Emphasise lifelong health gains over weight loss in obesity treatment, study suggests

The focus of obesity treatment should shift from mere weight loss to a broader perspective of lifelong health improvements, according to new research published in The Lancet this week.

Professor Carel le Roux, a spokesperson for the Irish Society for Clinical Nutrition and Metabolism (IrSPEN), emphasised that the true measure of success in treating obesity should not be confined to the number of kilograms lost, but rather the enhancements in overall health and quality of life. “The success of treating obesity should not be measured in kilograms, but improvements in health and quality of life,” he stated.

While the prevailing recommendation is to aim for a 15% reduction in body weight as an initial target to address most obesity-related complications effectively, Professor le Roux highlighted the inherent challenges in establishing a universal weight goal suitable for all patients. The diverse range of complications associated with obesity makes it “difficult to identify a single realistic weight goal suitable for all patients,” he noted.

In an interview on RTÉ’s Morning Ireland, Professor le Roux, who is also a co-author of the study, underscored that obesity should not be seen as a curable condition, but rather one that can be managed through continuous treatment. “Researchers now understand that obesity cannot be cured but can be controlled if treatments are continued lifelong,” he explained.

He warned that discontinuing treatment after achieving weight loss can lead to a relapse in obesity, negating all the health benefits that had been gained. “If obesity treatment is stopped once weight loss is achieved, the disease of obesity relapses and all of the benefits are lost,” he said.

“We want people to live longer, but also to live better, if we control the disease lifelong,” he continued, emphasising that the ultimate goal is not just about shedding pounds, but about combining weight loss with significant health gains, including a reduction in heart attacks. He added, “We’re not saying that it’s not about weight loss on its own, but it’s about the combination of health gain and actually living longer because of reduction of heart attacks.”

Professor le Roux stressed the importance of a sustainable approach to treatment, tailored to the individual’s needs and circumstances. “It doesn’t matter what the treatment is, provided it works for you and you can maintain it in the long term. Please don’t start a treatment if you’re not prepared to take it for the rest of your life,” he advised.

Addressing the societal stigma surrounding obesity, Professor le Roux, an obesity specialist at St Vincent’s University Hospital, pointed out that many individuals who have obesity have been unfairly blamed for their condition from a young age. “Most people who have obesity have been blamed for it since a young age,” he said, highlighting the need to shift the narrative from blame to responsibility. “While it is not their fault, it is their responsibility to treat the disease.”

He drew parallels with other chronic conditions to underscore this point. “The same way it would be your responsibility to treat the disease of asthma or epilepsy,” he added, illustrating that once people recognise obesity as a disease, they can access the appropriate treatment. “It becomes plain sailing and it’s incredible how it transforms peoples’ lives because they feel healthier, they feel more functional, they can do more things, and their quality of life improves dramatically,” he said.

Professor Helen Heneghan, a Bariatric Surgeon, echoed the sentiments of Professor le Roux, noting that medications for obesity are only effective as long as they are taken, necessitating long-term use to maintain the associated health benefits. “Obesity medications only work while patients take them and that long-term use is required to maintain the health benefits,” she remarked.

However, Professor Heneghan also identified several challenges affecting long-term adherence to obesity treatments, including high costs, supply chain issues for newer medications, and patient dissatisfaction with side effects. “A current issue with obesity treatment is that long-term adherence is low, which is affected by many factors such as high costs to patients, supply chain shortages for the newer medications, and patients’ dissatisfaction with side effects,” she explained.

For patients who do not achieve their treatment goals with medications, Professor Heneghan suggested that bariatric surgery should be considered. She further noted that patients who do not respond optimally to bariatric surgery or experience a recurrence of obesity-related conditions might benefit from transitioning to obesity medication. “If obesity treatment goals are not reached with medications, bariatric surgery should be considered,” she advised, adding, “People with a suboptimal response to bariatric surgery, or a recurrence of obesity-related diseases, may then benefit from moving to an obesity medication.”

Dr Mick Crotty, the Obesity Lead at the Irish College of General Practitioners, highlighted a significant barrier to effective obesity treatment: the widespread misconception that obesity is a self-inflicted condition that can be resolved simply by eating less and exercising more. “Many problems partly result from the common misconception that obesity is a self-imposed condition that can be treated by asking people to eat less and move more,” he said.

This misconception, Dr Crotty argued, contributes to the disparity in care provided to individuals with obesity compared to those with other chronic diseases, both at the individual and systemic levels. He called for the Health Service Executive (HSE) to ensure that the level of access to effective obesity treatments matches that of other chronic diseases. “The HSE should plan to maintain the same level of access or coverage for effective treatments for obesity as for other chronic diseases,” he concluded.