A Comprehensive Approach to Obesity Treatment

Obesity in the United States

Obesity is a critical public health issue that impacts all aspects of a person’s health and inflicts a significant burden on our health care system. According to the NIH, obesity and overweight are the second leading cause of preventable death in the United States. In recent years, the prevalence of obesity has significantly increased in the US and now affects nearly 40% of population. Although Utah has the fifth lowest rate of obesity in the country, it still affects about a quarter of our population and disproportionally impacts racial minorities.

Excess body weight is linked with many chronic conditions such as heart disease, diabetes, osteoarthritis and cancer. Increase in weight is directly associated with increase in mortality rate as those with BMI (body mass index) greater than 30 have a 1.5-2.5 times increase risk of dying than leaner individuals. Obesity claims the lives of 1 in 5 adult Americans between ages of 40-85 years old. In addition, excess weight has significant impact on psychological health and quality of life.

Why is it difficult to lose weight?

We know that the solution to this problem is weight loss and that even 5% to 10% weight loss can lead to significant improvements in health. So why is it so difficult to lose weight?

1. Evolution favors weight gain and weight maintenance. Humans have evolved to effectively store excessenergy as fat in times of food abundance so we can survive in times of famine. When someone limits their caloric intake, the body slows down metabolism and increases hunger hormones to offset the caloric restriction since this is seen as a threat to survival. In turn, most who diet will only lose a certain amount of weight over time and will then regain the weight that was lost.
   
   2. There is evidence that mutation in certain genes lead to susceptibility of environmental factors (such as availability of food, composition of diet and decrease in physical activity) and predisposition of certain individuals towards excess weight gain.
   
   3. ”A calorie is not just a calorie”. Different people will have different types of gut bacteria that allows calories from the same foods to be absorbed differently. Someone with a certain type of gut bacteria may absorb all 100 calories from a cookie while someone else may only absorb 50 calories. 

Other factors that contribute to difficulty losing weight include:

• Those with excess weight have been found to have enhanced response to sweets and high caloric foods making these foods more palatable. This leads to increase food consumption and cravings.

• Excess weight on weight-bearing joints, such as the knees and hips, leads to increase in joint pressure. Every pound of excess weight exerts about 4 pounds of extra pressure on the knees. So a person who is 10 pounds overweight has 40 pounds of extra pressure on his knees. This causes joint damage and pain, further limiting mobility making harder to burn energy with exercise.

• Many medications that are prescribed to help with certain conditions such as many of selective serotonin reuptake inhibitors (SSRIs) used for depression, older class of diabetes medications such as sulfonates, steroids, and some of anticonvulsants used for neuropathic pain, lead to weigh gain.

• A significant fear of failure, shame and many psychological factors may also inhibit someone’s weight loss success.

Treatment Options

The good news is that we have successful options for obesity treatment that address many of physiological and psychological barriers to achieving a sustainable, healthy weight. Bariatric surgical options have become much safer and have shown to improve and even cure many comorbid conditions, such as diabetes, obstructive sleep apnea, and hypertension.

• Bariatric surgery is often described as a metabolic procedure since it alters hormones related to metabolism, overcoming some of the physiological barriers that prevent weight loss.

• There are also less invasive options such as the gastric balloon, which is a soft silicone, saline-filled balloon placed endoscopically in the stomach for 6 months. The balloon makes someone feel full, limiting how much someone can eat and therefore leading to weight loss.

• Weight loss medications also play an important role in obesity treatment. The FDA has approved a handful of medications over the last several years that suppress appetite and cravings, helping overcome hormone resistance to weight loss. There are many of the newer diabetes medications such as GLP1-agonist that can be used in patients with diabetes to help with weight loss.

• It is also imperative to work on changing environmental factors. The basis of successful weight loss remains changes in lifestyle with changes in diet along with an increase in physical activity.

The University of Utah offers a comprehensive weight management program which includes medical, surgical and minimally invasive treatment options for those with overweight and obesity. Our program includes bariatric surgeons, a medical weight management specialist from the Division of Endocrinology, Metabolism & Diabetes, gastroenterologists, cardiologists, and psychologists in addition to registered dieticians, exercise physiologists, and health coaches. For medical weight management we offer both individual and group visits. For the surgical patients, we offer bimonthly information sessions and many support groups.

As we move to our new location in Sugar House on October 1st,2019, patients will be able to access all our specialists and additional services, such as exercise and cooking classes as well as Mindfulness Based Stress Reduction in one location. Please go to our website https://healthcare.utah.edu/weight-management/ or call 801-447-1195 to schedule an appointment or for additional information.