Facts about Obesity

This is a continuation of our discussion of weight loss myths, perceptions, and facts. Now it’s time to change gears again. In part one and part two of this series, we discussed myths (things that are believed but simply aren’t true), and in part three and part four we talked about presumptions (things we think are true but we can’t really prove it one way or the other – so, unsubstantiated beliefs). Let’s talk about some obesity FACTS that we KNOW are true (according to the NEJM):

• Although genetics plays a large role in our weight, they do not determine our destiny. Moderate environmental changes can promote very significant weight loss.
• Diets effectively reduce weight but generally don’t work in the long term. In the long term, there must be a significant reduction in energy intake (calories eaten).
• Regardless of body weight or weight loss, exercise improves health. Even if no weight is lost, an obese individual who increases physical activity can significantly reduce their health risk from their weight.
• If the amount is sufficient, physical activity and exercise aid in long-term maintenance of weight loss.
• To promote long term maintenance of weight loss, the conditions that led to the weight loss must be continued indefinitely. Because obesity is a chronic disease, when we treat it, it gets better. If treatment is stopped, it comes back.
• Treatment of overweight and obese children is best accomplished with a program that involves the parents and the home setting. This is why we wrote our “Healthy Steps for Healthy Kids” program as a family-based intervention – parents and kids working together on improving the home environment in a specific, structured way.
• Meal replacement products promote greater weight loss. Although this may seem counterintuitive (many patients I treat request more “holistic” or “natural” treatment), meal replacement programs (like Optifast, offered at CNC) offer greater weight loss than those promoting “balance,” “variety,” and “moderation.” In my experience, the fewer decisions an individual has to make throughout the day, the more weight loss is achieved. This strategy works well in maintenance, too. (I always enjoy seeing my pleasantly surprised patients who show me their careful food journals documenting that they have been eating 1000 calories a day with no weight loss for months. I put them on 1000 calories per day of a full Optifast meal replacement program and we can see 50 pounds of weight loss in less than 6 months. They frequently argue that the calories I am putting them on won’t be low enough – I argue that the converse is true. There is really no good way to estimate the calories we eat in prepared foods, and trying to count calories is so inaccurate it is probably not worth the time it takes. The food journal is still critical! Just not as a tool to assess caloric intake. For more discussion on this topic, set up a meeting with Dr. Lazarus, Heather Thomas, or your dietitian).
• FDA approved prescription medications used by obesity medicine specialists help patients with clinically meaningful weight loss. At Clinical Nutrition Center, our patients have had great results with both Phentermine and Tenuate, but only when combined with a behavioral program. Patients are also experiencing good results on the new weight loss drug approved by the FDA for long-term use, Qsymia, and we are excited that Belviq (another new weight loss drug approved by the FDA for long-term use) will be available hopefully by the time you read this. The weight loss is maintained as long as the medications are continued. Unfortunately, discontinuation of the weight loss medication, especially if done too soon after losing weight often results in regain of what was lost. Another study earlier this year (POUNDS Lost) suggests that treatment, in the opinion of Dr. Lazarus, should be discussed in terms of years of maintenance, not weeks or months. In fact, POUNDS Lost suggests that a new set point is beginning to be established 2 years after maintaining a stable weight, and that at this point the risk of regaining what was lost is significantly reduced.
• Bariatric surgery, for some patients, results in long-term weight loss and reductions in the risk of diabetes and mortality. It is important to remember that obesity is a deadly disease. For severely obese patients, gastric bypass surgery can offer a life-changing and sometimes lifesaving treatment.

That concludes this series of articles on myths, presumptions, and facts about obesity. We’d love your comments on these articles!

Written by Dr. Ethan Lazarus