The Obesity Medicine Association (OMA) would like to commend Dr. Akshay B. Jain on the excellent article in Medscape , “Obesity and the Bitter Pill of Truth.” This article nicely details that the disease of obesity and individuals affected by it remain highly stigmatized. We don’t tell people with depression to “Think happy thoughts,” because current science and medical understanding of depression is that it is a complex disease requiring multi-modal treatment. Similarly, current medical understanding of obesity is that it is a complex neuro-hormonal disease with genetic and environmental influences. Telling a person with obesity to “Eat less” is equally ineffective (and disparaging).
Unfortunately, medical education continues to fall short. Doctors (and their patients) continue to believe that obesity is solely the fault of the affected individual with no understanding of the genetic, biological and environmental processes involved in body weight regulation. At the OMA, we have sought to fill those gaps by providing high-quality and scientifically valid medical education on obesity.
Much like depression management, treating obesity requires a multi-component approach. We call this the “4 Pillars.” They are: intensive lifestyle intervention, physical activity, healthy nutrition, and medical management. If a person is having trouble with their weight due to an overly stressful job with no time for shopping, cooking, physical activity and sleep, how is telling them to “Eat less and move more” going to help? Intensive lifestyle intervention seeks to help that person with stress management, time management, setting enforceable limits, and learning to diminish the stressful lifestyle.
Similarly, how can we expect a person with obesity to lose weight if they are being treated with multiple medications for related problems making weight loss virtually impossible (sulphonylureas, beta blockers, depo-provera, paroxetine, atypical antipsychotics, amitryptiline, over-the-counter appetite-stimulating anti-histamines for sleep, and so forth)? Why is it that an estimated 86% of people with type II diabetes are offered medication to improve the diabetes, while only 1.4% of people with obesity are offered pharmacotherapy? Why is it that medications are used chronically for other medical problems like hypertension, but medications are typically only used short-term in obesity treatment, which flies in the face of current understanding of obesity as a chronic disease and goes against recommendations from the medical specialty societies?
One of the problems is that the majority of health plans do not cover any of the medications for obesity treatment. This includes Medicare, which does not allow payment for anti-obesity pharmacotherapy, lumping these medications with those for other cosmetic conditions, such as hair loss.
As physicians, we owe it to our patients to provide the current standard of care with regards to the diseases we treat. At the OMA, we urge all physicians to learn the most current science about obesity and the best treatment options. We are one of many organizations offering high quality education on these topics and more.
Again, we applaud the author of this article – it brings to light the bias and stigma that continues to exist towards people living with obesity by those in the public and in the medical field. Thank you for this relevant, timely and important publication.
Ethan Lazarus, MD
President-Elect, Obesity Medicine Association and Delegate, American Medical Association