Managing the multi-factorial clinical condition of obesity

Recent perspectives in managing the multi-factorial clinical condition of obesity

By Iliana Karagkouni, RD, RN, MSc, MHSM, PhD(c)

Obesity is commonly recognized as a chronic or non-communicable disease and characterized as a major public health challenge, due to its strong association with the increased risk of developing other chronic diseases, such as type 2 Diabetes Mellitus, Cardiovascular Diseases (including hypertension, myocardial infarction, stroke), dementia, fatty liver disease, osteoarthritis, obstructive sleep apnoea and several cancer types [1,2]. Population counseling and coaching about long-term body weight management may be one of the most challenging aspects of primary care.

The majority of healthcare professionals acknowledge their responsibility to address obesity in the community by counseling their patients about healthy lifestyle modifications [3]. Indeed, there is a large proportion of healthcare or fitness professionals who are willing to inform adequately the population about obesity prevention. However, all this counseling seems to have mild impact on obesity global trends. Particularly, the prevalence of obesity in adults and childhood has been increased over the past 50 years, reaching pandemic levels, worldwide [1,4]. Epidemiological obesity data suggest that this condition isn’t triggered only by a lack of persons’ motivation for body weight loss [5]. Probably, the multi-factorial pathways of obesity development constitute the major reason for the difficulty in managing more effectively individuals with this clinical condition.



According to literature, some physiology mechanisms of obesity occurrence are quite similar to those of other clinical conditions, such as drug addiction, alcohol abuse, eating disorders and depression. Given that the existence of obesity can lead to the onset of negative feelings (such as depression, social isolation etc) and behavioral disorders (such as alcohol abuse, drug addiction etc) the linking association pathways between obesity and the aforementioned conditions seem to be bidirectional and conclude to a vicious circle of disease development [5-7]. Patterns of meals consumption depends highly on individuals’ personality characteristics that shape behavioral styles related to the development and maintenance of obesity. Hence, obesity could be characterized as the end point of addictive eating behaviors.

Over the last years, it has been reported that feeding control and substance abuse share, to a high degree, common behavioral and neural systems. Cognitive behavioral tests, questionnaires about personality traits and brain imaging studies have concluded to the possible existence of a shared neuro-cognitive principle for individual’s vulnerability to drug use, uncontrolled eating and obesity [8]. Recent published review reported theory evidence that some foods or substances added to them can trigger signals to the molecular addiction process by activating in the cerebral tissue the same reward system generated by drugs, the mesolimbic system via dopamine. Palatable meals and drugs seem to activate this same circuit of reward and pleasure in the brain, through the release of dopamine. Morbidly obese individuals are characterized by a reduction in dopamine D2 receptors and may develop resistance to leptin, leading to compulsive eating [5]. However, no unanimously consensus has been reported on an explicit mechanism linking obesity and addiction with some of new studies to suggest that obesity and addictive characteristics may be less closely related than previously acclaimed [5,8,9].



Therefore, lifestyle and behavioral interventions with simultaneously clinical consultation and monitoring should be the basis of a comprehensive approach to the management of obesity, not only to the primary care, but also to rehabilitation care settings. The one-sided aim of reducing calorie intake and increasing energy expenditure in obese individuals have limited effectiveness, due to the pathogenesis complexity and the persistent hormonal, metabolic and neuro-chemical adaptations defend against weight loss and promote weight regain. A multidisciplinary team, including registered clinical dietitian, personal trainer, behavioral health specialist, psychiatrist, physician and health coach, is able to schedule and implement the most appropriate treatment plan of individuals with obesity in all care settings [2]. Principal components of obesity managing include appropriate dietary habits, regular physical exercise, stress management, adequate sleep duration and management of contributing diseases and medications. Bariatric surgery referral may be a treatment option in some morbidly obese patients with Body Mass Index (BMI) above 40 kg/m2 or BMI above 35 kg/m2 with comorbidities, but it should be thoroughly discussed with the individual [10]. Overall, obesity management should be adapted to the personal needs, behavioral characteristics and other clinical conditions of each one individual, according to the latest treatment guidelines.



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