Diet, exercise alone not sufficient obesity treatment for most

Researchers suggest that obesity is a chronic disease with a number of biological causes that make it impossible to be cured with diet and exercise alone in a recently published comment in The Lancet Diabetes & Endocrinology.

Eighty percent to 95% of people with obesity who lose weight eventually regain it. Several biological systems are triggered when caloric intake is reduced, which drives people to eat more high-calorie foods and, in turn, gain or regain weight. According to the researchers lifestyle changes are not enough to override the fat-loss defense for most individuals with sustained obesity.

“Although lifestyle modifications may result in lasing weight loss in individuals who are overweight, in those with sustained obesity, bodyweight seems to become biologically ‘stamped in’ and defended,” Christopher N. Ochner, PhD, assistant professor of pediatrics and psychiatry at Icahn School of Medicine at Mount Sinai and a research associate at the New York Obesity Nutrition Research Center at Columbia University Medical Center, said in a press release. “Therefore, the current advice to eat less and exercise more may be no more effective for most individuals with obesity than a recommendation to avoid sharp objects for someone bleeding profusely.”

Biological adaptations that occur with the development of obesity and undermine health weight loss effors can persist even in people who were are formerly obese and achieve a healthy bodyweight through dieting.

“Few individuals ever truly recover from obesity; rather they suffer from ‘obesity in remission,’” Ochner said in the press release. “They are biologically very different from individuals of the same age, sex and bodyweight who never had obesity.”

The researchers suggest that biological factors should be addressed to help sustain long-term weight loss, but current biologically-based interventions are limited to antiobesity drugs, weight loss surgery and intra-abdominal vagal nerve block. According to the researchers these interventions do not permanently correct the biological factors adaptations undermine healthy weight loss efforts. However, during use, the interventions alter neural or hormonal signaling associated with appetite, which can yield a 4% to 10% reduction in weight.

“Many clinicians are not aware of the reasons individuals with obesity struggle to achieve and maintain weight loss,” Ochner said. “Obesity should be recognized as a chronic and often treatment-resistant disease with both biological and behavioral causes that may require biologically-based interventions, such as pharmacotherapy or surgery, in addition to lifestyle modification. Ignoring the biological adaptations that undermine healthy weight loss efforts and continuing to rely solely on behavioral modification will surely result in the continued inability to treat obesity effectively and the premature deaths of millions of individuals each year.” 

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Ochner CN, et al. Lancet Diabetes Endocrinol. 2015;doi:10.1016/S2213-8587(15)70010.