WEIGHT MANAGEMENT AND OBESITY

For centuries obese people have been subject to teasing, ridicule and social prejudice. They are usually assumed to be greedy and lazy, and to lack any self control. These beliefs are only compounded when obese individuals attempt to lose weight but are unable to reduce their calorific intake and increase their energy expenditure sufficiently to effect long-term weight loss. Current research does not support this view of obesity, however, and it is already acknowledged that as much as 70% of our predisposition to obesity is genetic. Thereafter we are subject to the very powerful influences of the obesogenic environment - forces that can be sometimes impossible to overcome. Clearly, lifestyle change incorporating changes in dietary intake and physical activity levels, together with behavioural modification, are crucial for anyone embarking on a weight-loss programme but experienced clinicians will always be aware of some patients whose best efforts have been evident but who have not been able to effect meaningful weight loss.

To develop better treatment strategies we need to move away from a blame culture, and to offer support and education to patients rather than criticism; understanding instead of castigation. The physiological mechanisms involved in weight regulation are poorly understood but improved understanding of the causes of obesity does not negate the responsibilities of obese individuals to try to control their lifestyle habits. Will power is difficult to define. You can have it one day and not the next. Weight management is certainly about more than self-will.

*11/312/5*