America must start treating obesity like the disease it is.

What better time than the middle of the holidays, the peak of consumption of high-calorie cookies, cakes, tarts, puddings, and pastries, to deliver a message of absolution to those of us who have trouble containing ourselves?

There is a new vision of obesity that explains that it is not just about gluttony and lack of willpower, but about hormonal dysregulation. A disease exactly like diabetes, or any of the many diseases due to some chemical dysfunction that we don’t attribute to a lack of self-control.

This view is based on how our food intake is controlled by leptin, a hormone produced by fat cells.

Leptin provides a satiety signal to your brain: it tells you when you’ve had enough to eat (it has many other effects, too, but that’s beside the point). Overweight people tend to have leptin resistance, so they don’t get the message to stop eating. Research suggests that up to 80% of a person’s predisposition to being overweight is genetic, and is likely due to this leptin mechanism.

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By the way, too little sleep, too much stress, and eating too poorly also tend to cause leptin resistance.

prejudices and misunderstandings

Society, including doctors, tends to view obesity not as a disease like diabetes or high blood pressure, but as a sign of weakness and a stigma. But we need to change that thinking, says Dr. Fatima Cody Stanford, who has an MPH, an MPA, and is an associate professor of medicine and pediatrics at Harvard Medical School.

In an interview on NPR, he discussed this bias and how, for example, we don’t talk about “morbid blood pressure” or “morbid heart disease” the same way we talk about someone with a body mass index — a tool that’s used to assess a person’s weight along with their height, over 40 as “morbidly obese” (the CP term we must now use is “class III obesity”). A healthier BMI would be between 18.5 and 24.9.

Unfortunately, this bias is often held by doctors, he says, who are consequently resistant to prescribing surgery and drugs to help in the same way they would for other illnesses.

The claim is that only 2% of patients who meet the criteria undergo bariatric surgery and only 1% receive medication.

This is not to say that obesity is not a serious disease. It has many associated pathologies, as documented by Dr. Allen Hardy in the health section of The Free Lance–Star on November 13, in his column “A Look at Health and Obesity.”

The Harvard School of Public Health notes that a higher global incidence of chronic metabolic diseases such as diabetes and obesity-associated cardiovascular and liver diseases combine to form one of the “greatest global health threats of the 21st century.”

Things may be changing a bit. Not usually exactly at the forefront of innovative thinking, the American Medical Association declared obesity “a disease” in 2013. Yet Stanford complains that medical schools provide woefully inadequate instruction to doctors in training and postgraduates, which, considering that 42% of the population is overweight according to a 2018 survey, is a bit of a lack.

She promotes the use of the newest drugs for obesity, urging that they be used as a chronic treatment, just as we do insulin for diabetics. We don’t expect diabetics to be able to go without treatment after six months, as has been the norm with weight-loss drugs.

The problem is that weight loss drugs have a bad name. The most infamous was Fen-Phen, which was withdrawn from the market in 1990 due to damage to heart valves. But other drugs, like amphetamines and their counterparts, cause overstimulation and addiction.

A new class of drugs, GLP-1 receptor agonists, such as semaglutide (brand name Ozempic) and dulaglutide (brand name Trulicity), which you may have heard advertised on television and on the Internet, are for the treatment of diabetes. They stimulate insulin production, slow stomach emptying so you feel full more easily, and most importantly, reduce leptin resistance, which can lead to weight loss.

For those who don’t like manufactured medicines and want something more “natural”, tea, curcumin, cinnamon, wheat, soy, resveratrol and gardenia are also known to aid weight loss by stimulating the release of GLP-1.

We stop because “we haven’t recognized obesity for the disease it is,” says Stanford, and the thought “that people who are obese did this to themselves.”

In this time where prejudices against race, religion, gender, nationality and who knows what else are highlighted, it seems that we need to add obesity.

As another aside, I can’t resist throwing in this latest little irony I found.

We are threatened to be overwhelmed by the health problems of the 1.46 billion people in the world who are overweight or obese. But, according to the Food and Agriculture Organization of the United Nations, 805 million people in the world are in danger of being malnourished. The organization also points out that the volume of food produced worldwide is 1.5 times what is needed to provide everyone on the planet with a nutritious diet.

Dr. Patrick Neustatter of Caroline County is the author of “Managing Your Doctor: The Smart Patient’s Guide to Affordable and Effective Health Care.”

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