Obesity is a chronic disease, not just a matter of effort. It’s important to understand the influences of genetics, physiology, environment, job, education and what’s going on in the brain.
What is obesity?
More than just weight gain
Obesity is a chronic disease caused by genetic, metabolic, behavioural, psychological and environmental factors. These factors together with the pleasure we derive from food can all influence energy balance, which in turn can lead to weight gainOnce established, powerful neuro-hormonal factors effectively defend the body against weight loss, thereby often making obesity a lifelong problem, where weight regain (or relapse) is the rule, rather than the exception.
Underdiagnosed and undertreated
Obesity affects 650 million adults worldwide – that’s approximately 13% of the world’s population. It is recognised by healthcare professionals, organisations and people across the world as a chronic disease which requires long-term management. The Awareness, Care and Treatment in Obesity Management – an International Observation (ACTION IO) Study* found that 68% of people with obesity and 88% of healthcare professionals believe that obesity is a chronic disease. Although both people with obesity and healthcare professionals recognise obesity as a chronic disease, it remains underdiagnosed and undertreated.
*The Awareness, Care and Treatment In Obesity Management – an International Observation (ACTION IO) Study is the first international study to investigate barriers to obesity management among people with obesity and healthcare professionals in 11 countries worldwide (Australia, Chile, Israel, Italy, Japan, Mexico, Saudi Arabia, South Korea, Spain, UAE, UK). A total of 14,502 people with obesity and 2,785 healthcare professionals completed the survey.
What factors influence obesity as a disease?
Perhaps one of the reasons obesity continues to be poorly understood, underdiagnosed and undertreated, is that its causes are multifactorial. These causes can be physiological, psychological, genetic, environmental or socioeconomic. Many of these factors are outside of an individual’s control.
Environmental
Many aspects of our environment can contribute to the development of obesity, including exposure to oversized food portions, lack of physical activity due to high amounts of screen usage and easy access to unhealthy food.
Genetic
Some people are genetically predisposed to developing obesity, depending on their family history.
Physiological
Energy balance is a complex mechanism centrally regulated by the brain, with input from peripheral hormonal signals released from the gastrointestinal tract, pancreas and adipose tissue, which are integrated to regulate appetite and energy expenditure.
Psychological
Stress,15 boredom15 and psychological disorders are linked to overeating and can constribute to the development of obesity.
Socio-economic
Where a person lives, the society in which they live and their income can also influence their chances of developing obesity.
All about the science to obesity
Understanding the complexities of obesity goes beyond simplistic views of food availability and willpower, involving an intricate network of energy balance, metabolic adaptations, neurobiology, and hormonal influences.
Why is maintaining weight loss challenging?
A review of 14 long-term studies showed that one to two thirds of people with obesity regained more weight after weight loss achieved by dieting. Furthermore, the ACTION IO study found that 81% of people with obesity have engaged in one or more serious weight loss attempts; however, only 11% were able to maintain a 5% weight loss for one year or more.
Visual adapted from Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;622(3):220–233.
Maintaining weight loss is challenging for people living with obesity, and findings such as from the ACTION IO study* show that obesity isn’t about willpower.
To understand what the effective strategies for obesity management are, we need to consider, physiological, psychological and biological factors of obesity. Although diet modification and exercise continue to be key in the management of obesity, increasingly patients require pharmacological adjuncts in order achieve or maintain weight loss.
It is also crucial to understand the multiple systems involved in the pathophysiology of obesity and interventions to tackle these could be essential in providing lasting weight loss.
*The Awareness, Care and Treatment in Obesity Management – an International Observation (ACTION IO) Study is the first international study to investigate barriers to obesity management among people with obesity and healthcare professionals in 11 countries worldwide (Australia, Chile, Israel, Italy, Japan, Mexico, Saudi Arabia, South Korea, Spain, UAE, UK). A total of 14,502 people with obesity and 2,785 healthcare professionals completed the survey.
