A Disease Like No Other: Treating Obesity and its Comorbidities
by Angela Fitch, MD, FACP, FOMA
Dr. Fitch is the Co-Director of the Massachusetts General Hospital Weight Center and an Assistant Professor of Medicine at the Harvard Medical School. She currently serves as President-elect of OMA.
Funding: No funding was provided.
Disclosures: The author has no conflict of interest relevant to the content of this article.
Bariatric Times. 2022;19(2):20
Obesity is a serious, chronic, and treatable disease, yet there is still tremendous misinformation and bias when it comes to prevention and treatment. Much like other diseases, such as cancer, there is a spectrum of factors involved in the development of obesity. Genetics, epigenetics, and environmental and biological factors all combine to predispose the disease state.
While we are aware of the many nuances of obesity as healthcare providers, it is imperative that we relay to patients that obesity is more complicated than just weight; it’s more about adiposity, or the desire of the body to store excess energy as fat. Obesity impacts a patient’s physical and mental health, and when we educate them about the disease’s comprehensive impact, we can best collaborate to determine the best treatment course for lasting success.
Complications associated with obesity. The comorbidities associated with obesity make it different from any other disease. In fact, we are working to refer to comorbidities as complications, because the other diseases that complicate obesity are directly due to obesity. If the obesity wasn’t there, then there is a high likelihood the disease or complication would not be there either. When we treat obesity directly, its complications, such as Type 2 diabetes, high blood pressure, obstructive sleep apnea (OSA), and nonalcoholic fatty liver disease often resolve as well.
Heart disease, including coronary artery disease, heart failure, and atrial fibrillation, is another significant complication associated with obesity. Other common comorbidities include depression, anxiety, hyperlipidemia, osteoarthritis, inflammatory diseases, infertility, and cancer. While these comorbidities correlate with obesity, they have many direct causes and do not always resolve from obesity treatment.
Comorbidities and treatment. It is vital that we assess comorbidities associated with obesity, as they can impact the course of obesity treatment for patients in a variety of ways. In the case of diabetes, we might choose a medication that benefits both diseases and avoid medications that might exacerbate them, such as phentermine with uncontrolled hypertension. OSA treatment can enhance obesity treatment, so sometimes we can achieve better results when we treat them separately. Similarly, treating a patient’s arthritis concurrently with a comprehensive obesity treatment plan could help the patient find better success through a more active lifestyle.
Overlooked diseases associated with obesity. There are a number of corresponding diseases that can be overlooked, including a range of eating disorders. Weight stigma can serve as a barrier to appropriate care for a serious mental health disorder. A 2018 study from the Journal of Frontiers in Psychology revealed that patients with higher weights are less likely to be diagnosed with anorexia nervosa or atypical anorexia than patients with lower body mass indices (BMIs).1
Another overlooked disease is gout, which, similar to obesity treatment, can be exacerbated with dietary changes. Sleep is an important focus when treating obesity too, as insomnia and sleep apnea can be overlooked.
While the complexities of obesity are vast, when we evaluate and treat the whole patient, we can work to resolve multiple diseases in tandem and bolster long-term success. As healthcare providers, we must educate patients on how obesity is so much more than an issue of weight—it is connected to their whole health and plays a significant role in their long-term health.
As our knowledge of obesity and its complications continues to evolve, it’s vital that we continue our obesity treatment education. Join the Obesity Medicine Association to stay informed on the latest tools to care for your patients.2
References
- Veillette LAS, Serrano JM, Brochu PM. What’s weight got to do with it? Mental health trainees’ perceptions of a client with anorexia nervosa symptoms. Front Psychol. 2018;9:2574.
- Obesity Medicine Association. https://obesitymedicine.org/. Accessed 14 Jan 2022.
Category: Medical Methods in Obesity Treatment, Past Articles
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