Obesity is a complex disease and the stigma around it helps no one

Figures released by the World Obesity Federation last month were a stark reminder that rates of the disease and its associated chronic conditions are rising dramatically – and will continue to do so in the next decade unless corrective action is taken. The federation believes the economic impact could surpass $4 trillion by 2035, with the health of hundreds of millions of people severely compromised, including 7.5 million people in the UAE , who could be living with overweight or obesity by then. While new treatments and new research findings already offer hope for a better outcome, more action is needed. Destigmatising the disease and creating greater awareness about its myriad causes could go a long way to ensuring people seek support and understand the importance of consulting obesity medicine experts. Obesity is a complex disease with many different forms and causes. We know that some of the causes contributing to its development include genetic, socio-economic, behavioural and environmental factors. The risk for obesity can begin in the womb, with a mother’s insulin resistance or increased body fat raising the risk of future obesity for the foetus. Today, obesity is recognised as a disease by organisations such as the American Medical Association, and yet bias still exists, sometimes even among people working in the healthcare field. Well-meaning practitioners may offer simple advice such as “eat less, move more”. Unfortunately, that kind of advice reinforces the stigma that obesity is a behavioural problem and fails to address and manage the complexity of this chronic disease. A good place to start is to use person-first language that does not define people by their disease – a person “has obesity” or “is overweight” rather than being “an obese or overweight person”. The language we use can have a profound impact and help reduce the stigma. Social stigma surrounding obesity is commonplace and often considered acceptable. Sadly, children frequently experience stigmatisation from peers and adults, which can contribute to a decreased quality of life and raise their risk of low self-esteem, anxiety, depression and in extreme cases even thoughts of suicide. Similarly, studies have shown adults with obesity can face bias frequently, for example when exploring career opportunities or socialising. As a society, we need to be more empathetic and supportive of children and adults who struggle with weight and obesity and recognise that having obesity is not someone’s fault and does not mean a person lacks willpower or self-discipline. We need to address obesity in a non-judgmental, supportive and destigmatising way. Addressing obesity is important as the disease is linked to several other chronic conditions, including high blood pressure, diabetes, high cholesterol, fatty liver disease and sleep apnoea, as well as psychosocial factors such as low self-esteem, depression and anxiety. The earlier the intervention, the better, as complications can be progressive, for example, damage to blood vessels and organs accumulates over time. However, like the disease itself, diagnosing and treating obesity are complex matters, which is why seeing an obesity medicine physician can help. As far as diagnosis goes, body mass index (BMI) is a measure to estimate body fat based on weight and height, and a measure of 25 up to 30 is traditionally classed as overweight, while 30 and above is classed as obesity. However, BMI is not the only diagnostic tool since many factors – including body fat percentage and distribution associated with the development of medical conditions – can vary between people and between ethnicities. It is visceral fat – or fat surrounding organs – that is particularly harmful to health. No single treatment for obesity will work for everybody, and sometimes a combination of therapies is needed. Treatment should be comprehensive and include lifestyle factors such as adequate sleep and stress reduction. In addition, the body has survival and protective mechanisms that often resist the person’s weight-loss efforts, tending to yo-yo around a certain weight set-point it has established. To achieve this, our bodies have developed physiological mechanisms to slow or prevent weight loss. For example, the body can decrease the secretion of satiety hormones, increase hormones controlling hunger, or even lower its metabolic rate. So, while some patients could do well with lifestyle changes alone, others may need additional treatment. Fortunately, we have many effective and safe treatment options today, including new anti-obesity medications, bariatric surgery, in addition to endoscopic procedures. With an obesity medicine specialist, patients can work out the most appropriate and effective long-term treatment plan as well as receive personalised and evidence-based care. Research has shown that newer medications that are effective at treating Type 2 diabetes can also provide weight loss as well as other health benefits in some people who have obesity. When it comes to treatment, it is important to discuss with a trusted medical provider the various options available as medical therapy may not work well for some. A recent four-centre study that included Cleveland Clinic found that bariatric surgery provides superior long-term treatment for Type 2 diabetes in patients with obesity, compared with medical therapy. My colleague Dr Ali Aminian, one of the authors of the research, noted that bariatric surgery could help many study participants to control their diabetes without needing any medications, including insulin. To capitalise on these advances in medicine to treat obesity, it is important that patients feel they can approach healthcare providers for support without fear of judgment from anyone. If society can stop blaming and shaming those with obesity, the stigma associated with this complex disease can be reduced. As more people understand and accept that obesity is a chronic disease that needs long-term and effective treatment, my hope is that more people can access the therapies that they need to lead healthier lives.