Framing the Obesity Crisis: What the Healthcare Establishment Gets Wrong

The problem of obesity is extremely widespread in America. Many see it as simply a health issue. Most healthcare professionals are not framing the issue right. To do this, they would need to go to the root of the problem and look at it as a moral issue. This is because people ultimately make the decision to overeat.

Scientists began with the right questions: Why do we overeat? What mechanisms control hunger and body weight homeostasis? How is weight lost over time? How do we make weight loss more sustainable over the long term instead of encouraging a cycle of weight loss followed by weight regain? These are all great questions that attempt to understand something about the mechanisms of weight gain and weight loss.


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The Diet Solutions—A Numbers Game

However, the focus of medical practitioners has been, from the beginning of this obesity epidemic in the late seventies about weight loss diets. It seemed perhaps logical at the time, given our linear logic when thinking about the problem. Indeed, nutritional research showed that for every extra 3500 kilocalories consumed above caloric requirement, the body puts on one pound of fat. It goes to reason then, that a deficit of 3500 kcals leads to one pound of weight loss.

In a sense, doctors and dietitians began to tackle the obesity problem strictly as a numbers game. Standard diets for weight loss were prescribed for ½ lb, 1 lb, 1.5 lbs and 2 lbs of weight loss per week, and many times even more once the diet industry hijacked the therapeutic modality of dieting. In doing so it grossed hundreds of millions of dollars per year throughout the seventies and eighties.

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The Coming of the Gurus

By 2012 the industry was earning $20 billion yearly with an estimated 100 million dieters following some kind of weight loss program. Self-proclaimed diet gurus such as Drs. Atkins, Stillman and Tarnower proposed, early in the seventies, altering macronutrients to remedy the national weight gain problem.

Then came the Grapefruit Diet and the list goes on. The market consequently got inundated with high protein and high-fat diets as well as and high carbohydrate and low fat diets. The implications were that there had to exist some kind of formula for a most effective weight loss. The focus was on cutting calories to get rapid weight loss without really asking, how did the population/client get to be obese in the first place?

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The answer was obvious to everyone: patients overate.  The dieting trend went on for years before Traci Mann, a researcher now at the University of Minnesota, found that weight loss diets were actually making Americans fatter rather than leaner.

Fatter Not Thinner

The reason was that weight loss can be deceptive.  The bottom line is that the medical field believed that eating fewer calories per day would lead to weight loss; the diet industry pushed the concept to dangerous levels, sometimes pushing very low calorie diets consisting in 300-800 kcal/day. Indeed, it did lead to the excess weight coming off.

However, it did not last long. About a third of dieters ended up adding more weight back within three years than they originally had. For the most past, the rest returned to their original weight before dieting.

This was evidently the wrong approach. Researchers have found that calorie restriction causes primitive homeostatic survival mechanisms to fire up in order to either prevent weight loss or ensure that lost weight returns to the body.

Embrace Obesity

This led to another wrong framing of the problem. The low dieting success rate intimated to liberal progressives that obesity was a mere diversity issue.  The solution seemed easy enough: embrace your obesity as a beautiful expression of self.

However, the problem, lurking beneath the surface, was much bigger than anyone had imagined. Healthcare professional soon saw that this framing would not work.

The National Institutes of Health (NIH), gathering information about population body weights and dietary habits from a series of cross-sectional studies in the U.S. between 1978 and 1995, concluded that a population shift had occurred that was so massive that it baffled NIH epidemiologist Katherine Flegall. At the societal level, something had gone horribly wrong, but nobody was asking the question: How does so great a part of an entire population become so obese so rapidly?

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The medical field understood, at a fundamental level, that obesity was not a diversity question. It was dangerous and presented a true medical risk for patients, as it heightened the risk of hypertension, cardiovascular disease, heart-disease, type-2 diabetes and some cancers

A Pharmaceutical Approach

Medical non-compliance by patients was viewed by doctors as a prevalent problem and inconsistent with long-term health. Consequently, medical strategy shifted around 2013 towards a pharmaceutical solution to obesity.

Currently, many physicians prescribe Qsymia — a combination of the drugs phentermine and topiramate—with impressive short term weight loss results. Gone are the days in which dietitians would guide patients through wise food selection and portion control.   The medical field reverted to simply treating the symptom—overeating—by pharmaceutically cutting the appetite.

A Stopgap Measure  

Why is this wrong? Medically, the appetite is the prime indicator of health; consequently, messing with appetite is a long term formula for disaster especially with obese pediatric patients. Additionally, the long term success of the drug is poor, as all who cease taking the drug invariably put their weight back one…and more.

Physicians now agree that much like depression, pharmaceutical treatment of obesity must be prescribed for life. So in the end, health care professionals have remained fixated on prescribing low calorie diets and now drugs.

But at a much deeper level, for obesity to become an epidemic, there is a profound social malaise that is driving overeating. We need to look at the source of the problem not the symptoms. It should be evident that something has gone terribly wrong!


Dr. David Bissonnette is an Associate Professor of Nutrition at Minnesota State University, Mankato where he does obesity research. He advances that obesity is a mere symptom of a much greater social malaise which medical science has failed to address. He is author of two textbooks: It’s All About Nutrition and Nutrition for Healthcare Professionals. He has produced documentaries and manages the web site: The Nutrition Report.

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