Obesity Abstracts

Obesity is not simply a behavioural or lifestyle issue, but a set of complex chronic and relapsing diseases worthy of the same consideration as any other life-threatening diseases. While obesity is often viewed as a single risk factor for other diseases, there are in fact many distinguishable subpopulations living with different types of obesity, including those defined by risks of complications and others by optimal treatment response. While subpopulations will overlap, the decomposition of the amorphous collective of people with obesity into clinically relevant subpopulations will revolutionise future obesity care. Treating specific disease subpopulations will lead to better results. Much research to date has focused on exploring the aetiology of obesity. While multiple causes and risk factors for obesity have been identified, with few exceptions this has not led to successful treatment of most people living with obesity. We need to focus on diagnosing patients with specific obesity diseases and thus specific treatment needs. Treatment can now focus on reducing the risks associated with those diseases, and delivering the optimum response. This goes far beyond current ‘one size fits all’ approaches, which have often delivered poor results to date. By diagnosing and treating well-defined subpopulations of obesity, we may be able to offer new hope. New scientific knowledge generated will only have value when it changes perceptions and behaviours of people living with obesity, clinicians, regulatory bodies, payment agencies and industry alike. There is a common ill-informed perception that obesity is solely a behavioural condition and that it is the responsibility of people living with obesity to address their own condition through willpower alone. This perception is held by patients themselves, by clinicians, by payment agencies, and by industry and leads to inappropriate choices: patients do not seek medical help, clinicians fail to apply chronic disease models to treat the disease, reimbursement agencies are slow to pay for treatment and industry try to develop one-size-fits-all interventions. This is deeply counterproductive, given the ongoing cost (to the patient’s quality of life, in clinical time and resources) of obesity and its complications. By helping stakeholders to understand that obesity is a set of complex and chronic diseases, and that complications and clinical outcomes can be predicted and prevented, we may be able to establish a new narrative, understanding and vocabulary.