Seeking expert treatment and management for obesity

Obesity is a complex and progressive disease that, in many cases, requires long-term medical management to improve health and quality of life.

Here, Professor Carel Le Roux, award-winning specialist in metabolic medicine, provides an expert insight into obesity, including how it can be treated and managed.

How can obesity be managed?

The critical response to this question is that obesity is a complex and chronic disease that requires long-term treatment. At the moment, there are many treatment options available, including nutritional therapies, pharmacotherapies and surgical therapies.

Despite this, it is important to understand that these treatments are not weight loss solutions. Rather, these are medical treatments intended for the disease of obesity. This is because patients who suffer from obesity will achieve the most health gains when the disease is under control.

Thus, when it comes to managing obesity, the focus needs to shift away from weight loss to the health gains that can only be achieved with long-term management. The modalities (type) of treatment that can be used, however, can differ between each individual patient.

How is obesity diagnosed?

In the past, obesity used to be defined in terms of how tall a patient was and how much a patient weighed, with the result being that patient’s unique body mass index (BMI). However, this is not a very helpful tool, because it does not reveal information about the amount of fat that sits under the skin or the fat that sits around the organs. This fat is called adipose tissue. It also does not reveal any information about a patient’s deterioration in health.

As a result, the WHO definition is now used, which indicates that a doctor must look for excess adipose tissue – more specifically, adipose tissue that causes a decline in health – to diagnose obesity. It is the decline in health that needs to be focused on particularly, because a doctor must understand the health deteriorations that need to be targeted.

A doctor may ask themselves:

• How much weight does a patient need to lose to become healthier?
• What are the health targets that are specifically important to a patient?

These health targets may be:

• Mechanical (for example, joint pain)
• Metabolic (for example, diabetes or high blood pressure)
• Mental (for example, depression or a low mood)

It is important to address all these health complications in the long-term, and to do it effectively.

When is obesity considered to be dangerous and/or life threatening?

This varies from patient to patient, because even patients with the exact same height and the exact same weight will develop different health complications depending on the type of obesity that they have.

Some health complications increase the risk of death, for example, due to a heart attack. Thus, for example, if a patient develops Type 2 diabetes as a result of their obesity, then it is known that that patient will have a higher risk of suffering a heart attack. In this case, a doctor will need to prevent the development of Type 2 diabetes in advance by advising that patient to lose a significant amount of weight.

Besides these complications, there are functional complications associated with obesity that need to be considered as well.

These may arise when a doctor asks themselves:

• Is a patient able to sit on the floor and stand up without using both of their hands?
• Is a patient able to cut their toenails, or put their socks and shoes on, without difficulty?

While these functional complications may not be life-threatening, they will certainly threaten and reduce a patient’s quality of life. Treatment for the disease of obesity can improve and reverse these complications in the long-term, allowing patients not only to live longer, but also to live better.

How is obesity treated and controlled?

The objective when it comes to managing obesity is for each patient to find a treatment that they will be comfortable with for the rest of their life. If the treatment, for example, is going to change the way a patient eats and what a patient eats, then that patient must be able to enjoy that food for the rest of their life. This is effective in 2 out of 10 patients, who are able to change what they eat and change how they exercise, losing a substantial amount of weight and keeping it off in the long-term.

The other 8 out of 10 patients, however, will not respond to this treatment and will need to be escalated to pharmacotherapy instead. With medication, patients will naturally eat less food, because their mind will not be thinking about food all of the time and they will not be worried about what they are going to have for breakfast, lunch or dinner. This will allow patients to keep the disease of obesity under control, leading to a gradual loss in weight.

Besides these, there are surgical treatments available for obesity that have been the mainstay for more than 50 years for healthy, long-term weight loss. These operations are very safe and very effective.

As a result, patients can now choose between nutritional therapies, pharmacotherapies and surgical therapies for a treatment that will work for them and that will deliver long-term benefits.

If I am diagnosed with obesity, what are the next steps?

After diagnosing the disease of obesity, the next step is to find out whether a patient is prepared to understand that obesity is a complex disease that requires treatment for life.

There is no cure for obesity at the moment, but the disease can certainly be treated and controlled in the long-term. This be achieved with nutritional therapies, pharmacotherapies or surgical therapies.

Patients who choose to have surgical therapy, in particular, can move forward with that treatment without having had nutritional therapy or pharmacotherapy beforehand. This is because a doctor has no way of fully knowing the type of treatment that a patient is going to respond to - whether a patient chooses or a doctor chooses, both will have the same chances of being right. However, a doctor’s job is to make sure that a patient fully understands the advantages and the disadvantages of each treatment.

Overall, most patients will choose to have nutritional therapy. This is very safe and very effective in 2 out of 10 patients.

Some patients, however, will choose to have pharmacotherapy after having tried out multiple nutritional therapies in the past. Pharmacotherapies are now very effective and they can help 7 out of 10 patients to achieve sustained long-term benefits, provided that they continue to take their medication in the long-term. Medications are also very safe and well-tolerated, which helps with the management of chronic diseases like obesity.

Approximately 2/3 out of 10 patients will choose to have long-term surgical therapies. Of those patients, the majority will sustain long-term weight loss. For the other small minority, management of obesity may require a combination of medications, lifestyle changes and nutritional therapies to work alongside surgical therapies.

Effective treatment will help patients to achieve better control of the disease of obesity. However, it is important to understand that ultimately treatment will not make patients slimmer or happier, but rather healthier and more functional in the long-term.

Professor Carel Le Roux is an award-winning specialist with more than 25 years of experience.

If you wish to receive expert treatment and management from a healthcare professional for obesity, do not hesitate to visit Professor Le Roux’s Top Doctors profile today.