People who are obese know that long-term weight loss doesn’t come easy. Yet, often they are prescribed to simply make diet and exercise changes to treat their excess weight. Research has shown that obesity is much more complex than simply a matter of overeating and not moving enough—there are biological factors at work. In an article published in The Lancet Diabetes & Endocrinology, obesity experts explained that while a healthy diet and exercise may help obese individuals lose weight in the short term, around 80-95% eventually gain back that weight. They say that it’s in part because of a type of biological “fat loss defense” that is activated when obese people reduce their calorie intake. The defense mechanism encourages the body to stay at a higher weight. It was beneficial in the past when we had food scarcity, but works against us in our modern time of food abundance. Most obese people are not able to override the mechanism in the long-term.
So, if this is the case, what can be done? The experts say that obesity should be recognized as a ‘chronic and often treatment-resistant disease‘. Weight loss surgery appears to be the only obesity treatment that works long-term. Weight loss procedures, such as gastric bypass, have been shown to reverse changes in appetite-related hormones, addressing some of the underlying issues contributing to a person’s obesity. With the surgery, the necessary eating and lifestyle changes have a much better chance of leading to success.
The authors do encourage people to make healthy lifestyle changes because they can be beneficial even if they don’t lead to weight loss. If an obese person starts to exercise regularly and eats the same amount, he or she may not lose weight, but they’re reducing some risks associated with obesity.
The recently published article in Lancet reinforces what bariatric surgeons have known for quite some time: diet and exercise rarely result in long-term weight loss. However, we have to be very careful with how study results are perceived by our patients. Firstly, it is important to encourage our patients to exercise regularly to help with their cardiovascular conditioning, body contouring, and emotional well-being. Secondly, although we refer to many surgical interventions as “permanent”, experience tells us that long-term effects of all stapling procedures wane over time. Therefore, it is true that surgical intervention has the highest chance for accomplishing long-term weight loss. But, without significant behavioral modification (change in relationship with food), even surgical procedures suffer from lack of durability.
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