Obesity: A Rising Threat to Global Health
Fatima Cody Stanford, MD, MPH, MPA, FAAP, FACP, FAHA, FTOS
Obesity Medicine Physician and Scientist
Harvard Medical School
In the Grand Rounds on Obesity: A Rising Threat to Global Health that was delivered on Sunday, September 13, 2020, we covered several points:
· What is obesity and what problems does it present in the US, in Qatar, and throughout the world?
· How did obesity become a threat to global health?
· How do we as physicians and healthcare providers play a role in weight bias and how can we make a change?
· Which strategies might we take to address the obesity epidemic?
In this presentation, I presented work on the definition of obesity based upon Body Mass Index (BMI) criteria from the World Health Organization (WHO). We acknowledge the prevalence of overweight and obesity in the US, Qatar, and around the world. We evaluated the national obesity rates for men, women, boys, and girls in Qatar. It was noted that the national obesity risk for Qatar is 7.5 out of 10 for adults and 8.5 out of 11 for children.
We dispelled the myth that obesity is a simple energy balance equation. Obesity is a multi-factorial disorder in which genetics, environment, development, and behavior all play a role in a person’s likelihood of having the disease. In the regulation of food intake, we demonstrated the role of the hypothalamus and its interaction with hormones such as ghrelin, leptin, PYY, CCK, and insulin. We discovered that levels of BDNF, brain derived neurotropic factor, are elevated in persons who are lean and decreased in persons with obesity.
Fetal programming, and its role in obesity in offspring was explained. We demonstrated how women that have an improved weight status prior to pregnancy have children with a lesser likelihood of severe obesity, improved insulin sensitivity, improved lipid profile, and more beneficial hormone profile. We explored the myriad of potential contributors to obesity which fall under the realms of environmental pressures on physical activity, biological/medical, maternal/developmental, economic, food and beverage behavior and environment, psychological, and social. We explored the prevalence of weight bias and the deleterious role it plays on health. Weight stigma leads to poor eating and physical activity behaviors, physiologic reactivity, poor access to healthcare services, weight gain, psychological ill health and distress, and physiologic health and distress.
We concluded by evaluating the role of lifestyle modification, anti-obesity pharmacotherapy, and metabolic and bariatric surgery in the management of obesity. We discussed the role of weight promoting medications in weight dysregulation. We concluded by studying several patient examples that demonstrated success with lifestyle approaches, medication, and surgery.
Our conclusions were as follows:
· Obesity is a multi-factorial disorder that is pandemic.
· We should utilize all potential treatment strategies, with diet modifications and exercise being first line.
· Pharmacotherapy and metabolic and bariatric surgery should be considered as an option for appropriate patients.
· Weight stigma has a negative impact on the overall health of patients with obesity.
· Obesity is a chronic disease which requires lifelong therapy.
References:
1. Stanford FC, Stevens JR, Stern TA. Editors Facing Overweight and Obesity: A Complete Guide for Children and Adults. Boston: Massachusetts General Hospital Psychiatry Academy, 2018.
2. Stanford FC.Controversial issues: A practical guide to the use of weight loss medications after bariatric surgery for weight regain or inadequate weight loss. Surg Obes Relat Dis. 2018 Oct 30. pii: S1550-7289(18)30343-5. PMID: 30527889
3. Tauqeer Z, Gomez G, Stanford FC. Obesity in women: insights for the clinician. J Womens Health (Larchmt). 2018 Apr;27(4):444-457. doi: 10.1089/jwh.2016.6196. Epub 2017 Oct 27. PMID: 29077514
4. Patel DK, Stanford FC. Safety and tolerability of new-generation anti-obesity medications: a narrative review. Postgrad Med.2018 Mar;130(2):173-182. doi: 10.1080/00325481.2018.1435129. Epub 2018 Feb 8. Review. PMID: 29388462
5. Mastrocola MR, Roque SS, Benning LV, Stanford FC. Obesity education in medical schools, residencies, and fellowships throughout the world: A Systematic Review. Int J Obes (Lond). 2019 Sep 24. doi: 10.1038/s41366-019-0453-6. PMID: 31551484