Empowered Health Course · Lesson 17 · 5:09
I want to talk about a general treatment approach to obesity. If we think of obesity as a chronic disease — like high blood pressure or asthma — it helps us get our minds around the approach.
Take asthma. First we think about lifestyle: if someone's wheezing, we might reduce dust, get rid of the cat, and so on. If that's not enough, we add medications, weighing the risks and benefits of each — an inhaled steroid, a bronchodilator. If there's still trouble, we might step up to oral steroids, which carry more risk, and if needed, to biologics that strongly suppress the immune system — higher risk, but greater benefit in the right situation.
Obesity has similar tiers. First is lifestyle — something we should all work on, whether or not we live with weight, because it affects our well-being. It's implemented through behavior change. For some people, behavior change is straightforward: they get an app, change their diet, start exercising, feel great, and never look back. But most of us have real difficulty with it — some more than others — partly due to social circumstances and partly due to genetics and how our brains are wired. The lifestyle tools are nutrition, movement, sleep, and stress reduction, and they're the foundation, just as they are for other chronic diseases.
Next is medical therapy. Knowing that the deep brain is the seat of obesity, we have drugs that interact with those brain areas to bring body weight down when lifestyle alone doesn't get us there.
The third tool — when the criteria are met — is bariatric surgery. Many clinicians are shy to bring it up, largely because of bias. People often have a knee-jerk reaction that it seems extreme or like a last resort. But I'll ask: if you had a gallbladder stone causing symptoms, the right treatment would be to remove the gallbladder. Bariatric surgery is often the right tool to resolve symptoms of obesity, for certain individuals — generally a BMI over 35 with health complications, or a BMI over 40. From a population view, symptoms of obesity improve much more in those who have surgery than in those treated with medication and lifestyle alone.
So these are the tools — and I think of them as your tools. We'll go deeper on each: lifestyle, medications, and consideration of surgery, all against the backdrop of understanding how habits form and how we can shift things in our favor.
This transcript has been lightly edited from the video for readability. For the complete experience, please watch the video above.