|Fighting obesity epidemic trickier than it seems
By Dawn Brazell
Weight gain can be clever.
a registered dietitian with MUSC’s Weight Management Center, likes to
mix berries into her protein shakes for a quick, nutritious addition to
her diet. For more information on the programs at WMC or how to get a
nutritional consult, call 792-2273 or visit http://www.muschealth.com/weight.
For her shake recipe, visit http://www.musc.edu/catalyst/shake.html.
A pound or two gained each year during the holidays that never get
shed. Not getting enough sleep. A virus. All these are factors that
research is showing can be culprits in the creeping obesity epidemic in
Patrick M. O’Neil, Ph.D., director of MUSC’s Weight Management Center,
hopes the New Year will bring more awareness about the causes and
effects of obesity and that MUSC staff and employees will take steps to
adopt healthier lifestyles and become more vocal advocates for
legislative change. There needs to be a push to get more comprehensive
insurance coverage for weight-loss programs, especially given the
costly impact of obesity-related diseases, he said.
With as much as is known now about the complex causes of obesity, the
condition shouldn’t be depicted as a moral issue or character flaw.
There are some state legislators who would like to add an insurance
surcharge to state employees with a higher BMI (body mass index), but
that is an issue on which medical professionals should take a strong
stand, he said.
“It’s a slippery slope because if you do that, then you could take
people who might have some combination of dietary and genetic factors
that predispose them to breast cancer or something else and what are we
going to do with them? I think it’s inappropriate, and it’s misplaced.”
It also puts the state health plan in the position of penalizing
patients for having a condition where the prevention and treatment
methods are not covered by the plan, he said. Most people don’t realize
how even a small loss in weight can positively influence general
“We see improvements in the various health problems associated with
obesity —elevated blood sugar, triglycerides, cholesterol and so
on—among people who come through our Focus program where the average
weight loss is about 10 percent.”
O’Neil said one of the difficulties with dealing with obesity from a
policy standpoint is the condition’s complexity. Obesity is a result of
a collision of factors including genes, environment and personal
behavior, he said.
“We have an environment today that is much more fattening than the
world people lived in 50 years ago. We have much more readily
available high-calorie and sometimes high-fat items everywhere. Portion
sizes have increased greatly. People are bombarded with food stimulus
and inducements to consume high-calorie products. We also live in an
environment that requires, on average, much less physical activity than
was the case a couple of decades ago.”
O’Neil said obviously people have to control what they eat and drink
and how active they are.
“But let’s be realistic how much harder it is if we’re living in an
environment that triggers a lot of innate tendencies that have been
important to the survival of the species. It makes it difficult for a
person to make healthier choices.”
There also are genetic factors at work that scientists are only
recently beginning to identify, showing that it’s harder for some to
manage their weight than others.
“People differ in their responsiveness to food cues. I think there’s an
inadequate appreciation of those differences. A nonsmoker doesn’t know
what it’s like to have a smoker’s brain and how it feels to that smoker
when they have that first hit of nicotine. I don’t think it’s
reasonable to assume that the way I react to a taste of chocolate is
the way you respond.”
Other differences show up with exercise.
There’s a combination of genetic factors that affect people’s response
to exercise, said O’Neil, citing a recent Pennington Biomedical
Research Center study. Participants were placed on the same
fitness training regimen for a 20-week program done three times a week
at set intensities monitored by trainers with measurement taken of
maximum oxygen intake (VO2 max).
“It wasn’t that some were more compliant than others, but they had
varying fitness gains, and people with certain genetic variants showed
very little improvement.”
Given the stigma attached to obesity and the resulting discrimination,
O’Neil hopes all the new obesity research will raise awareness and
encourage more treatment and support for obese patients.
“We’re really just starting to develop an appreciation that it really
is harder for some people to manage their weight at a healthy level
than it is for other people. There certainly is an element of the
management of obesity that requires participation and cooperation of
the patient, but that is not saying that obesity is the fault of the
The change in attitude requires more education of the public and being
open to other possibilities, he said.
“It’s much more complicated than we know. There’s actually a virus
that’s been identified that’s associated with obesity. We’re never
going to find out that it’s not important for people to be active and
vigilant about their weight, but I think we are finding out that
there’s more to the story than simply pushing back from the table.”
Friday, Jan. 14,