SECOND OPINION | Another look at obesity: It’s not simply about eating too much – Health

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What causes obesity? That question is proving extremely difficult. But there is emerging agreement that it’s much more complex than simply overeating.

The Endocrine Society has released a scientific statement defining obesity as “a disorder of the energy homeostasis system,” which means the mechanism that regulates energy intake and energy output is out of whack.

In March, the World Obesity Federation issued a position statement defining obesity as a “chronic, relapsing, progressive disease process.”

The Canadian Medical Association and the American Medical Association have released statements defining obesity as a disease.

But there is still no scientific consensus about either the cause or the cure. Dr. Michael Schwartz told CBC’s Health unit that’s why he agreed to write the Endocrine Society’s new scientific statement.

“There have been lots of people making their pitch about their particular idea about what causes obesity,” he said. “Some people say it’s too much couch potato time. Or some might say it’s because you’re eating too much carbs. Someone might say it’s genetics. But there hasn’t been any previous document that sought to put pretty much everything we know in a larger context.”

Two things happen, according to the new scientific statement. First, there is a long period of energy imbalance, where the body is taking in more caloric energy than it burns.

Then the body somehow cranks up its weight set point to a higher level and then fights to keep the weight at that new level.

‘Other than bariatric surgery, there is no medical therapy of obesity that is proven to result in sustained weight loss greater than seven per cent.’
— Dr. Michael Schwartz

“The problem with obesity is not that there is no regulation of body fat, but that the regulation is occurring at an elevated level,” said Schwartz. “That’s what we mean by a disorder of energy homeostasis.”

And that mysterious mechanism is responsible for the biggest challenge in obesity treatment. Any lost weight almost always comes back within five years.

“By and large, other than bariatric surgery, there is no medical therapy of obesity that is proven to result in sustained weight loss greater than seven per cent,” said Schwartz.

There is a key role for lifestyle, diet, and other…

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