Last week’s New England Journal of Medicine has an article titled “Mechanisms, pathophysiology, and management of Obesity” by Thomas Wadden, an eminence grise, and Steven Heymsfield, who I don’t know but presumably he is a high muckety-muck of this subject. They both receive fees for being on advisory boards of various weight loss enterprises like Medifast, Nutrisystem, Weight Watchers and drug companies. (1)
I guess now is as good a time as ever for an overview of this vast subject in a major medical journal and I guess you can do a brief summarizing outline of obesity in 10 pages.
The mechanisms are eating to much good food and not exercising enough, some medications, and genes. We know genes are important since even today, “Not all people exposed to prevailing urban and rural environments become obese,” although the majority of those genes are still unknown. Also we know that it is very hard to fix, “High relapse rates are in accord with this view and are consistent with the concept of obesity as a chronic disease that requires long-term vigilance and weight management.”
The pathophysiology is that obesity is bad.
The management is lifestyle interventions, drugs and surgery. The components of “high-intensity comprehensive lifestyle interventions” are counseling, diet, exercise and behavioral therapy and that can accomplish 5 to 10% reduction in body weight. The high intensity part and the 5-10% part make this unappealing to most people, moreover it is expensive, painful and usually not paid for by insurance. But you don’t need a doctor; you can do it yourself. Drugs that you are allowed to take forever, when accompanied by at least a little of that lifestyle stuff, can push your weight down a small additional amount, especially the phentermine-topiramate combination. Surgery can cause and make it easy to maintain a 30% weight loss on average, especially gastric bypass. In conclusion, “Creating the conditions for healthy living in our modern environment, including prevention of obesity. is one of the great challenges for humankind.” Prevention is otherwise not talked about in this summary.
And that’s the way it is for Thursday, January 19, 2017
John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- email@example.com or phone-354-6605.
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