicine in Boston.

“Just as we view hypertension or type 2 diabetes as chronic, lifelong medical conditions requiring long-term management, classifying obesity as a disease acknowledges that it is a persistent, relapsing condition,” Dr. Hafida says.

Focusing on overeating as a cause of obesity also misses many additional contributing factors, including:

• Genetics Specific genes may affect hunger, metabolism, and fat storage. Insatiable hunger known as hyperphagia is a genetic disease.

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• Gut Bacteria People with obesity may have fewer and less diverse gut bacteria and viruses than those without obesity, according to research.

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   These gut microbes also communicate with hormones that control appetite, insulin, and body weight.

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• Medications Weight gain is a possible side effect of many common drugs including antipsychotics, antidepressants, steroids, and beta-blockers.

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• Hormonal Imbalances Conditions such as polycystic ovarian syndrome (PCOS) and hypothyroidism can disrupt the way your body uses energy and stores fat, which can contribute to obesity.

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• Obesity Is Cyclical As body fat increases, our hormones may make it harder for our brain to realize we’re full and easier to believe we’re hungry. This may change diet or exercise habits, which are only some of the potential causes of obesity.

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Healthy lifestyle choices alone may not overturn these biochemical changes. And the failure to recognize these complex root causes of obesity has been damaging to patients, Hafida says.

“It fostered pervasive stigma and shame, leading individuals to avoid medical care or engage in unhealthy behaviors due to internalized biases,” she says. “It has also led to severe undertreatment of individuals.”

Viewing obesity as a disease, rather than something effort alone can fix, changes your treatment options. It also may require testing and iterating to find a plan that works for you.

“One of the things that we don't know right now is which person needs exactly which treatment and why,” Dr. Gudzune says.

Weight Loss Medications

Bariatric Surgery

• Gastric Sleeve In this procedure, about 80 percent of your stomach is removed to reduce the amount of food you can eat.

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• Gastric Bypass A small stomach pouch is created and attached to a part of your small intestine, bypassing parts of your stomach and intestine to reduce their capacity.

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• Duodenal Switch This surgery combines a gastric sleeve with an intestinal bypass, rerouting the small intestine, including the duodenum, so food passes through a shorter section of it.

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• Gastric Band Also known as lap-band surgery, in this procedure a silicon band is placed around part of your stomach to reduce its capacity.

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“We actually see changes in those hormones that regulate body weight immediately after surgery,” Gudzune says. “It's through those metabolic hormonal changes that a lot of the benefits from bariatric surgery are derived from.”

Lifestyle Changes

Although medications and surgery may be the most immediate ways to address obesity’s root causes, experts still recommend addressing your weight loss goals with lifestyle changes first.

“We will start with lifestyle change because we need to see how you respond — and there are folks that do really well in that regard,” Gudzune says.

“Treatment of obesity is not about weight loss,” Hafida says. “It's about health gain.”

Rather than obsessing about the scale, it may be helpful to focus on other health benefits of treating obesity. Work with your doctor to set improvement goals, Hafida says, in areas such as:

• Stamina
• Clinical markers such as blood sugar, blood pressure, triglycerides, liver fat, or sleep apnea
• Mobility and pain-free movement
• Quality of life, from better sleep and higher energy to improved mood and reduced depression or anxiety

“Celebrating these non-scale victories provides motivation even when reduction in the body weight plateaus or is not a certain number of pounds,” Hafida says.

• Loss of muscle mass
• Hormonal changes, such as during the menopausal transition
• Metabolism changes
• Less activity

“Similar to a person with hypertension who needs ongoing medication to keep their blood pressure within a safe range, stopping obesity medication often means the body’s powerful regulatory systems reassert themselves,” Hafida says.

This is why managing obesity requires a team, just as other serious medical conditions such as diabetes, heart failure, or cancer would, Hafida says. Over time, your care providers may include everyone from your primary care physician, sleep-medicine specialist, and physical therapist to a cardiologist, registered dietitian, and surgical team, depending on your obesity-related complications. Keep conversations going with your medical team about your physical and mental health, too.

“This collaborative approach ensures all aspects of the disease — biological, nutritional, behavioral, and psychological — are addressed in a coordinated, compassionate way,” Hafida says.

• Recognizing obesity as a chronic disease helps shift the focus from blaming individuals to addressing the complex biological factors that may be the cause.
• Treatment plans that focus on root causes over willpower and calorie deficits may lead to more effective personalized care.
• Lifestyle changes are still a pillar of weight loss treatment, even if you are also receiving a more intensive treatment such as bariatric surgery.
• Continuous management and regular monitoring with a healthcare team are critical, much like managing other chronic conditions.