As appeared on MDAtl.com.
As the coronavirus pandemic comes closer to the 2-year mark, the impact of many chronic conditions continues to become more evident in American society. It is clear that a history of heart disease, diabetes and obesity increases morbidity and mortality with COVID.
The southeastern United States continues to lead the nation in rates of those three risk factors.1 It is common for practicing physicians in the Atlanta metro area to hear a common story from their patients. "My health got worse during the lockdown." "I gained 20 pounds during the pandemic." Or "I'm under so much new stress that I don't have time for myself." The change in daily living during these past two years has greatly impacted the quality of life of many communities that we serve.
Obesity continues to be a prominent driving force that contributes to many associated comorbidities. The rate of obesity in the United States continues to rise. An estimated 42.4% of Americans are now classified as obese as of 2018 CDC data. Severe obesity is seen in 9.4% of the population. These rates have continued to rise year over year since the 1990s when obesity was classified as an epidemic.2
As the importance of treating obesity is being realized, efforts to redefine and treat this chronic disease state have emerged. Multidisciplinary approaches are being developed to treat the obese population in a manner that moves away from the traditional thinking of focusing on willpower, calorie imbalance and increasing energy expenditure. We have become aware that obesity is a much more complex disease process that requires a spectrum of treatment options to help address the particular cause of obesity.
This spectrum of treatment involves different medical specialties and disciplines. Treatment options can start with simple support from family and friends, move to working with a dietician and exercise physiologist, or get therapy with a behavioral health provider. Supervised diet programs and medical weight loss at the direction of a medical bariatrician provide a more structured tool. Surgical interventions are the most invasive, but also most effective and longest-lasting option.
All of these "tools" only work as well as the person can use them. Just taking medication or getting surgery does not guarantee a good outcome. Overall lifestyle changes, behavioral health support and control of possible underlying medical conditions are all necessary to get the best possible outcomes.
The pandemic and the resulting lockdowns, quarantines and changes for many to a work-from-home environment have elevated the importance of lifestyle choices. The number of people seeking help with weight has increased over the past year. Also, the amount of revisional bariatric surgery has increased as well.
I feel that this is also due to life events that have derailed people from their normal habits that were helping to maintain their weight postoperatively. The interplay between weight, physical and emotional stress, nutritional shifts, financial uncertainty and new ways of social interactions has had a strong effect on a population of people that can already be hard to treat.
In this issue of Atlanta Medicine, we want to provide current and ongoing changes in the field of obesity and bariatric medicine. There is a move away from using traditional definitions of obesity based on BMI and looking more at overall adiposity and its distribution in the body. The importance of exercise on overall health and sustained weight loss has been known for some time but is now getting a fresh look. There have been multiple newer-generation medications that have come to market in the past few years, and a couple of them have stood out as being most effective in both the amount of expected weight loss and sustained weight loss.
Trends in bariatric surgery are shifting as well. There is a very strong move away from lap bands, and newer, more aggressive options are gaining popularity. Protein after surgery continues to be an important topic, and the reasons for the recommendations are discussed. And finally, the delicate balance of how to address weight issues without causing more harm is addressed. Changing the perception and goals of weight management can be an effective and more supportive approach when dealing with issues of weight.
Obesity has long been a known and increasing problem in the United States, but it has not truly been treated as a chronic disease state until more recently. As the stigma around weight continues to wane and society becomes more aware of the complex circumstances that surround obesity and weight issues, more efforts and insight into effective treatment options are being made.
Research in obesity medicine is far-reaching and expanding. From exercise physiology to gut microbiota, medications to aggressive bypass operations, genetics to effects of social and physiological well-being, current efforts are addressing the very complicated interactions that make up the disease of obesity.
References:
- Lyudmyla Kompaniyets, PhD; et al. Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020-March 2021. Prev Chronic Dis. 2021; 18: E66.
- Craig M. Hales, M.D., Margaret D. Carroll, M.S.P.H., Cheryl D. Fryar, M.S.P.H., and Cynthia L. Ogden, Ph.D; Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018; NCHS Data Brief No. 360, February 2020.
