(Sustained) weight loss is hard

Adiposity-based chronic disease (ABCD) arises from obesity, and represents a complex, chronic illness with multiple causitive factors - genetics and epigenetics, dietary choices, activity level, medications, sleep quality, etc.

Conditions associated with ABCD include high blood pressure, abnormal cholesterol/lipid levels, heart disease and stroke, sleep apnea, non-alcholic fatty liver disease (NAFLD), type 2 diabetes and prediabetes, and arthritis.

Why it matters:
There is a tendency in our culture to "blame the victim" of ABCD, believing ABCD is the result purely of weak will and poor choices. However, studies show while that losing weight can be difficult, sustaining weight loss is even more problematic.

• The graph below shows weight loss in response to 68 weeks of semaglutide (Ozempic/Wegovy), followed by the weight response after the medication is stopped.

• Several changes in the body occur with weight loss and which serve to make it more difficult to maintain weight loss over the long term. For example, decreased leptin levels decrease a sense of fullness and increase the appetite, driving body weight back toward it's "set point."
   
• We are subject to two forces - our culture and our psychology - which act like a two-headed monster, making it hard to follow through on our good intentions.

What you can do:
Three-tiered approach to weight management:

1. Healthy lifestyle behaviors. Learn about and practice improving your nutrition, exercising regularly, getting quality sleep, and managing stress. A health coach, behavioral health program, or an accountability partner can be very helpful.
    
2. Medications. Consider adding medication to help you achieve your goals, under knowledgeable supervision, if you are not making progress. Just like we might treat high blood pressure or high cholesterol with medication, ABCD treatment might need something more than just healthy choices if you are not making progress. There is no shame in needing or wanting more help.
    
3. Metabolic surgery (also called bariatric or weight-loss surgery). Surgery has been shown to be very powerful and effective for treating ABCD, and is a very appropriate choice for the right person if the first two approaches have been ineffective.

Please, discuss your concerns or questions with Sarah or me at your next appointment. Treatment of ABCD is very important, not always easy or straightforward, and needs to be individualized to your circumstances and preferences.

Have a good week,

Dr. Topher Fox

P.S. If you missed any previous emails, the content is posted weekly here

P.P.S. Below are the pictures from my exam room wall which we are exploring for this email series.