If you missed it from earlier today: Obesity

Commercial products targeting obesity are a billion € industry, with less regulation than you would want or expect. What to avoid?  Any product that says it works without changing what you eat or including any physical activity, any product or diet that can target weight loss from just a certain area of the body, any product that promises weight loss faster than 2 lb/1 kg per week, any product using “amazing” before and after testimonials, and usually anything in an IG post #ad.

If you missed it earlier, today I talked #obesity on LMFM radio earlier.

It’s a great week to talk about obesity.  A certain blue-ticked IG influencer was in the tabloids this week promoting her new weight loss journey. Unsurprisingly, the social media promotion of her journey is sponsored by both a supplement company and a fitness company.

Influencers have shaped how we talk about weight.  But when we talk about weight, it is critical we remember that weight is NOT beauty. Weight is not body image (and influencers focus on that a lot, before we even get into the filters and photoshopping).   We need to talk about it.   In fact, as 60% of Irish adults and 20% of Irish children/adolescents are overweight or have obesity.

Weight is part of health (that’s the science). Not more than that – but not less either.

What do I want patients struggling with health risks from excess weight to know?

1. Obesity is a chronic and complex disease.   That means ALL the things that apply to disease apply to obesity. Such as if you don’t get treatment, it can progress and cause more problems later.
2. Treatment is more than just “eat less, move more”
3. Love your body as it is. It is amazing.  Love it enough to take care of it and keep it healthy to help you stay amazing!
4. Like many chronic diseases, the causes are multiple. That means that genes play their part (around 70% in some studies), but so does lifestyle. Also where you live. What job you do.
5. Like other chronic diseases, it can recur. Treatment of obesity is lifelong, and weight can recur.  It is really common to regain weight.  It should be normalised, not shamed as a failure.  But same as recurrence with other diseases, it needs treatment to be adjusted.
6. Do any commercial programmes work? Yes, modest results are possible from programmes that combine evidence-based nutritional advice, increased physical activity, and good psychological and behavioural support. However, in many studies, as few as 4% of participants had the weight loss results they expected.   The weight loss in these programmes is also less likely to help with reducing blood pressure or blood sugar levels.
7. In studies, the type of diet (they studied diets like Ornish, DASH, Mediterranean) or genetics had little effect on how well a diet worked: it was all about compliance.
8. Fasting? The data is still out.  No evidence yet that it is better than any other option.
9. Beauty and fashion influencers are not your best source of advice regarding weight loss. In fact, I am of the strong opinion** that discussion about obesity treatment is completely inappropriate in a context of beauty or fashion. Obesity medicine is not aesthetics or cosmetic.
10. What are the long term health effects of obesity that we are so keen to avoid? (Fact: many of which go into remission with weight loss.)
    1. Mental: depression, anxiety, disordered eating
    2. Breathing: Asthma, sleep apnoea, increased shortness of breath
    3. Pain: arthritis, lower back pain, plantar fasciitis (type of foot pain)
    4. Women’s health: menstrual problems, fertility problems
    5. Skin infections
    6. Gout
    7. Liver disease
    8. Diabetes
    9. High blood pressure (can lead to heart disease and stroke)
    10. High cholesterol (can lead to heart disease and stroke)
    11. Reflux
    12. Urinary problems
    13. Erectile dysfunction (men)
    14. Increased risk of certain cancers
    15. Economic: increased risk of disability affecting employment and medical costs
11. Like all chronic disease, treatment takes more than one approach.  Medications, lifestyle changes, and surgery ALL have their part, and no two patients are the same.

Best advice:  Experts that can help include starting with your GP, who can refer you to hospital-based weight management programmes.   Other options include referral to obesity medicine consultant and INDI/CORU registered dietitians.  Chartered and CORU registered physiotherapists can be excellent at helping people increasing activity, especially for those with significant pain.  Many patients need support from qualified counsellors or psychologists for so many reasons.  Lifestyle medicine docs (like me!) also work with patients to support weight loss journeys at all stages.

So where is the problem?  Patients simply need better access to weight management services throught the HSE.  The lack of affordable and/or accessible properly qualified healthcare professionals (docs, clinical nurse specialists, psychologist, dietitians, physios), access to drugs such as liraglutide or semaglutide*, and bariatric surgery is costing patients more every day.  This is forcing patients to consider unsafe options, including medical tourism for surgery.  This gap in care also leaves patient feeling desperate or being vulnerable to being preyed upon by a multi-billion €, poorly-regulated weight-loss industry (supplements, IV drips, teas, pills, vitamins, shakes, hyponosis, infrared, detoxes, colonics…)

When I work with patients with obesity, I usually try to have the patient commit to trying just one small change at the end of the consultation. If you are reading this, and want to try just one evidence-based effective change?  Eliminate or cut down all sugared beverages and reduce alcohol to low-risk levels (go to drinkaware.ie to calculate your low-risk amount).

Previous Posts on Weight:

Weight Recurrence:  https://emdoc.ie/2022/07/18/why-we-should-use-the-term-recurrence-when-talking-about-weight

**Weight is Not Beauty:  https://emdoc.ie/2022/03/06/should-a-beauty-show-include-or-promote-weight-loss-treatments

Weight is just a Number:  https://emdoc.ie/2022/03/31/weight-is-just-a-number

*What to know about the new drug Wegovy? https://emdoc.ie/2022/02/09/what-are-the-facts-about-new-weight-loss-drug-wegovy