Monday, November 17, 2014
In the latest issue of Canadian Family Physician, my colleagues JP Chaput, Zach Ferraro,Denis Prud’homme and I briefly address common myths about obesity.
Here is what we had to say about the commonly held notion that obesity is just about eating too much and/or not moving enough:
“Unhealthy diet and physical inactivity are the “big 2” on which almost all preventive and therapeutic programs for obesity are focused, thereby neglecting other possible contributors to excess body weight. Although intuitively appealing, clear evidence (eg, individual-level epidemiologic data and randomized experiments) beyond ecological correlations is lacking for the big 2.
Many other putative contributors to the increase in obesity (eg, insufficient sleep, psychological stress, endocrine disruptors, medications, intrauterine and intergenerational effects, etc) have supportive evidence that is as compelling as, if not more compelling than, the evidence for the big 2.
These nontraditional or new determinants of obesity influence energy input and output; overeating and reduced energy expenditure are perceived as “symptoms” and not as the root causes of the excess weight.
On the treatment side, an accumulating body of evidence shows that insufficient sleep can impede weight loss and addressing sleep for weight management has recently been endorsed by the Canadian Obesity Network.
Overall, accumulating evidence suggests that health practitioners and clinicians might need to consider a broader range of influential factors (eg, medications, lack of time, psychological stress, fatigue, chronic pain) to adequately identify and address the key factors responsible for the patient’s obesity, which is likely a clinical sign of chronic caloric “retention” (similar to edema being a clinical sign of fluid “retention”). This will enable health practitioners and clinicians to develop a personalized framework that addresses the root causes of patients’ weight gain.
Physicians must move beyond the simplistic and generally ineffective recommendation to “eat less and move more” by investigating and addressing the determinants of increased energy intake, decreased metabolic rate, and reduced activity.”