Kaiser Permanente. US: The mantra in obesity treatment is “eat less and move more.” But a leading group of obesity experts, including Adam G. Tsai, MD,
from Kaiser Permanente Colorado’s departments of Internal Medicine and
Metabolic-Surgical Weight Management, question the current wisdom that
diet and exercise alone are sufficient to treat the complex nature of
obesity in an online editorial posted in The Lancet Diabetes & Endocrinology.
They argue that obesity is a chronic disease with biological as well as
behavioral causes that requires biologically based, as well as
behavioral, interventions for most individuals with obesity to maintain
significant weight loss long-term.
Many people with obesity can lose weight, but 80 percent to 95
percent eventually regain those pounds. One explanation for this limited
long-term success, in the opinion of the authors, is that reducing
caloric intake triggers several biological systems that encourage us to
eat high-calorie foods and regain lost weight. The authors argue that if
weight loss is to be sustained for the long-term, at least some of
these biological factors need to be addressed.
“Although lifestyle modifications may result in lasting weight loss
in individuals who are overweight, in those with chronic obesity,
bodyweight seems to be biologically ‘stamped in’ and defended,” explains
Christopher Ochner, MD,
lead author and assistant professor of pediatrics and psychiatry at
Icahn School of Medicine at Mount Sinai in New York. “Therefore with
current advice to eat less and exercise more may be no more effective
for most individuals with obesity than a recommendation to avoid sharp
objects for someone bleeding profusely.”
Moreover, recent evidence suggests that biological adaptations to
obesity that additionally undermine healthy weight loss efforts could
persist indefinitely, even in formerly obese individuals who achieve a
healthy bodyweight through dieting.
“Few individuals who have had chronic obesity ever truly recover from
it,” Dr. Ochner says. “Rather, they suffer from ‘obesity in remission.’
They are biologically very different from individuals of the same age,
sex and bodyweight who never had obesity.”
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