Is Obesity a Question of Choice?

This is the title of a Canadian Institutes of Health Research (CIHR) Marketing & Communications and the Institute of Nutrition, Metabolism and Diabetes (INMD) 2008 Journalist Workshop being held in Toronto.

Speakers include INMD Director Diane Finegood, Angelo Tremblay, JP Despres, Gillian Booth, Kim Raine, Hertzel Gerstein, Mark Tremblay and JP Chanoine (all of whom are prominent Canadian Obesity Network members), very much reflecting the wide range of issues relevant to obesity.

I had the privilege of delivering the Keynote Lecture at the dinner event in which I focused on why I believe that patients with obesity deserve treatment like patients with any other chronic disease of our times. Even if we do not know how to cure obesity, we certainly have treatments that work and know the significant benefits that treatment can have on morbidity and quality of life.

As expected, this notion led to an interesting and extensive discussion with the usual challenges including not least the question why people with obesity cannot simply pull themselves together and make “healthy choices” to overcome their problem.

Well, of course that was the whole point of the symposium – to explain how complex the psychosocial and biological determinants of obesity actually are and why it is that individuals have such a hard time controlling their weight.

I emphasized all the usual points, well known to readers of my blog:

1) Weight is tightly controlled and cognition-driven changes in energy intake or output are immediately countered by the body’s natural ability to restore energy stores making long-term weight-loss maintenance a life-long struggle

2) For obesity treatments to work (irrespective of whether they are behavioral, pharmacological and/or surgical) they have to be continued indefinitely to avoid relapse

3) Lack of adequate access to obesity treatments within the health care system is largely a reflection of the continuing bias that obesity is a self-inflicted condition that can be controlled by will-power alone

4) Because obesity is a remarkably heterogeneous condition, no single treatment fits all

5) The vast majority of health professionals are not trained to deal with this condition (which is why for example the University of Guelph and Humber College in Ontario have now decided to offer a course specifically for fitness professionals wishing to work in this area).

Lot’s of great questions and note taking – curious to see what the media will do with all this information in the next few weeks.