Obesity. Is it more than one disease?

I recently had a patient ask me, "What is your approach to weight loss?".   To this I responded, "I do my best to help people isolate their individual drivers of weight gain."  Whenever I give this response, I am hoping that the person across from me smiles and says, "yes, that's what we need!", but instead what I usually get is a blank stare as a response.

Gina Kolata of The New York Times recently wrote a great article on the topic of treatments for obesity, highlighting the fact there is no single treatment that works for everyone.  I think that most people intuitively know this based on their personal experiences.  After all, many of us have a friend who has lost weight with a certain type of diet and yet that same diet has not worked for their friends.  Trial and error certainly plays a part in discovering what approach will work for you, but I don't think it has to be all trial and error, and this is where a good obesity care professional can be of assistance.  Medications, finances, current state of health, an understanding of how to balance energy, learning new behavioural 'tricks', knowing what foods you will enjoy long term, balancing moods, or improving stress management skills are all potential areas that a professional could help isolate and 'fast track' you toward your long term success. 

I think its high time we started discussing some of these causes of obesity as a society, especially our food environment and access to physical activity spaces, and perhaps once we do this I won't be getting the blank stare as a response to the question, "how do you approach treatment for the obese patient".   I couldn't help but notice some of the comments to this article from readers who are reverting to the same old 'will power arguement', blaming and shaming obese patients for the bad choices they must be making.  Its very easy to judge obese patients when you aren't one, and I think everyone needs to step back and realize that the personal responsibility argument is a very small fraction of the puzzle, and the drivers are more complex than any of us can imagine at this stage.  Only then can we move forward and help each other manage our weight and our health better.