Written by Vinh Le, MS 4, Larner College of Medicine
Obesity is a serious, chronic, and multifactorial condition defined by abnormal or excessive fat accumulation leading to health risk.1 It contributes to some of the world’s leading causes of early and preventable death, such as hypertension, stroke, type 2 diabetes, and even some forms of cancer.1-3 In 2017 alone, it was responsible for the deaths of more than four million people around the globe, and over the next three years it affected 41.9% of people in the United States (increased from 30.5% in 1999-2000).2,4
The sheer volume of books, articles, and anecdotes on this subject can be overwhelming and sometimes even contradictory, so let’s begin by clearing up a few misconceptions. First, obesity cannot be attributed solely to undisciplined eating and physical inactivity (even though they do play a key role).5 Rather, it is associated with many causes and presentations differing for each individual. Underlying medical conditions such as hypothalamic dysregulation, insulinomas, hypercortisolism, and hypothyroidism can certainly play a role.6,7 Certain genetic conditions can also contribute, but it’s not always easy to pinpoint a single causal gene or mutation.3,8 Beyond this, there are nuanced environmental, psychological, socioeconomic, drug/medication, and lifestyle components to obesity and its development.9
As such, we must dismiss the temptation to find a one-size-fits-all solution to obesity. Individual lifestyles and preconceptions should all be uniquely considered. For example, the “Eat Less, Move More” campaign, while important in attempting a global solution, has not proven effective in combating rising obesity rates, even if it has helped decrease excess food consumption.10 For one thing, the raw amount of food consumed does not necessarily correlate with nutritional value, calorie count, or energy density. The mantra has also at times inspired generic and vague advice from medical practitioners – advice that is not always tailored to each individual and their circumstances.11
The existing tools we have to reduce and prevent obesity should be used to their full potential, but none of them should be unhealthily overemphasized, just as none of them should be underutilized. Routine exercise is very important in countering excess weight gain, and it has significant metabolic and cardiovascular benefits. However, it is not a cure-all, and it is important not to exaggerate calorie expenditures for exercise-based activities.3 Limiting consumption of dietary fats can play a role in obesity management, but obsessing over low-fat diets and calorie counting can be detrimental. In fact, some low-fat foods introduced over the years include processed carbohydrates that trigger fat cell storage and slow metabolism – contrasting with natural, unprocessed foods that are truly beneficial to health.12 Also, while saturated and trans fats increase the risk of cardiovascular disease and cancer, mono and polyunsaturated fats help achieve the opposite.3
In addition to recognizing these factors, it’s important to understand the rate of weight loss. Significant health benefits can be achieved even with small amounts of weight loss, but that does not detract from the reality that significant and rapid initial weight reduction can contribute to more effective long-term maintenance.3,13 Lifestyle changes can be more impactful than medication in achieving this.14,15 Yet when used properly, medications can support the process, address root causes, and provide cardiovascular, metabolic, and mortality benefits.16
While reading about obesity, you may encounter theories on the role of the gastrointestinal microbiome. Although it’s true that this microbiome contains trillions of organisms that can impact metabolism, a definitive link between these organisms and obesity development has not been definitively shown.17 Similarly, it’s important not to place too much stock in vitamin, herbal, mineral, or amino acid supplements, which can play an important role in health but do not necessarily contribute to meaningful weight reduction.18
Ultimately, it is a major challenge to navigate and address obesity when stigma and societal pressures exist, misinformation abounds, and personal complexities prevent the formation of broadly effective strategies.19 However, a focus on understanding the biological and environmental factors behind obesity, developing plans that emphasize balance and moderation, and paying attention to the body and its unique needs, are steps in the right direction.
Learn more from these high-quality sources of information on obesity prevention:
- Trust for America’s Health: State of Obesity 2023
- Obesity Prevention: Harvard T.H. Chan School of Public Health
- Thirty Obesity Myths, Misunderstandings, and/or Oversimplifications: An Obesity Medicine Association Clinical Practice Statement 2022
References
2 Adult Obesity Prevalence. Centers for Disease Control and Prevention
4 Obesity. World Health Organization
8 Cohen, D. A. Five Myths About Obesity. Rand Corporation
9 Masood, B. & Moorthy, M. Causes of obesity: a review. Clin. Med. 23, 284–291 (2023).
10 Prentice, A. M. & Jebb, S. A. Obesity in Britain: gluttony or sloth? BMJ 311, 437–439 (1995).
12 Have low-fat diets made us fatter? Harvard T.H. Chan School of Public Health
