The Treatment of Overweight and Obesity as Chronic Medical ConditionsPosted: Oct 16 in Obesity Medicine by Craig Primack MD FACP
To begin our discussion, let’s discuss the current thinking about overweight and obesity. Physicians and scientists now believe that overweight should be considered a chronic medical condition. Practically, this means that we should consider treating our weight like we would consider treating ourselves if we had high blood pressure.
For example, if you found out you have high blood pressure, most people would first go to see their primary care physician. The primary care physician would check your blood pressure and likely start out by asking you to do a few things on your own to help the blood pressure like cut out salt and decrease alcohol use. At your next visit, if the blood pressure was still high, your physician would likely prescribe medical therapy for your blood pressure in the form of a high blood pressure pill. At your follow up visit , if your blood pressure is well controlled, your physician would refill your medicine and arrange the for future monitoring. If after several adjustments in medication your blood pressure is not within normal limits or if your blood pressure is severely elevated which can lead to organ damage, your physician would then refer you to another physician, likely a nephrologist, a specialist in blood pressure control. Your blood pressure specialist will use tools and medications that your primary care does not use everyday as the nephrologist has more experience with hard to treat blood pressure. If at any time, you were decide to stop treatment with your blood pressure medicine or to have a really salty meal, it is no doubt that your blood pressure would go up again.
Let’s use weight in the same example as blood pressure. When you first seek treatment for overweight or obesity, the first person to visit is your primary physician. Your physician may recommend a particular diet and exercise regimen. Like easily controlled blood pressure, this may be all you need. If your weight does not respond adequately (your loss is not enough) or if the diet is too hard to follow or you have been on it prior and had weight regain or you have multiple medical conditions that your current weight is worsening like diabetes, high blood pressure or sleep apnea your physician should send you to a specialist in weight loss called a medical obesity specialist (see www.ASBP.org or www.ABOM.com). This physician is well trained in comprehensive medical weight loss and will use techniques not well studied or known to your primary care physician.
To treat our weight any other way than as a chronic disease (like blood pressure) would be to go against current medical and scientific thinking. Aggressive low calorie diets, exercise, behavioral modification and medical oversight including various weight loss medications are the current best known way to lose weight, and give you the best known way to keep it off. When you are successful in using dietary change, weight loss medicines, exercise and behavioral methods to lose weight, if you stop dieting, taking your weight loss medication or exercising, it is likely that you will regain your weight.
It is unfortunate that at this time we do not have a true cure for obesity. Medical science is continuing the pursuit for a cure. Until a cure is found, we will have to use comprehensive approaches to lose weight and continue these treatments for long periods of time to prevent regain.