A report from the U.S. Centers for Disease Control and Prevention shows that obesity rates have remained at a staggering 40 percent since 2021 and that severe obesity is at about 10 percent.
I get it. As a Gen X physician, I grew up on fast food, TV dinners, Twinkies and soda pop. Over the decades, I watched my waistline get older and wider. By my mid-20s, I was overweight, with a Body Mass Index hovering near 30.
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When I became a physician in the early 1990s, I adopted a plant-based diet and started to regularly exercise. Though unaware at the time, I was very fortunate because that shift resulted in significant weight loss and good health.
My own experience initially led me to believe that weight loss was just a matter of commitment and a modicum of self-control. Without having to take any regularly prescribed medications, at 58, I’m in the best health of my life.
Back then, early in my career, fellow physicians — most of whom were lean — argued that obesity was a direct result of laziness and overindulgence. Many of my lean colleagues refused to recognize obesity as a disease.
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The National Institutes of Health declared obesity a disease in 1998. In 2013, the American Medical Association voted to recognize obesity as a disease requiring treatment and prevention efforts.
Irrespective of its designation, the morbidity and mortality associated with obesity has been known since the time of Hippocrates. Obesity is a risk factor for many serious medical diseases such as hypertension, dyslipidemia, Type 2 diabetes and coronary artery disease.
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It’s also a risk factor for many psychological ills such as depression, anxiety, shame and poor self-esteem, and has been associated with several forms of discrimination.
Until recently, with few exceptions, I prescribed for my overweight patients only lifestyle changes that mimicked my experience. My attitude was that if it worked for me, it should work for them.
Unfortunately, only a minority of patients responded. The ineffectiveness was frustrating; I also became condescending to them.
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It has taken me a decade or so to appreciate that obesity is a complex and mostly neurological and inheritable disease.
Over 500 obesity gene-like structures have been identified to date. Twin obesity studies show that heritability is correlated with the disease in roughly two-thirds of people, with a range of 40 percent to 75 percent.
For people who are adopted, their BMI correlates better with that of their biological parents than their adoptive parents. Factors including energy expenditure, food choices, hunger and satiation have all been shown to be significantly heritable.
Like most diseases, environmental factors certainly contribute.
My childhood environment included easy access to calorie-dense food and a sedentary lifestyle, so when that was superimposed on my own genetic predisposition, it contributed to my becoming overweight.
But I do not think I would have become overweight if I had a different set of genes. Similarly, my favorable response to lifestyle changes would not have been possible had I inherited a different set of genetic elements that predisposed me to obesity.
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Only a small and very fortunate subset of obese people can effectively lose significant weight with a change in lifestyle. For most, the prescription of calorie restriction and vigorous exercise takes great effort but unfortunately becomes futile.
Many of my patients valiantly tried for years to lose weight. Unlike lucky me, most fail. It’s not usually a matter of effort or moral failure. It’s a matter of different obesity-predisposing genetic elements that canceled out a lot of discipline and sometimes heroic efforts.
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With the recent advent of a new class of GLP-1 drugs, including Ozempic and Wegovy, for the first time in my 31-year career as a physician, there is finally a set of drugs that can really help obese patients.
Awaiting a broader and longer clinical experience with these seemingly revolutionary drugs, I am cautiously optimistic about physicians helping patients effectively treat this scourge of obesity.
With science, not supposition, it is possible to slow the rates of obesity for a healthier population.
