Public Is Urged to Treat Obesity as Chronic Disease : Health: Medical panel calls for long-term weight management rather than focusing on loss alone. Surgery, drugs should also be options, report finds.
The Institute of Medicine called Monday for a fundamental change in public thinking about obesity, saying that the condition should be regarded not as a cosmetic problem but as “an important, chronic, degenerative disease that debilitates individuals and kills prematurely.”
Treatment should be aimed toward long-term weight management, rather than weight loss alone--with the goal of achieving and maintaining the appropriate weight for a person’s overall health instead of for appearance only, the institute said.
Anti-obesity medications and surgery, for example, “deserve a new look as potentially powerful and effective weight-management treatments, if used properly, for some people,” specifically those who have failed with other approaches, the report said.
The panel urged health professionals to consider changing the way anti-obesity drugs are administered--typically they are limited to several months’ use--so that such medications “are treated similarly to those used for the treatment of other medical problems, such as hypertension.”
The institute, part of the National Academy of Sciences, is a private, nonprofit organization chartered by Congress that advises the federal government on health policy. While its recommendations are not binding, they typically wield considerable influence among decision-makers.
The recommendations are likely to take on added importance in light of a movement to promote more tolerance toward those who are overweight and an increasing body of scientific evidence indicating that obesity could have metabolic and genetic underpinnings.
Last week, in fact, researchers announced that they have identified and cloned a gene responsible for obesity. The gene is responsible for secreting certain proteins, or “satiety factors,” which signal the brain that the stomach is full, thus telling it to “stop eating,” the researchers said. Researchers believe that, when this gene is damaged or defective, the signal is not sent or received and obesity may result.
Obese people often suffer discrimination, said the report, compiled by a panel of outside experts on internal medicine, diet and nutrition and psychology. “Perhaps most lay persons, health care providers and even obese individuals themselves do not perceive the metabolic nature of the disease and thus view obesity as a problem of willful misconduct--eating too much and exercising too little,” the report said.
The term obesity refers to excess body fat, while the term overweight usually refers to an excess amount of total body weight--including all tissues.
Men with more than 25% body fat and women with more than 30% are considered obese.
One of every three American adults and one of every four teen-agers and children are obese, according to the panel. The condition has been associated with numerous medical ailments, including cardiovascular disease and hypertension, certain cancers, such as breast and colon cancer and other chronic ailments at an annual health care cost of more than $70 billion a year, the committee said.
However, obese individuals need not reach a rigid appropriate weight to improve their health, the panel said. “Scientific evidence suggests strongly that dropping even small amounts of weight--10% to 15% of initial body weight--can reduce the risk of premature illness and death,” the committee said.
Meanwhile, former Surgeon Gen. C. Everett Koop launched a new campaign timed to coincide with the document on obesity, urging Americans to “eat sensibly, exercise regularly, drop a few pounds (and) shape up.”
Koop, backed by medical organizations, several food and other major corporations, said that his effort is designed to convince Americans of the benefits of even modest weight losses. He is to be joined today by First Lady Hillary Rodham Clinton to kick off the new campaign.
After smoking, “obesity-related conditions are the second leading cause of death in the United States, resulting in about 300,000 lives lost each year,” Koop said.
Americans spend more than $33 billion annually on weight-loss programs and diet aids, such as drinks and foods, a figure that does not factor in “human costs,” such as lowered self-esteem and clinical depression, the panel said.
“We have an epidemic of obesity in this country among both adults and children,” said Judith S. Stern, professor in the nutrition and internal medicine departments at UC Davis, who chaired the panel.
“Tens of millions of people are dieting at any one time, spending billions on weight-loss programs, yet few reduce their body fat to a healthy level, and even fewer maintain the weight lost beyond two or three years,” Stern added. “They need tools for making better decisions about how to lose weight. And all weight-loss programs should be encouraged to better serve the consumer.”
The panel urged the diet industry to engage in full disclosure when dealing with consumers, including releasing information about how well their programs work, approaches and goals. The committee also advised the public to judge the programs based on their success in achieving long-term weight loss, which is defined as maintaining at least a 5% reduction in body weight for a year or longer.
The panel said that drugs and surgery, when used, should be combined with a program of diet, physical activity and behavior modification.
Panelists also said that gastric surgery that makes the stomach smaller helps reduce health problems in severely obese patients who have failed with non-surgical measures.
