“Look beyond the size of their bellies”
This is the message that Prof. Liesbeth van Rossum conveyed to her listeners during her inaugural acceptance speech as Professor of Obesity and Stress on Friday 29 September.
Obesity is a complex and multifaceted condition. This is why physicians who regularly see severely overweight people in their consultation rooms should avoid coming to the conclusion too quickly that these patients’ only problem is bad eating habits and not enough exercise. Obesity should, as with other diseases, first be checked for underlying causes. Only then can a treatment plan be drawn up that is most likely to be successful.
Half of the obese patients that report to the Center for Healthy Weight, a collaboration between Erasmus MC, Maasstad Hospital, and Franciscus Vlietland Hospital, take drugs that can increase their weight. Chronic stress can also lead to extra abdominal fat and a growing appetite for snacks. In addition, lack of sleep can also contribute to weight gain. Many patients sleep poorly as a result of sleep apnea or working in shifts.
This is why Van Rossum pleas for ‘’Looking beyond the size of their bellies!”. “If these factors are taken into account, the likelihood of finding the right way to lose weight greatly increases.”
So give obese patients that bit of extra support, says Van Rossum. For some patients certain drug types can prevent weight loss, such as medicines for high blood pressure and diabetes, and medication that contains corticosteroids.
“Of course you can’t just stop giving all diabetes patients insulin. But as physician you can check whether certain drugs can be stopped or dosages reduced if a patient then takes part in a combined lifestyle intervention. This is all the more important now that these lifestyle interventions are expected to be included in the basic health insurance package in the near future. By removing a potentially fattening drug from the list, you are helping the patients. You are improving the conditions to lose weight.”
There are also many misunderstandings about the development of obesity. Society often thinks that overweight people are fat as a result of a weak will and eating far too much. The real reasons are often much more complex. This is why Van Rossum appeals to society not to judge obese people so harshly. “Obesity is a disease, but there is very little support available for these people. I see a lot of unhappiness and shame in my consultation room.”
There is the yo-yo effect, for example: regular crash diets make people heavier. And there are also intestinal bacteria and hormone disrupting chemicals in the environment that appear to be linked to obesity. Unconscious habits also often contribute to an increase in weight, which is why the psychological component of a lifestyle approach is essential for behavior change. Measures to make the environment healthier in terms of nutrition and exercise opportunities for obese people could also help.
A small number of people even have an underlying condition such as a hormonal disease or a congenital defect that eliminates the feeling of satiety or slows down metabolism at an early age. This could call for a very different treatment method to lose weight.
In other words, in addition to all the known causes of becoming fat such as unhealthy diets and lack of exercise, the list of potential causes for severe obesity is long. “It is usually a combination of several factors for most individuals. At the Center for Healthy Weight, we have a unique approach whereby we first identify all the individual factors and then offer an individually tailored treatment plan. This is more effective in combating obesity.”