Experts say treat obesity for what it is: A disease

BOSTON — It is a perennial pledge that, for many Americans, is doomed from the start: a resolution to lose weight.

Statistics show that last year, the top three New Year’s resolutions all had something to do with shedding pounds. To exercise more came in at 48 percent, followed by eating healthier at 44 percent and losing weight at 41 percent.

Obesity experts say many dieters fail in their quest to get slimmer not because of a lack of willpower, but because primitive genetic engineering is up against the realities of the modern food supply.

“We have all of this easily available, high fat, high sugar, very palatable food that we look at and we want it,” said Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital. “Our bodies are saying, ‘Let’s store the fat, in case (the food) isn’t there tomorrow.’ Basically, your body thinks: ‘Let me eat this now because tomorrow we may not have it.’”

What this means is that many Americans are defending a higher body weight because of these primitive instincts, said Apovian.

“Once we develop that higher body weight, for whatever reason, it’s very hard to go back to the lower body weight,” she said. “Because somehow our bodies believe that we need to be this (higher) weight. And so you can’t just diet and exercise. If you really work hard and reduce your calorie intake and exercise more, yeah, you can lose weight. But the hunger hormones come back and they basically make you eat until you’re back at that other weight.”

“We think that those people who have obesity have more of the gene that, eons ago, was such a survival advantage,” said Apovian. “If you can eat more and store more body fat when there is food available and survive during the periods of time when there’s no food available, you survive. And those people that are lean, no matter what they eat, they would have died eons ago.”

These are the people who, today, can seemingly eat whatever they want, without appreciably gaining weight. Apoivian said it’s thought that, at a cellular level, those ‘doomed to leanness’ burn excess calories as heat.

“And those people with obesity, they have the genes that are creating hormones like insulin, that are taking all that energy, being really efficient, at storing it as fat,” she said. “That’s what we think is happening.”

But though it is seemingly ‘only natural’ that some hang on to weight and others don’t, there are compelling health reasons for those with obesity to shed excess pounds.

“It is unhealthy what is going on in the United States with this increased prevalence of obesity,” said Apovian. “It causes joint problems, back problems, breathing problems, mobility issues.”

But those direct effects from excess weight almost pale in comparison to the other maladies linked with obesity, including diabetes, stroke, heart disease, hypertension and some forms of cancer.

Apovian said often it’s not just consumption of too many calories that’s a problem, but also the type of calories consumed.

“Ultra-processed food, which is ubiquitous in this country, is very unhealthy,” Apovian said. “Because it’s usually full of fat and sugar and non-food items, such as preservatives, that are not healthy for your body and are devoid of nutrients that your body needs.”

These foods are also not conducive to reaching a point of satiety, even though thousands of calories might be consumed in a single meal. Apovian advocates a diet of lean protein, whole grains, fruits and vegetables -- which not only give caloric ‘bang for the buck’ in terms of nutrition, but also induce feelings of fullness -- in part, because of the sheer volume that can be consumed without calorically overeating.

Apovian is at the forefront of a relatively new concept in endocrinology: to treat obesity not as a moral failing or a character flaw, but as a chronic disease, one that can be treated with, for example, medications that provide the hormones necessary to feel full while eating less.

“The good news about our anti-obesity medications is that they’re safe and effective,” Apovian said.

The newest ones, liraglutide and semaglutide, are classified as GLP-1 receptor agonists.

“They’re naturally occurring gut hormones,” Apovian said. “With these new medications, we’re giving you more of the satiety hormones. You shouldn’t really look at them as ‘drugs.’”

Despite obesity rates soaring in the U.S. -- up almost 12 percent since the turn of the century to nearly 42 percent of adults, the CDC reports -- relatively few are seeking treatment for the disease.

Part of the reason, Apovian said, is the ongoing misperceptions many have about obesity.

“It’s just like saying, ‘I have heart disease but instead of getting a stent placement or coronary artery bypass surgery, I know I can do it on my own. I’m going to diet and exercise,’” Apovian said. “If you go to your doctor and you have chest pain and your doctor says you need a stent, you don’t say, ‘Oh no, doc, I don’t want that procedure, I know I can do it on my own.’”

Similarly, many dieters can’t do it on their own, even though every January, millions try.

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