Neustatter: America needs to start treating obesity like the disease it is

Neustatter: America needs to start treating obesity like the disease it is

What better time than the middle of the holidays – the zenith of the consumption of high-calorie cookies, cakes, pies, puddings and pastries – to bring a message of absolution to those of us who are struggling to hold back?

There is a new vision of obesity which explains that it is not only about gluttony and a desperate lack of willpower, but about a hormonal imbalance. A disease just like diabetes, or any of the many other diseases due to chemical malfunction that we don’t attribute to a lack of self-control.

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

Leptin provides a satiety signal to your brain – it tells you when you’ve had enough to eat (it also has a bunch of other effects, but that’s beside the point). Overweight people tend to 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 being overweight is genetic, and it’s likely through this leptin mechanism.

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Incidentally, too little sleep, too much stress, and too many bad foods also tend to cause leptin resistance.

Prejudices and misunderstandings

Society, including doctors, tends to view 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 way of thinking, says Dr. Fatima Cody Stanford, who holds a master’s degree in public health, a master’s degree in public administration, and an associate professor of medicine and pediatrics at Harvard Medical School.

In an interview on NPR, she talked about this bias and the fact that, for example, we don’t talk about “morbid blood pressure” or “morbid heart disease” the same way we talk about someone with a body mass index – a tool used to assess a person’s weight as well as height – over 40 as having “morbid obesity” (the PC term we’re supposed to use now is “Class III obesity”) . A healthier BMI would be between 18.5 and 24.9.

Unfortunately, this bias is frequently nurtured by doctors, she says, who are consequently reluctant to prescribe surgeries and drugs to help in the same way as they would for other illnesses.

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

This does not mean 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 of 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 diabetes, cardiovascular and liver disease associated with obesity, which combine to form one of the “greatest global health threats of the 21st century”.

Things may be changing a bit. The American Medical Association — usually not exactly at the forefront of innovative thinking — declared obesity “a disease” in 2013. Yet, Stanford complains, medical schools provide woefully inadequate training for aspiring physicians and doctors. postgraduate students – which, considering 42% of the population is overweight according to a 2018 survey, is a bit of a deficiency.

She promotes the use of new drugs against obesity, insisting that they be used as a chronic treatment, just as we do with insulin for diabetics. We don’t expect diabetics to go off treatment after six months, as has been the norm with weight-loss drugs.

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

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

For those who don’t like manufactured drugs and want something more “natural”, tea, curcumin, cinnamon, wheat, soy, resveratrol and gardenia are also known to help with weight loss. by stimulating the release of GLP-1.

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

In this age where prejudices against race, religion, gender, nationality and who knows what else are highlighted, it seems we should add obesity.

As an aside, I can’t help but add that last little irony I encountered.

We are threatened with being overwhelmed by the health problems of the 1,460 million people in the world who are overweight or obese. But, according to the Food and Agriculture Organization of the United Nations, 805 million people worldwide are at risk of being undernourished. The organization also points out that the volume of food produced globally is 1.5 times what is needed to provide everyone on the planet with nutritious food.

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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