Managing Obesity: A Work In Progress

Obesity is considered by many to be one of the gravest health threats of our generation. Rates of overweight and obesity in the U.S. have risen at epidemic proportions over the past two decades. Medical complications of obesity are significant and deaths attributable to obesity approach the number attributable to tobacco abuse. Despite this, we have yet to find a “cure” or a consistent treatment that successfully addresses more than a minority of obese patients.

Obesity is neck and neck with cigarette smoking as the most important modifiable medical risk factor, and affects risk of diseases of virtually every organ system, including certain cancers

Approximately 66% (percent )of Americans are either overweight or obese. That's roughly 110 million people.(1) If current trends continue, it has been estimated that nearly all American adults will be overweight or obese by 2030.(2) The rate of childhood obesity and extreme obesity has increased dramatically.(3) And now, even developing nations are seeing an increase in obesity and obesity−related complications, partly because they have adopted a Western diet and lack of exercise.

There are significant ethnic disparities in rates of overweight and obesity. Rates of overweight in African−American and Mexican−American women are approximately 35% greater than age−adjusted rates for Caucasian women; rates of obesity in African−American and Mexican American women are approximately 50% greater than the rates for Caucasian women of the same age.(4)

Obesity is neck and neck with cigarette smoking as the most important modifiable medical risk factor, and affects risk of diseases of virtually every organ system, including certain cancers (Table 1).(5)

Obesity is the most important risk factor in the development of type 2 diabetes, the sixth leading cause of death in the United States. Hypertension and high cholesterol levels are significantly higher risks in patients who are overweight, compared with normal weight patients, and in patients who are obese, compared with overweight patients. Obesity also increases overall mortality, and has recently been shown in Framingham and other populations to shorten life expectancy by a mean of at least several years.(4)

No other field of medicine is as subject to fads and hype, as well as to unreasonable patient expectations, as is obesity treatment. Part of the reason lies in the inherent difficulty of reconciling a society whose main fuels are high caloric density and tasty with an ideal “Barbie doll” body type.

In addition to the medical risks of obesity, obese patients face unfortunate emotional, psychological and social consequences (though the desire to avoid these psychosocial factors strongly motivate many people to try to lose weight). There is widespread prejudice against obese individuals, even among young children. People who are overweight and obese often experience social and job discrimination. This negative feedback from their world often contributes to low self−esteem and the high rate of depression among obese people who seek treatment. In American society, obese women, compared to obese men, bear much greater social stigma.

No other field of medicine is as subject to fads and hype, as well as to unreasonable patient expectations, as is obesity treatment. Part of the reason lies in the inherent difficulty of reconciling a society whose main fuels are high caloric density and tasty with an ideal “Barbie doll” body type.