This morning, at the XIX World Congress of the International Federation of Surgery for Obesity and Metabolic Disorders (IFSO2014), I have the great honour of presenting the 2014 Scopinaro Lecture.
This lecture is named after Nicola Scopinaro, who in 1976 performed the first biliopancreatic diversion for the treatment of obesity.
The Scopinaro Lecture is the highest recognition for a non-surgeon to be awarded by IFSO.
In thinking about what to present, I settled on discussing the topic of whether or not obesity is a disease. Looking back over the work that I have done over the past 25 years, I came to realise that the issue of why some people with excess weight develop health problems and others don’t, has indeed fascinated me for a long time.
Initially, this interest was focussed on trying to understand why some people with obesity develop high blood pressure and others don’t. We were indeed able to show that part of this may be explained by differences in the expression of hormones involved in blood pressure regulation from fat tissue.
More recently, as many regular readers are well aware, I have broadened this interest in describing the limitations of BMI and advocating for a clinical staging system that classifies overweight and obese individuals based on how “sick” they are rather than how “big” they are.
Clearly, this work is of considerable interest to those involved in bariatric care (including bariatric surgeons), as it provides a framework for better prioritizing and assessing risk/benefit ratios than BMI or other anthropometric measures alone.
As I point out in my talk,
- The etiology of obesity is complex and multifactorial.
- The physiology of energy regulation is complex and subverts volitional attempts at weight loss.
- Access to obesity prevention and treatments must be driven by the recognised medical needs to address this condition.
- Multidisciplinary management of this life-long disorder requires resources similar to those required for other chronic diseases
In receiving this honour, I am fully aware that all of my work stands on the shoulders of the many researchers and clinicians who came before me and the considerable support and help that I have been fortunate enough to receive from my many students, trainees, colleagues and supervisors.
This award will certainly serve an a strong incentive to continue my work and advocacy for better treatments for obesity and the advancement of bariatric care.