Live Healthier, Live Freely

ave you ever tried to lose weight? Most of us have. You prepare in advance. You choose a start date. You go to the grocery store and buy healthful food. Maybe you join a gym or commit yourself to daily walks in the neighborhood. And your good intentions get you through a few days. 

You see a change in the numbers on the scale in the first week or two, so you keep going. Your clothes fit a little better. You’re excited! And then, inevitably, the scale stops changing numbers. You are still doing all the same things, but nothing is happening. You get more and more frustrated and start to wonder why you are putting in so much effort when you aren’t getting the results you want. Why isn’t it working?

Unfortunately, this is the scenario that plays out for many of us when we try to lose weight. The reason is this: Obesity is a disease, just like high blood pressure or diabetes. How do you treat high blood pressure or diabetes? Well, sometimes, with mild forms or early onset of the disease, diet and exercise can turn things around. But most people need to see a doctor for help, and a lot of them do need medication. So, why don’t people turn to their doctors for help with their obesity?

This is a great question, but it has a sad answer. Most people who suffer from obesity feel like their disease is their fault. They have been told their whole lives, by well-meaning friends and family members, maybe even by some doctors, “just eat less,” or “just exercise more.” They have started a variety of weight loss and exercise programs that they have seen work for others, but that did nothing for them. Or maybe they lost some weight, but when the program ended, they gained it all back, plus more. 

Now they are left wondering why they can’t achieve the before-and-after results they’ve seen on Instagram and Facebook. They feel shame, and they don’t want to talk about it with their doctor, because they know the doctor will just tell them the same thing they’ve been hearing their whole lives. Eat less. Exercise more.

Well, the truth is that sometimes, diet and exercise simply don’t work. In fact, in a study from Cleveland Clinic where they evaluated patients with morbid obesity who were on a defined diet and exercise plan, only 5% of the patients on the plan were able to maintain significant weight loss. FIVE percent. That’s only five out of 100 people. That means that the other 95 were not successful. Why don’t diet and exercise solve the problem of morbid obesity?

To answer this question, first we have to define what we are talking about. Morbid obesity is defined as a BMI (body mass index) of greater than 35. BMI is calculated based on height and weight, and there are free calculators online to check your own personal BMI. Most people think of obesity as just being “overweight,” but it is more complicated than that. 

Obesity has a large genetic component, meaning that some people are predisposed or more likely to carry excess weight, no matter what they do. On top of that, over time, overeating and lack of regular exercise can “reset” the processes that regulate body fat and appetite control. With a new set point, it can become impossible to lose weight, because the body thinks it is where it should be. 

Can you just eat way less and exercise a lot more? Sure. That is what we would call a crash diet. Crash diets often work in the short term, but they lower a hormone in the body called leptin. Leptin is stored in fat tissue and signals you that you are full. People who have obesity already don’t respond to leptin like others do; it doesn’t signal them to be full. 

When you crash diet, it reduces your fat cells, thereby reducing the leptin hormone. When leptin decreases, it signals the body to feel hungry. You already don’t respond to leptin very well, and now there is a lot less of it! Suddenly, you’re starving and can’t keep up with your crash diet anymore. That’s why so many people regain their weight after crash dieting. 

So now you’re probably asking, why does this matter? If I’m genetically predisposed to have obesity, and you’re saying diet and exercise are not going to work for me, shouldn’t I just love my body the way it is and accept who I am? This is a tricky one! Yes, you should absolutely love your body and appreciate it! Give it credit for all that it can do, and all that you two have been through together so far. But our goal as humans is to live a long, healthy, happy life, right? Unfortunately, obesity can derail that goal. 

Having an elevated BMI is risky, because morbid obesity leads to other medical conditions that can negatively affect your health. Morbid obesity has been shown to directly worsen high blood pressure, diabetes, obstructive sleep apnea, and osteoarthritis. It’s also been shown to cause or impact a variety of other conditions. That means that TREATING obesity also treats those conditions! It’s like a two-for-one (or five-for-one!) deal. 

So, if diet and exercise are not working for you, how do you treat your obesity? Where can you start?

Fortunately, in 2022, we are seeing a lot of advances in the world of obesity medicine. You can ask your primary care provider. They know you best and want to help you to be your healthiest self. Tell them you are concerned about obesity and you are open to treatment. If you don’t have a PCP, there are doctors and other healthcare professionals who specialize in obesity. You can find them by searching for people certified by the ABOM (American Board of Obesity Medicine) or who are members of ASMBS (American Society for Metabolic and Bariatric Surgeons). 

What will these healthcare providers tell you? Well, they will certainly help you with education about healthful food and, of course, exercise. But we know that can get us only so far. There are also new medications that decrease appetite and provide significant weight loss. They can help you determine which medication may be right for you. And, of course, there is bariatric surgery. 

Bariatric surgery (sleeve gastrectomy or gastric bypass surgery) has been shown to reduce excess weight by 70% or more. That means that if you need to lose 100 lbs, and you have one of these surgeries, on average you can lose 70 or more lbs. And bariatric surgery CHANGES those pesky hormones that we have been talking about! It resets that set point and allows your body to find a new baseline at a healthier weight. 

Bariatric surgery is NOT cosmetic surgery. It is a surgical treatment for the disease of obesity. Treating obesity prevents or reduces high blood pressure, diabetes, sleep apnea, and osteoarthritis. It can lead to a longer, happier, healthier life! Don’t delay any longer! There is help for you! If you are suffering from obesity, call a healthcare provider today, and get started on the path to a healthier you!