Column: Impact And Treatment Of Obesity

[Written by Dr Fatima Cody Stanford]

As many know, obesity is now classified as a disease by several medical organizations, including the American Medical Association [AMA], the organization that represents doctors nationwide in the U.S.

Taking away the blame

For people who struggle with their weight and the physicians who care for them, this designation of obesity as a disease has been viewed as a victory. Traditionally, there were few resources available to those with obesity as this condition was viewed as self-induced, and therefore presumed to be cured simply with proper diet and nutrition.

Many have believed that if you eat the right foods in the proper portions and follow a dedicated exercise regimen, you will never develop obesity. However, science has taught us that, while this may be the case for some, there is not a “one size fits all” approach to obesity.

Studies show that hormones in the body, such as leptin and ghrelin, can affect people’s weight. These hormones are just a few of the hormones that regulate energy balance in the human body. Leptin, a hormone that is primarily produced by fat, circulates in the bloodstream and signals to the brain whether the body has had enough to eat.

People with higher leptin levels tend to eat more because their body does not sense when there is sufficient food or energy onboard.

Some studies suggest that black people are more likely to have a higher leptin level than Caucasian people. One such study indicated that leptin levels were much higher in black women, even after controlling for factors such as weight. The authors suggested that further research into leptin is needed to investigate racial differences in obesity-related diseases.

Obesity’s impact

Per the Bermuda Hospitals Board, 75 per cent of all Bermudians have overweight or obesity. Trends are similar in the United States.

Ethnic minorities have the highest rates of obesity. In the U.S., these trends persist even when accounting for variations in income and education: African-American men who have a college degree are more likely to have obesity than African-American men without a high school education. African-American women also have higher rates of obesity if they have higher income and education levels.

While we have yet to understand all the reasons that cause higher obesity rates in the African-American community, it is clear that African-Americans are disproportionately affected by obesity and obesity-related disease processes, such as Type 2 diabetes and heart disease.

Relatedly, twice the number of black Bermudians [16 per cent] reported that they had been diagnosed with diabetes as compared to white Bermudians [8 per cent].

Opening doors

Around the world, more dollars need to be allocated towards the treatment of obesity in the adults and children who already have this diagnosis. Efforts should also be made towards prevention of obesity by ensuring adequate resources for all populations.

Estimates of obesity costs demonstrate that this disease process could cost more than $15 million in Bermuda in the next decade.

While the war on obesity is far from over, we have won one battle: obesity has been acknowledged as a disease. Now let’s focus our attention on reducing obesity to improve the health of generations to come.

- Fatima Cody Stanford, MD, MPH, MPA is an obesity medicine physician for adults, adolescents, and children at the Massachusetts General Hospital Weight Center in Boston, and an Instructor of Medicine and Pediatrics at Harvard Medical School.

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