The obesity issue: It’s about more than weight

I attended a seminar on obesity earlier this month, led by Dr. Arya Sharma, professor of medicine and chair for obesity research at the University of Alberta. I am glad I did, because obesity is a lot more complex than I believed.

Let me begin with attitudes. In some African communities, a young woman may be considered unfit to be a mother and ineligible for marriage if she is thin. Our own society tends to idolize slimness.

As a result, many large individuals have a poor self-image. Twenty per cent of thin Canadian women are dieting to get thinner.

We blame the obese for being so.

“It is because they eat junk food, drink pop and lie on the couch” is a common attitude. It could be because both breadwinners are working and have no time to prepare and eat healthy meals. Maybe there is insufficient money to purchase fruits and vegetables.

Once large, weight management is difficult and hard to sustain. It is all because of the nature of the human brain and its “set point.” A person’s set point is the highest weight he reaches.

That weight starts small when we are infants and grows as we grow. It increases further when we put on weight. The set point will reset if we gain, but can’t decrease.

When weight falls below the set point of an individual, his brain will use all its control mechanisms to oppose the weight loss. No wonder sustaining weight loss is a lifelong commitment — if you live in a calorie-rich society.

Some big people remain healthy and live long lives. Many develop significant diseases, such as diabetes and high-blood pressure. The list of possible health complications is long. The bigger you are, the less likely you are to be healthy.

The drivers of weight gain are many. Nevertheless, 95 per cent of the gain is due to taking in too many calories, as opposed to too little physical activity or a low metabolic rate.

You can eat a lot more calories per minute than you can burn in a minute of exercise. Activity is valuable for other reasons. It makes you feel better and reduces stress. In turn, you may eat less.

The three biggest barriers to weight loss are lack of time, stress and sleep deprivation. If you do not eat regular meals, there is little chance for success. Healthy foods need to be prepared and chewed. Fast foods are energy dense, with many calories in a tiny package.

Is there a quick fix? There are no drugs approved in Canada to help with weight loss. After weight-reduction surgery and medically supervised low-caloric diets, individuals still need lifelong commitment to sustain the initial loss.

Nor is the individual prescription simple and straightforward. You have to explore the life issues that are underlying eating habits and set individual health goals.

A weight loss number should not be the sole goal. It should be about improving health and well-being. You may need a variety of health-care professionals to support you: family physician, dietician, psychologist and physiotherapist, to name some. Long-term follow up is essential.

It is clear now the best treatment for obesity is prevention.

So far, Ontario has taken only baby steps in this direction. But with the right leadership and long-term commitment, it can be done.

Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective.