An Incomplete Prescription: The Limitations of “Eat Less, Move More” in Obesity Treatment

| July 1, 2020 | 0 Comments

by Angela Fitch, MD, FACP, FOMA

Dr. Fitch is the Associate Director of the Massachusetts General Hospital Weight Center and faculty at the Harvard Medical School.

FUNDING: No funding was provided.

DISCLOSURES: Dr. Fitch serves as Vice President of the Obesity Medicine Association.

Bariatric Times. 2020;17(7):20–21


The number of American adults living with obesity has increased 200 percent over the past 40 years.1 Skyrocketing obesity rates continue to pose a number of public health issues, such as the disease’s associated comorbidities and healthcare costs, as well as legitimate concerns about overall population health in face of novel contagions, such as COVID-19.2,3

Fortunately for the 72 percent of the population who struggle with overweight or  obesity, our clinical understanding of these conditions has also grown over the past four decades.4 We understand the hormonal and metabolic differences between people with obesity and those without the condition.5 We understand that there are a number of effective treatment options for people living with obesity.6 Plus, we understand the limitations of physical activity and obesity management.7

As the country continues to grapple with obesity’s growing prevalence, learning how to best incorporate physical activity into treatment plans for patients with the condition should be a priority for clinicians across the healthcare spectrum.

“Eat Less, Move More” is an Incomplete Prescription—Here’s Why

The dramatic physical transformations of contestants on the TV show, “The Biggest Loser” that won primetime audiences was achieved, in part, through highly intense physical training. Certainly, prescriptions for high levels of exercise can produce significant results, especially in the context of a television show with around-the-clock monitoring of its contestants; however, these types of intense regimens tend to be unsustainable for most people with overweight or obesity.8 Furthermore, one of the major takeaways from a long-term study of Biggest Loser contestants was that physical activity played a bigger role in maintaining their weight loss than in creating it.9

Of course, that doesn’t mean physical activity has no role in weight loss. But it might be worthwhile to consider physical activity in a more holistic sense, as opposed to isolated exercise, which is an ineffective weight loss treatment for patients with obesity.10 For example, we know that sitting for prolonged periods of time can negatively impact insulin resistance, and that breaking up those periods with short walks can reduce insulin and glucose responses.11 With all of that in mind, a more sustainable—and effective—take on the concept “eat less, move more” might be “sit less, walk more.”

Incorporating Physical Activity into Treatment Plans—What Providers Need to Know 

No matter the medical specialty, an increasing number of patients with obesity are coming into our practices. As clinicians, we share a responsibility to guide them toward better health outcomes, and that includes collaborating on a plan of care to treat overweight or obesity in our patients. Physical activity alone might be an ineffective weight loss treatment, but it can power a number of other positive health results, including improved lipoprotein levels, blood pressure, insulin resistance, mood and brain functioning, and cardiovascular health.12

Consider the following best practices for integrating physical activity into treatment plans for patients with obesity:

Create realistic expectations. Educate your patients regarding what weight loss, if any, they can expect based on their individual activity programs.13 Encourage them to take a long-term view of the weight loss journey. This might help mitigate feelings of burnout or frustration with the process. It’s also a good idea to set proper expectations about things such as sore muscles when starting new workout routines. To use an exercise metaphor: It’s a marathon, not a sprint.

Start slow. Many patients with obesity take an “all or nothing” approach to physical activity, and while that enthusiasm can inspire positive changes, it can also increase the risk of exercise-related injury. Work with patients to determine their individual fitness levels and identify ways to support and gradually increase the intensity. You might also want to think about advising patients over 50 years of age to begin incorporating resistance training into their routines—it can reduce the risk of cardiovascular events later in life.14

But start somewhere. Patients with obesity might need help getting started. Consider prescribing an easy-to-follow, actionable routine that effectively incorporates physical activity into patients’ daily lives. For example, advise patients to start their routine by walking a certain number of steps each day and increasing that footprint each week. It’s an easy first step that can lead to sustainable, long-term results, particularly in bariatric patients who can benefit from increased physical activity after surgery.15

Reframe the discussion. Physical activity offers a number of health benefits beyond weight loss. Keep the plurality of positive health outcomes at the top of your patients’ minds. Help them understand that physical activity is part of a broader plan of care that addresses their overall health. This insight might make it easier for patients to prioritize healthy exercise in their daily lives.

Advance your obesity medicine knowledge. Clinicians can deliver better treatment outcomes to this growing population when they are empowered with a deeper understanding of obesity medicine. The Obesity Medicine Association (OMA) offers a number of resources for clinicians and other healthcare providers, such as The Obesity Algorithm®, Obesity Treatment Proficiency Badges™, and ABOM certification preparation materials, to name a few.16–18

The number of people in the United States struggling with obesity has significantly increased over the years, but so has our clinical understanding of the disease. Clinicians can help this growing population achieve better health outcomes by bringing this knowledge into their practices and taking a more active role in shaping patients’ physical activity goals. 

For more obesity medicine resources, or to become an OMA member, please visit: www.obesitymedicine.org.

References

  1. United States Centers for Disease Control and Prevention site. Obesity and overweight. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm. Accessed 11 Jun 2020.
  2. Brown WV, Fujioka K, Wilson PWF, et al. Obesity: Why be concerned? Am J Med. 2009;122(4 Suppl 1):S4–11.
  3. Medical Economics site. COVID-19 and obesity: reducing risk with healthy habits. https://www.medicaleconomics.com/news/covid-19-and-obesity-reducing-risk-healthy-habits. Accessed 12 Jun 2020.
  4. United States Centers for Disease Control and Prevention site. Selected health conditions and risk factors by age. https://www.cdc.gov/nchs/data/hus/2018/021.pdf. Accessed 11 Jun 2020.
  5. Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597–1604.
  6. Obesity Medicine Association site. 2020 Obesity Algorithm®. https://obesitymedicine.org/obesity-algorithm/. Accessed Accessed 12 Jun 2020.
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  9. Fothergill E, Guo J, Howard L, et al. Persistent metabolic adaptations 6 years after the biggest loser competition. Obesity (Silver Spring). 2016;24(8):
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  10. Thorogood A, Mottillo S, Shimony A, et al. Isolated aerobic exercise and weight loss: a systemic review and meta-analysis of randomized control trials. Am J Med. 2011;124(8):747–755.
  11. Dunstan DW, Kingwell BA, Larsen R, et al. Breaking up periods of prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care. 2012;35(5):976–983.
  12. Exercise and Obesity site. Biological and psychological benefits of exercise in obesity. http://apjcn.nhri.org.tw/server./markwpapers/mark_books/Downloads/EXERCISE%20AND%20OBESITY/Biological%20and%20psychological.pdf. Accessed 11 Jun 2020.
  13. Swift DL, Johannsen NM, Lavie CJ, et al. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 2014;56(4):441–447.
  14. Ryan AS. Exercise in aging: its important role in mortality, obesity, and insulin resistance. Aging Health. 2010;6(5):
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  15. Jacobi D, Ciangura C, Couet C, Oppert J-M. Physical activity and weight loss following bariatric surgery. Obes Rev. 2011;12(5):366–377.
  16. Obesity Medicine Association site. The 2020 Obesity Algorithm. https://obesitymedicine.org/obesity-algorithm/.
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  17. Obesity Medicine Association site. Obesity treatment proficiency badges. https://obesitymedicine.org/badges/.
    Accessed 11 Jun 2020.
  18. Obesity Medicine Association site. Review course for ABOM exam. https://obesitymedicine.org/review-course-for-abom-exam/. Accessed 11 Jun 2020.

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Category: Medical Methods in Obesity Treatment, Past Articles

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