By Jennifer Seger, MD

The Treatment of Obesity

By Jennifer Seger, MD

When I went through medical training a little over 20 years ago, we were taught very little about obesity. In fact, obesity was not even considered a disease until 2013 when the American Medical Association issued its declaration. Despite this milestone, obesity continues to be the most undertreated chronic disease of modern time.

Currently, two out of three Americans are considered overweight (BMI >25 kg/m2) or have obesity (BMI >30 kg/m2) (NIDDK). The prevalence of obesity is expected to reach 50% in the U.S. by 2030, with 29 states having a prevalence above 50%. Zero states are predicted to have a prevalence below 35% (Harvard T.H. Chan School of Public Health). Obesity affects every organ system in the human body and is a significant contributing factor in hundreds of chronic diseases, therefore, no medical specialty is immune from its impact on patients. Even if a provider isn’t equipped to address obesity, he or she must still take it seriously and provide the patient with information related to effective treatment options. The good news is that there are many options (more on that later).

It often seems as though there is an unspoken policy of “don’t ask, don’t tell” in doctors’ offices when it comes to weight. We readily address the patient’s diabetes, high blood pressure and high cholesterol, but often make little to no mention of the patient’s abnormal BMI. Prescriptions are written and costly interventions are performed, without a word about the importance of losing weight. If advice is given, it often amounts to “eat less and exercise more.” Doctors frequently report feeling uncomfortable discussing weight with their patients. This could be due to a lack of knowledge or inexperience in treating obesity or perhaps he or she is struggling with their own weight. After all, we know obesity affects all ethnicities and all socioeconomic groups, including many of us in health care.

Nowadays, you cannot pick up a medical journal without reading at least one article on obesity. If you haven’t had the time, or perhaps the interest, in keeping up with the rapidly evolving research around obesity, you may be surprised to learn just how complex of a disease it is. The old belief of calories-in versus calories-out has been shown to be a gross oversimplification and does injustice to the metabolic mayhem that obesity can inflict. Underlying contributing factors such as unhealthy nutrition, sedentary lifestyle, hormones, medications, sleep disturbances, stress and even the gut microbiome all play a role in obesity. Genetics also plays a role in sending one down the path of obesity; however, our genetics as a species have not changed in the past 40-50 years, but rather our environment has and that is where we must turn our attention.

It can be uncomfortable, but we need to find a way to start the conversation with our patients about their weight. Perhaps next time you have a patient sitting across from you in the office, consider asking the patient for permission to discuss his or her weight and how it may be related to the other problems you are addressing for the patient. Simply letting the patient know that you are concerned can go a long way to motivate the patient and move him/her along the levels of readiness. If doctors continue to ignore their patients’ weight and its relationship to other chronic diseases, we will only perpetuate the viscous cycle of disease, promoting further pain and suffering and exposing the patient to future health risks.

If you are interested in learning more about obesity, please check out both The Obesity Medicine Association (www.obesitymedicine.org) and The Obesity Society (www.obesity.org) — both excellent organizations dedicated to educating providers about obesity. There is also a more formal pathway in which physicians can obtain certification in Obesity Medicine through the American Board of Obesity Medicine (www.abom.org), which as of today, has certified over 5,000 physicians in the U.S. and Canada. For those interested in an even more extensive education and formal fellowship, please check out the Obesity Medicine Fellowship Council at http://www.omfellowship.org. There are currently 22 active fellowships in the U.S.

Finally, for whatever reason, even if directly treating obesity is not comfortable for you, please don’t ignore the patient’s obesity. Consider a referral to a physician who is certified by the ABOM and one who is experienced, knowledgeable and able to provide all available safe and effective treatment modalities in a comprehensive and compassionate center of care. To find one near you, you can visit https://abom.learningbuilder.com/public/membersearch.

Jennifer Seger, MD is a member of the Bexar County Medical Society.