Does treating obesity as a disease help?

Harping on people ad nauseam to lose weight is rather "sadistic", there's little evidence the treatment of obesity works and even the benefits of weight loss are debatable.

In arguments like these, being played out in the official journal of the College of Family Physicians of Canada, doctors are debating whether it's futile to try to treat obesity.

"The few patients who manage to lose weight and keep it off achieve something truly remarkable. From a public health standpoint, however, the treatment of obesity is a failure," writes Dr. Jana Havrankova, of Clinique familiale Saint-Lambert in Quebec, in the current edition of Canadian Family Physician.

One weight-loss drug after another has been pulled off the market over serious harms and the long-term effects of existing treatments remain controversial, adds associate scientific editor Dr. Roger Ladouceur in an accompanying editorial.

"Why, then, do we tell our patients to lose weight?" he asks.

"Why do we repeat, 'You should lose weight'? What's with that? Somewhat sadistic, don't you think? Do we do this as a way of shifting the guilt and transferring the responsibility of the therapeutic failure?"

The statements, observers say, reflect a remarkable and possibly significant shift away from the prevailing medical dogma that everyone who is obese needs to lose weight.

No one is claiming that obesity is harmless. Havrankova says the evidence of obesity's health-damaging effects is "irrefutable" and the costs to society and individuals "astronomical."

Yet, "there is very little evidence that the treatment of obesity works," Havrankova said. Of the studies done, most are of mediocre quality and, for the small percentage of patients who succeed, the weight loss is modest, and gradually regained over time.

"For every individual who wants to lose weight, I maintain hope," Havrankova stressed.

But prevention, starting in early childhood, "offers the best hope in the fight against obesity," she said.

In his editorial — "Should we stop telling obese patients to lose weight?" — Ladouceur says the genetic, environmental and societal factors linked to obesity are "deeply rooted" within us. "It is very difficult for us to change."