It happens almost every day. A radio commercial, a magazine article, a Facebook Ad, the cover of a magazine promising the next best way to lose weight. Many patients come to the office with at least one concern that is weight related. It’s clear that people are concerned about their health or should I say, their weight. But I don’t treat obesity. I don’t do weight loss treatments. I don’t have a weight loss program.
Obesity is a real health issue, or at least that’s what we are told. The statistics are high, many people struggle with obesity, billions of dollars annually are spent on treating obesity, entire medical clinics are devoted to a business plan of weight loss. If it strikes you as strange that we have a defined health problem and yet as a doctor, I refuse to treat it, I invite you to keep reading.
I don’t treat obesity because obesity isn’t the problem. Obesity is a symptom. And until we start recognizing that, we will never be successful in treatment.
What is it that causes obesity? There’s the antiquated, simplistic theory of calories in and calories out. While we can’t completely discount how many calories we eat vs how many calories we burn, if it were that simple, we wouldn’t have an epidemic. But this is just one variable. Obesity is a symptom of poor health and until we address health, we won’t address obesity. So let’s talk about that for a minute. In essence, we don’t get healthy by losing weight, we lose weight by getting healthy.
But before we dive too deep into the variables of obesity and weight loss, let me share a few things about weight. Weight is a term that we use loosely to describe body fat, however, true weight as a measure is made up of more factors than just fat. It includes the mass of the skeletal structure, muscle, organs, water, and body fat. Body fat is at best 1/5th of the equation. Weight is a measure, but it’s an incomplete measure in terms of health. Another common health marker is Body Mass Index (BMI) which is an utterly ridiculous measure used in an antiquated medical system that assumes only two variables, height and weight. It completely ignores muscle mass, body fat percentage, inflammation, and hydration. I might even go so far as to say it’s the worse indicator we use in medicine as a health marker. To do a true assessment of health, one must look at the percent of body fat compared to lean muscle mass. When we evaluate these markers, weight becomes less important and BMI non-existent and we get a true indicator of health because neither excessive body fat or deficient lean muscle mass represents health.
Now, let’s talk about variables of obesity.
Hormones play a significant role in obesity. Imbalance of hormones will cause appetite to increase, fat storage to increase, metabolic disorders, lack of energy, lack of motivation, difficulty being satiated with meals, and many other effects.
Our thoughts regarding food are skewed. We use food as a coping mechanism. We console with it, we celebrate with it, we socialize with it, we evade and avoid with it, we medicate with it. We try to balance an imbalanced life with food and it’s not working. We’ve been sold a bill of goods by the weight loss industry in that a pill or a shot will solve our weight problems. We have believed that excessive weight loss in short periods due to addictive medications and/or excessively restrictive dieting practices are healthy simply because the number on the scale fits our definition of healthy. We have the common view as a friend of mine recently put it, “I want results without having to do the work”.
Our stress management skills are lacking. Our mental emotional coping mechanisms are lacking. We stack our schedules full and disregard the importance of rest and recreation. Many of us are steeped in debt and work in a job we hate. We sit in traffic, complain about politics, and fight with our partners over unmet expectations and we have little to no skills in boundary setting and healthy expression of emotion. So we stew and stress and work ourselves into a mental state that does not promote health.
Our lives are sedentary. We sit in traffic, sit at a desk, and sit on the couch. The majority of our days are spent sitting. When we do exercise, we often do it in a less effective fashion. I don’t typically get too picky about the genre of exercise people do, I like the fact that there are so many styles to choose from and I advise people to do the exercise they enjoy and that they will stick with. Having said that, studies support High-Intensity Interval Training (HIIT) as most effective in overall health, decreasing cholesterol and triglycerides, reversing insulin resistance, and preventing Type 2 Diabetes. Getting up and moving your body is paramount to health.
So here is the situation we have in a nutshell. Our hormones are imbalanced. Exercise is prioritized low. Making poor food choices is common. We eat our emotions and our understanding of food as fuel is flawed. We are tired, busy, stressed and overwhelmed. We demand convenience even at the high cost of our health. We can post all the memes we want about loving ourselves and about valuing what money can’t buy, but until we are willing to objectively look at our shortcomings in regards to lifestyle, we will remain in an obesity epidemic. Until we are willing to put in the work to heal our bodies and our minds, we will at best only have short-term success.
Spending the time and energy to address the aspects of health, feed your body proper fuel, move your butt consistently in a high-intensity manner, add in some resistance training, balance your hormones, and manage your stress, the result will not only be health, it will also be weight loss. And this is why I don’t treat obesity.