Obesity as a Disease

 Many people think of obesity as a moral failing. They think that obese people simply have no self-control, and if they did they would be slim.

But that doesn't explain why you can have two people who eat exactly the same things and one is skinny and one is fat. I once read of a mother who had two daughters, one fat and one thin. She told her doctor that one daughter loved vegetables and the other one loved doughnuts and pizza. The veggie lover was the one with the weight problem.

Many of us already know that obesity isn't a moral failing, but sadly some health care practioners do not, and blaming their patients for their weight problems can cause even more harm. Luckily, they do not all think this way. Here is a practitioner, Dr. Lee M Kaplan, who told healthcare professionals at a recent virtual meeting that obesity isn't a moral failing but a disease caused by dysfunction of the metabolic system that regulates body fat, in the same way that immune dysregulation can lead to asthma.

Now, if you're thinking of mildly overweight, for example the "freshman 10" or "freshman 15," the amount of weight that some college freshmen are said put on in their first year, that's not apt to be a disease but stress or a more fattening diet than they had at home. If it were a disease, they would have arrived fat.

We're talking about real obesity, a BMI (body mass index) of 30 or more, the kind that really doesn't want to leave no matter how much the person diets. Or if they starve themselves into losing, the weight just returns with time.

No one really understands what causes this metabolic dysfunction. When the hormone leptin was discovered in 1994, some people thought the problem was solved. But it wasn't. Obesity, like type 2 diabetes, is undoubtedly multifactorial, and because of this, different people have different reasons for the problem and different responses to treatment.

A few people who lack leptin can transform from obese ravenously hungry constant eaters to slim normal eaters when given leptin. But those cases aren't common. Most of us will have to find a way of eating that lets us slowly lose the excess weight or resort to weight-loss surgery.

There is no one perfect weight-loss diet. If you're diabetic, I think the best place to start is with a low-carb diet, as this controls blood sugar levels as well as weight. Then you can tinker with the diet to get something you enjoy and you can follow for years. 

On your journey it's important to realize that your obesity is not your fault. You have a disease. Try to find a health care team that understands this and is willing to work with you to find the best treatment for your particular physiology.

It is good that Dr. Kaplan is trying to educate health care professionals. Let's hope that in the future we will all be educated about the complex factors controlling weight.