The other pandemic: How best we can tackle the obesity health crisis

The “World Obesity Atlas 2022”, which is published by the World Obesity Federation, predicts that a billion people—one in five women and one in seven men—will be living with obesity by 2030.

In Kenya, 13.4 per cent of women and 3.6 per cent of men are living with obesity. The country’s obesity prevalence is lower than the regional average of 20.8 per cent for women and 9.2 per cent for men though.  In the United States, obesity is the second-leading cause of preventable death. 

Obesity is an abnormal or excessive fat accumulation that may impair health. It is not simply caused by overeating or unhealthy diet and lack of physical exercise but a complex condition whereby different factors play a role in how the body regulates weight. These include age-related changes, genetic factors, disordered eating, sleep deficits, physical disability and increased sedentary time.

Many individuals struggling with obesity resort to dieting and long hours of exercise to lose weight but, on cessation, the majority (96 per cent) regain the weight. According to Dr Fatima Stanford, an obesity medical consultant at Massachusetts General Hospital and Harvard University Medical School, obesity has little to do with willpower but is determined by what a person’s brain ‘thinks’ the body needs. She challenges other notions about obesity. Below are some of her insights.

Recognition of obesity as a disease: Obesity should be categorised as a disease. It is the brain that instructs the body how much to eat and how much to store. Reluctance to recognise obesity from this perspective is mainly from people not understanding this cause.

Main cause is genetic

Too often, obesity is considered a lifestyle choice yet its main cause is genetic. Individuals born to obese parents have a 50-85 per cent chance of having the disease even with optimal exercise, diet, sleep and stress management. Medical staff should treat it with the same care and aggressiveness as they do heart disease. Then, the stigma associated with obesity could be eliminated. For example, instead of referring to someone as ‘obese’, refer to them as a ‘person with obesity’.

Teaching obesity at medical schools: Studies by Dr Stanford found that most medical schools neither teach obesity as a disease nor offer courses on its diagnosis and treatment. This results in doctors not understanding obesity and, therefore, treating it with indifference compared to other diseases.

In some cases, obesity is exacerbated by medical staff not considering the possible side-effects on obesity of medications they prescribe for other diseases, or through incorrectly prescribing medication to treat obesity. This calls for medical schools to integrate obesity into their educational programmes to ensure doctors treat the disease correctly.

Insurance coverage for obesity treatment: Most insurance companies do not cover anti-obesity medication. These drugs are expensive, so most people cannot afford them. If more insurance companies covered these medicines, overall government and private healthcare spending would be reduced.

As Dr Stanford notes, “It is very frustrating to see patients daily who desperately need to lose weight to reduce their risk of diabetes, hypertension, stroke or heart disease but they aren’t able to receive effective and safe drugs because insurance won’t cover them.”

Some companies list obesity drugs in the same category as those used for cosmetic purposes while others recommend only counselling on behavioural change. This is akin to telling a type-2 diabetes patient to stop eating sugar and they will be fine!

Appropriate treatments

Research and regulation are essential. The pharmacology market comprises all sorts of prescription drugs for obesity. This stems partly from doctors lacking knowledge of appropriate treatments. Additionally, there are huge costs associated with the correct drugs.

It is, therefore, incumbent upon governments to invest in research to develop more effective obesity treatment options. That will not only reduce the overall treatment cost but also ensure patients receive safe and adequate drugs with minimal side-effects.

Governments need to be more proactive to ensure that obesity is recognised as a disease and recommendations such as Dr Stanford’s taken seriously. The inaccurate notion that people with obesity lack willpower, or are not doing enough in terms of dieting and exercise, must be abandoned. Doctors ought to prescribe safe medications that will not have obesity as a side-effect or result in other health complications.

Through awareness and reduction of stigmatisation, patients suffering from obesity can be treated with dignity.

Dr Kakonge, PhD, former Kenya’s Ambassador and Permanent Representative to UN Office and WTO in Geneva (Switzerland). [email protected].