In addition to doing my own literature reviews, I attended a nutrition conference session presented by independent obesity scientists, including Ted Kyle. The session was sponsored by Novo Nordisk. I was not paid to write this post and my opinions and experiences are my own.
This week is Obesity Care Week 2020.
Obesity is a complex physiological, social, psychological, health challenge. Nobody wants to be obese. Yet there are no shortages of obstacles, which includes limited access to treatment, weight bias and more. Obesity is a word that’s thrown around a lot in my profession and other medical professions. Sometimes, there’s a lot of judgement. We hear it called an “epidemic”. Some claim that the “multi million dollar weight loss industry” is failing since obesity statistics keep growing.
Obesity impacts both children and adults, and there are now more than 93 million Americans impacted by the disease. It clearly is a disease that we don’t want to give up on. Everyone seems to have an opinion about the cause and treatment. Some blame sugar. Some blame overeating. Some blame sedentary lifestyles. But should we throw in the towel?
What if I told you that overeating doesn’t cause obesity, but the disease of obesity causes overeating?
Obesity means a lot of different things to different people. Body weight does matter to medical practitioners who take a variety of things into consideration when it comes to weight. For instance, an anesthesiologist will assess a person’s weight before surgery in order to dose medication. Nutrition counselors provide in-depth nutrition counseling, and are also sure there is always a comfortable chair in their office, appropriate for all of their patients. Primary care physicians may address weight with their patients too, although they may not always know what to say.
Registered dietitians are well aware that every individual’s struggles with eating and health are very personal and unique. When treating a patient for any reason, communication can make a huge difference in both the patient’s acceptance and understanding of a diagnosis. Healthcare professionals should be aware that some of the language has changed over the years.
Ted Kyle has experience in collaborating with leading health and obesity experts. I asked him about how obesity is viewed in the US, and what his advice is about using the appropriate terminology.
“In general, people like to be known as the whole and unique persons that they are. The word “obese” tends to reduce a person’s identity to a diagnosis – a diagnosis that is highly stigmatized.” ~ Ted Kyle
Ted feels it’s important to meet a patient where they are. Here are his tips to help you stay respectful and objective when discussing weight:
- Use neutral, non-stigmatizing language that is respectful.
- If you want to talk about a diagnosis, use the word “obesity” with care.
- Don’t use words like “morbidly obese” or “morbid obesity.”
- In general, it’s best to avoid the adjective “obese” because it’s disrespectful.
- When in doubt, listen to the patient and use the language that they are comfortable with.
It’s Not Just About Numbers or Behavior
It’s human nature to look for easy solutions to problems. We like the path of least resistance. I used to regularly counsel patients for weight loss. My goal was always to listen, and then help them set realistic goals. Years ago I (along with many in my profession) regarded weight management as a simple equation. We knew obesity was classified as a disease, but we may not have realized how the causes varied so much from person to person. We helped patients find ways to reduce calories and potentially burn more of them. Calories in. Calories out.
This equation does work for some people, but we now know that it’s not that simple for everyone. Obesity is a highly heritable disease. For many people with obesity, there is a disorder in the function of normal metabolism. More challenging, this dysregulation of metabolism varies from person to person and does not have the same cause. The causes could include impairment of normal appetite hormones, abnormal energy balance, or endocrine dysfunction including insulin resistance.
Diagnosing and Defining Obesity
It’s also important to understand there is a clinical diagnosis for obesity. According to Ted Kyle, BMI is great for epidemiologists but has a lot of limitations. He feels using BMI can cause problems for clinicians and patients. Instead, there are two clinical scaling systems to aid healthcare providers in their diagnosis.
“The simplest definition for obesity is an accumulation of fat that harms health. BMI is a proxy for obesity, but it neither defines nor diagnoses it. Other measures help a provider assess body composition and the impact on health.”
A person with a normal BMI can still have fat stored deep in the abdomen around the organs, and a person with a high BMI may be metabolically healthy. “One of the few things in obesity that people agree upon is that BMI has serious limitations for the diagnosis of obesity.” says Ted.
We still have a lot of challenges in determining best treatment approaches, and it’s likely best to consider a variety of approaches. Hopefully this information will help you think differently about people who suffer with this disease. It is surely not just a battle of “willpower”. It’s a complex metabolic disorder.