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Dr. Devika Umashanker: Why Diet, Exercise Isn’t a Weight-Loss Formula for Everyone

January 22, 2018

As an Obesity Medicine Specialist, I care for people  with obesity after bariatric surgery, prior to bariatric surgery, not interested in or do not meet criteria for bariatric surgery.

It is common to hear during an office visit, “If I eat less, exercise more, I know I can lose weight.” Although this may be true for some people, it does not apply to all.

How do we know “Eat less, exercise more” is not universally applicable? Our country is in an obesity epidemic. One out of every every three people are considered obese — but obesity is not entirely due to poor food choices and lack of activity.

Obesity is a complex and multifactorial disease. Research shows people with obesity have brain circuit dysfunctions and dysregulation of hormones produced from the gut and fat cells, causing weight gain.

Obesity is similar to bone joint disease, lung disease, heart disease in which lifestyle modifications and medications may not be enough and surgery may be the next best option.

The American Society of Metabolic and Bariatric surgery provides guidelines when surgery should be discussed with patients.  Surgery should be considered with patients with a Body Mass Index of greater than or equal to 40, patients with a Body Mass Index greater than or equal to 35 and one or more obesity-related comorbidities, such as Type II diabetes (T2DM), high blood pressure and obstructive sleep apnea or patients who have been unable to sustain healthy weight loss with prior weight loss efforts, including weight loss medications.

Weight is sensitive. Patients vary considerably in their readiness and capacity for weight management and weight loss surgery. When discussing weight loss surgery with patients, using the 5 As (Ask, Assess, Advise, Agree, and Assist) helps facilitate a sensitive, nonjudgmental, and respectful conversation:

• ASK for permission to explore readiness for change in treatment.
• ASSESS obesity class, complications, and barriers
• ADVISE on obesity risk, benefits of modest weight loss. Discuss treatment options such as weight loss surgery.
• AGREE on health outcomes  and treatment plan
• ASSIST in accessing appropriate resources and providers for bariatric surgery, if appropriate.

Obesity is a chronic relapsing disease.  Weight loss medications and surgery may not be suitable for everyone.  But as a clinician, I know that providing the best options for patients is critical to achieving their best weight.

Dr. Devika Umashanker is a Hartford HealthCare Obesity Medicine Specialist. For more  information on medical weight loss, click here.