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The U.S. needs to start treating obesity like the disease it is

What better time than in the midst of the holidays – the height of consuming high-calorie cookies, cakes, pies, puddings and pastries – to deliver a message of absolution to those of us who struggle to contain ourselves?

There is a new view of obesity that explains that it is not just gluttony and a hopeless lack of willpower, but a hormonal imbalance. A disease exactly like diabetes, or one of many other diseases that results from a chemical dysfunction that we don’t attribute to a lack of self-control.

This view is based on how our food consumption is controlled by leptin, a hormone produced by fat cells.

Leptin sends a satiety signal to your brain – it tells you when you’ve eaten enough (it has a bunch of other effects too, but none of that matters). Overweight people often have leptin resistance, so they don’t get the message to stop eating. Research suggests that up to 80% of a person’s predisposition to obesity is hereditary, and it’s likely due to this leptin mechanism.

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Incidentally, too little sleep, too much stress and too much of the wrong diet also cause leptin resistance.

Prejudice and misunderstanding

Society, including doctors, tends to see obesity not as a disease like diabetes or high blood pressure, but as a sign of weakness and a stigma. But we need to change that thinking, says Dr. Fatima Cody Stanford, who has a master’s degree in public health and a master’s degree in public administration and is an associate professor of medicine and pediatrics at Harvard Medical School.

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In an interview on NPR, she spoke about this bias and how, for example, we don’t talk about “morbid blood pressure” or “morbid heart disease” the way we talk about someone having a body mass index — a tool used to compare someone’s weight along with their height. rating – of over 40 as “morbid obesity” (the PC term we have to use now is “Class III obesity”). A healthier BMI would be between 18.5 and 24.9.

Unfortunately, this prejudice is often held by doctors, she says, who are therefore resistant to prescribing surgery and drugs to help in the same way they do for other illnesses.

The claim is that only 2% of patients who meet the criteria undergo bariatric surgery and only 1% receive medication.

This is not to say that obesity is not a serious disease. It has many associated pathologies, as documented by Dr. Allen Hardy in The Free Lance-Star Health section on Nov. 13, in his “A Look at Health and Obesity” column.

The Harvard School of Public Health notes an increased global incidence of chronic metabolic diseases, such as obesity-related diabetes, cardiovascular disease and liver disease, which together represent one of “the greatest global health threats of the 21st century.”

Things might change a bit. In 2013, the American Medical Association—not usually a leader in innovative thinking—declared obesity “a disease.” Yet, Stanford laments, medical schools provide woefully inadequate education for aspiring doctors and graduate students — which, given that 42% of the population is overweight according to a 2018 study, is a bit of a shortfall.

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She promotes the use of the newer obesity drugs and insists that they should be used as a chronic treatment, just as we do with insulin for diabetics. We do not expect diabetics to go without treatment after six months, as is the norm with weight-loss drugs.

The problem is that weight loss drugs have a bad reputation. Most notorious was Fen-Phen, which was withdrawn from the market in 1990 due to damage to heart valves. But other drugs, such as amphetamines and their counterparts, cause overstimulation and addiction.

A new class of drugs, the GLP-1 receptor agonists, such as semaglutide (brand name Ozempic) and dulaglutide (brand name Trulicity), which you may have heard a lot about on TV and the Internet, are for the treatment of diabetes. They boost insulin production, slow stomach emptying so you feel full faster and, crucially, reduce leptin resistance, which can lead to weight loss.

For those who dislike manufactured drugs and want something more “natural,” tea, curcumin, cinnamon, wheat, soybeans, resveratrol, and gardenia are also known to aid weight loss by stimulating the release of GLP-1.

We’re held back because “we haven’t recognized obesity for the disease it is,” says Stanford, and thinking “that obese people have brought this on themselves.”

In this day and age where prejudices about race, religion, gender, nationality and who knows what else are emphasized, it seems we need to add obesity to that.

On a side note, I can’t resist throwing in this last little irony I came across.

We are in danger of being overwhelmed by the health problems of the world’s 1,460 million overweight or obese people. But according to the Food and Agriculture Organization of the UN, 805 million people in the world are at risk of malnutrition. The organization also points out that the amount of food produced worldwide is 1½ times what is needed to provide everyone on the planet with a nutritious diet.

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Dr. Patrick Neustatter of Caroline County is the author of “Managing Your Doctor: The Smart Patient’s Guide to Getting Effective Affordable Healthcare.”



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