Globally, millions of people struggle with obesity. In the United States alone, obesity is the second leading cause of preventable death. Obesity is defined as an abnormal or excessive fat accumulation that may impair health.
Obesity is not simply caused by overeating or an unhealthy diet and lack of physical exercise, but a complex condition whereby different factors play a role in how the body regulates weight. These contributory factors include, among others, age-related changes, genetic factors, disordered eating, sleep deficits, physical disability, and increased sedentary time.
Many individuals struggling with obesity resort to dieting and long hours of exercise to lose weight, but on cessation, the majority (96 per cent) regain the weight. According to Dr Fatima Stanford, an obesity medical consultant at Massachusetts General Hospital and Harvard University Medical School, obesity has little to do with willpower but is determined by what a person’s brain ‘thinks’ his/her body needs. She further challenges other notions about obesity. Some of her insights include:
Recognition of obesity as a disease: Obesity should be categorized as a disease. It is the brain that instructs the body on how much to eat and how much to store. Reluctance to recognise obesity from this perspective comes mainly from people not understanding this underlying cause. Too often, obesity is considered a lifestyle choice. In fact, the main cause of obesity is genetics.
Individuals born to obese parents have a 50–85 per cent chance of having the disease even with optimal exercise, diet, sleep, and stress management. Medical staff should treat obesity with the same care and aggressiveness as they would treat heart disease. Additionally, by recognising it as a disease, the stigma associated with obesity could be eliminated. For example, instead of referring to someone as ‘obese’, one can refer to them as a ‘person with obesity’.
Teaching obesity at medical schools: Studies by Dr Stanford found that most medical schools neither teach obesity as a disease nor offer courses on its diagnosis and treatment. This results in doctors not understanding obesity and thus treating it with indifference compared to other diseases. In some cases, obesity is exacerbated by medical staff not considering the possible side effects of obesity on medications they prescribe for other diseases, or by incorrectly prescribing medication to treat obesity. This, therefore, calls for medical schools to integrate obesity into their educational programmes to ensure doctors treat the disease correctly.
Insurance coverage for obesity treatment: Most insurance companies do not cover anti-obesity medication. These drugs are expensive, so the great majority of people cannot afford them. If more insurance companies covered these medicines, overall government and private healthcare spending would be reduced. As Dr. Stanford notes, “It is very frustrating to see patients daily who desperately need to lose weight to reduce their risk of diabetes, hypertension, stroke, or heart disease, but they aren’t able to receive effective and safe drugs because insurance won’t cover them.” Some companies list obesity drugs in the same category as those used for cosmetic purposes, while others recommend only counselling on behavioural change. This is akin to telling a type-2 diabetes patient to stop eating sugar and he/she will be fine!
Research and regulation are essential: The pharmacology market comprises all sorts of prescription drugs for obesity. This stems partly from doctors lacking knowledge of appropriate treatments. Additionally, there are huge costs associated with the correct drugs. It is therefore incumbent upon governments to invest in research to develop more effective obesity treatment options. This will not only reduce the overall cost of treating the disease but also ensure that patients receive safe and adequate drugs with minimal side effects.
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In summary, governments need to be more proactive to ensure that obesity is recognised as a disease and recommendations such as Dr Stanford’s are taken seriously. The inaccurate notion that people with obesity lack willpower, or are not doing enough in terms of dieting and exercise, must be abandoned. Doctors need to prescribe safe medications that will not have obesity as a side effect or result in other health complications. Through raised awareness and reduction of stigmatization, patients suffering from obesity can be treated with dignity.
Dr Kakonge is the former Kenya Ambassador and Permanent Representative to UN Office and WTO in Geneva (Switzerland)