Individualized approaches key to treating obesity as a disease
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Health care providers should treat obesity as a disease and use a step-by-step approach that is tailored to each individual, according to a speaker at ObesityWeek Interactive.
“We can treat obesity as a disease, provided that we understand that it is a complex and chronic disease,” Carel Le Roux, MD, PhD, professor of experimental pathology at University College Dublin, said during a presentation. “All we have to do is use normal approaches that we use for all of our chronic diseases. Obesity is not more special, but neither is it less special than our other chronic diseases.”
Le Roux noted obesity should not be thought of as a single disease, but rather multiple diseases, because the cause of obesity differs from person to person.
“Obesity may not be one disease,” Le Roux said. “It may be multiple diseases, and thinking that we are going to find one silver bullet that is going to treat everybody is probably not going to be the most successful way of treating obesities as a disease.”
One challenge providers have faced is figuring out which organ to treat. A genetic study published in Nature in 2015 found that at least 80% of genes associated with obesity are linked to the central nervous system, with the subcortical areas of the brain being the most important to treating obesity.
However, Le Roux said, cortical areas of the brain can also play a role in treating obesity. Because of the interconnectedness of the brain, changes in the subcortical areas of the brain can have an impact on the cortical areas.
“Hunger is the best source,” Le Roux said. “If somebody has the biological drive that makes them feel more hungry, or stops them from feeling satisfied after a meal, what you will see is they have increased food-seeking behaviors, so-called appetitive behaviors, and therefore all food looks palatable. High-calorie-dense foods appear even more palatable. That means we have to treat obesity with a combination of approaches. There is no point just focusing on the subcortical areas. We also have to think how we can use cognitive-behavioral therapy and other approaches to combine the entire brain, both the subcortical and cortical areas.”
Le Roux outlined a step-by-step treatment strategy providers can use to find an effective treatment. A typical treatment strategy begins with self-directed lifestyle changes. If that does not work, professionally directed lifestyle changes can be implemented. If lifestyle changes are not enough, providers should add weight-loss medications. If medications do not produce the desired results, weight-loss surgery would be the next option, followed by a combination of therapies.
Le Roux also emphasized the importance of ensuring each individual with obesity realizes that obesity is a disease and to not blame them for having it. Communicating this can help foster a stronger relationship and trust between those with obesity and providers.
“What we can say to patients is [obesity] is not your fault, but it is your responsibility, and it is my responsibility to treat this as a chronic disease,” Le Roux said. “Therefore, we can be successful in the longer term.”
Reference:
Locke AE, et al. Nature. 2015;doi:10.1038/nature14177.
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Le Roux C. Treating obesity as a disease. Presented at: ObesityWeek Interactive; Nov. 2, 2020 (virtual meeting).
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