Obesity management has to do with lifestyle changes like cutting down on calories and burning fat by regular physical activity. Obesity experts point out that obesity is a chronic disease with largely biological causes that cannot be cured with just diet and exercise.
80%-95% people with obesity regain their lost weight in a few months. One explanation for this limited long-term success is that reducing caloric intake triggers several biological systems that drive us to eat high-calorie foods and gain weight.
Lifestyle changes might not be the only way to tackle the fat-loss fight.
Dr. Christopher Ochner, lead author and Assistant Professor of Pediatrics and Psychiatry at the Icahn School of Medicine at Mount Sinai in New York, USA explains, "Although lifestyle modifications may result in lasting weight loss in individuals who are overweight, in those with chronic obesity, body weight seems to become biologically 'stamped in' and defended. Therefore, the current advice to eat less and exercise more may be no more effective for most individuals with obesity than a recommendation to avoid sharp objects for someone bleeding profusely."
Recent evidence suggests that these biological adaptations could persist indefinitely, even in formerly obese individuals who achieve a healthy body weight through dieting. "Few individuals ever truly recover from obesity; rather they suffer from 'obesity in remission'. They are biologically very different from individuals of the same age, sex, and body weight who never had obesity."
The authors argue that if weight loss is to be sustained in the long-term, at least some of these biological factors need to be addressed. However, current biologically based interventions are limited to anti obesity drugs, weight-loss surgery and intra-abdominal vagal nerve blockage, which do not permanently correct the biological factors that undermine weight-loss effort.
Only Roux-en-Y gastric bypass, a common surgical procedure for extreme obesity, has been shown to reverse obesity-induced changes in appetite hormones and the brain's response to food. This might explain why bariatric surgery is the only treatment showing long-term effectiveness in individuals with sustained obesity.
According to Dr. Ochner, "Many clinicians are not aware of the reasons individuals with obesity struggle to achieve and maintain weight loss. Obesity should be recognised as a chronic and often treatment-resistant disease with both biological and behavioural causes that require a range of medical interventions including biologically based interventions such as pharmacotherapy or surgery as well as lifestyle modification."
He adds, "Ignoring these biological factors and continuing to rely on behavioural modification will surely result in the continued inability to treat obesity effectively and the premature death of millions of individuals each year."