Recognize obesity as a disease, not a lifestyle condition

HCPs are advised to avoid using the word fat to describe a person with obesity, says an expert.

Professor Dr Rohana Abdul Ghani, department of internal medicine, Universiti Teknologi MARA, noted the current practice is to recognize the preference of not identifying or labelling a person by their disease. Therefore, it is better to describe someone as a “patient with overweight or obesity (PwO)” or “patient with pre-obesity or obesity” and not obese or fat patient.

The current understanding of obesity is that it is a multifactorial disease with many contributing factors. Obesity is influenced by endocrine, epigenetic, immunological, neurobehavioural, medical and environmental factors. The interplay between these contributing factors is what accounts for individual manifestation and variable responses to treatment. Thus, there is no one-size-fits-all approach when it comes to the management and treatment of PwO.  

Even though there is a genetic component to obesity, most severely obese individuals do not demonstrate monogenic mutation. Instead, the trait is likely to be polygenic in nature. A recent genome-wide association study looking at millions of datasets with links to weight supports this view. The study arrived at a genome-wide polygenic score (GPS) for weight and obesity that can confidently determine a person’s risk of developing obesity based on inherited genes that predispose an individual to obesity. This polygenic score effect on weight emerges early in childhood and increases as the person grows into adulthood. [Cell 2019;177(3):587–596.e9]

However, Rohana noted all is not lost. While genetic factors may predispose a person to overweight or obesity, studies show that modifiable lifestyle behaviours may reduce the risk conferred by genetic variants associated with obesity. Some obesogenic lifestyle risk factors such as alcohol intake, education level (as a proxy for socioeconomic status), exercise, sleep habits, smoking and shift work can factor into a person’s obesity risk. A person with low genetic predisposition but high scores in lifestyle risk factors may be just as likely to become obese as someone with high polygenic risk scores.

According to the Obesity Medicine Association in the US, obesity is defined as a “chronic, progressive, relapsing and treatable multifactorial, neurobehavioural disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical and psychosocial health consequences.” Here abnormal fat mass physical forces are biomechanical physical forces that cause pathogenic stresses on weight-bearing joints, immobility, tissue compressions, and tissue friction. [Curr Opin Endocrinol Diabetes Obes 2014;21(5):345–351]       

Obesity in Malaysia
Looking at the regional statistics, the obesity epidemic has already taken hold. Malaysia is by far the country with the highest prevalence of obesity at 15.6 percent followed by Brunei at 14.1 percent and Thailand at 10 percent. The remainder of Southeast Asian (SEA) countries have obesity prevalence rates in the single digits. Trend wise, the obesity rate is still on an upward incline with no sign of plateauing in the near future. [Metabolism 2022;133:155217]

In 2030, the World Obesity Atlas predicts obesity prevalence in Malaysia to hit 23.4 percent. The annual increase in adult obesity from 2010 to 2030 is 3.3 percent, which is categorized as very high. Even higher was the annual increase in childhood obesity, which stood at 4 percent, and was again categorized as high. Life expectancy drops as BMI increases and it is associated with multiple complications that are mental, metabolic and even mechanical (joints and movement) in nature.

In treating PwO, Rohana said it was important to engage the patient and focus on the problem. It helps greatly to evoke a patient’s motivation and to tap into reasons for change. They are more likely to lose weight when they have solid reasons to do so. The role of the clinician is then to plan the treatment and set targets for the patient.