Obesity For Healthcare Professionals

Obesity in focus: a multidimensional approach

Almost all of us grew up hearing and interiorizing the phrase "eat less, move more," and there couldn’t be a more stigmatizing and frustrating statement, as if each person's weight depended solely on their own willpower. Preconceived ideas and thoughts about individuals have developed, leading to negligent and discriminatory behavior towards a condition that we now know to be a disease - Obesity. Like any other disease, it has causes, treatments, and implications for the patient’s physical and mental health.

Many variables are involved in determining an individual's weight, including genetic (hereditary) and metabolic factors, as well as behavioral, professional, familial, social, cultural, environmental and economic factors, in addition to iatrogenic situations (induced by treatments for other diseases) and/or some diseases (like hypothyroidism or Cushing's syndrome/disease). There are numerous causes contributing to excess weight/obesity, and they are often multifactorial, intersecting with each other throughout the patient’s life. And so a simplistic approach like "eat less, move more" will never work.

It is mandatory to view obesity as a chronic disease that requires (and deserves) personalized treatment and ongoing support throughout life. This multidisciplinary treatment does not consist solely of a standard dietary plan for 60 days, much less in three months of gym attendance. A lifestyle change for life is necessary, but one feasible and adapted to each one, taking into consideration their religion, profession, beliefs, or current state. When discussing lifestyle, it involves dietary plans (food choices), exercise (the best exercise is the one the person actually enjoys and will do, so they won't give up at the first sign of rain or discomfort), being active in daily life (using the stairs more, walking more, etc.), sleeping well, and managing stress and anxiety levels; essentially, being healthy and happy.

Furthermore, it is vital to have a healthy relationship with food. Often, food can be a source of comfort or an escape, or even both, and in these situations, cognitive-behavioral therapy and psychological and/or psychiatric support play a very special role. Losing weight does not have to be a torment nor should it be painful. Let’s look at it from another perspective: being sick, indeed, is a source of unhappiness; being healthy and balanced is supposed to bring happiness (nobody, in their right mind, wants to be sick unless they are psychologically unwell). And if it is common knowledge that a disease is treated with medications or surgery, the same applies to obesity. Nowadays, there are several treatments that we can (and should) offer our patients. Besides being a disease, obesity also conditions many other diseases and worsens the prognosis of others, being responsible for increased morbidity and mortality at all.

But what if the patient does not come to us for obesity but for some other reason? How can we approach obesity without creating stigma, without offending or alienating the patient? Currently, the "5 A's" approachis recommended:

• ASK - Always start by asking for permission to discuss the topic and explore whether the patient is ready for the discussion;
• ASSESS - The degree of obesity (not just the weight and body mass index numbers, which are only numbers, but how the adipose tissue and its impact on health), what the triggers/causes, complications, and barriers to treatment are;
• ADVISE - The patient about the risks of the disease, discussing the benefits of weight loss and treatment options;
• AGREE - Reach a realistic consensus, focused on health and quality of life gains (rather than setting numerical goals);
• ASSIST - And we continue to assist the patient, adjusting treatment, advising, referring, involving other areas and specialties, personalizing care for the specific patient and adapting therapy, because life changes, conditions change, triggers change, and people also evolve.

This personalized, adapted follow-up focused on the patient, involving them and making them part of the decision-making process, yields much better and more rewarding results. We are giving autonomy and independence to our patients in managing a chronic disease for which they can't be blamed for but can make more conscious, informed, and structured decisions. We must be clear and informative, anticipating the challenges and problems that may arise when the patient embraces this project of lifestyle change and health improvement, and there is no better ally to have on our side than the patient. A well-articulated and functional doctor-patient partnership will result in much better outcomes and will respond to the needs as they arise over time. It's important to remember that overly demanding and/or short-term projects can lead to yo-yo situations (gaining and losing weight) that are frequent and traumatizing for patients. When a person adopts a caloric restriction plan (compared to their usual intake), the body responds by increasing hunger because it seeks consistency, stability, and wants to return to what it is accustomed to. As such, it reacts to this deprivation by attempting to increase caloric intake once again. Let's not forget that this is an evolutionary advantage - it was precisely with this protection and homeostasis (stability) that the body defended itself and allowed us to survive as a species.

Thus, more than just losing pounds or reaching a magic number on the scale or clothing, it is important to be healthy, to achieve a weight suited to each individual (their best weight), and to know how to maintain it. We are all different, so believing that there is a single number for everyone, a pre-formatted shape that fits all, is simply out of fashion and stigmatizing. Let's do our best for our patients, as the legis artis dictates - we will gain years of life and years of quality life, above all.