Obesity affects 890 million adults worldwide.2 In other parts of the world, it is recognised by healthcare professionals and organisations as a chronic disease which requires long-term management.1,3-6 The Awareness, Care and Treatment in Obesity MaNagement – an International Observation (ACTION IO) Study* found that 68% of people with obesity and 88% of healthcare professionals believe that obesity is a chronic disease. 7
Although both people with obesity and healthcare professionals recognise obesity as a chronic disease, it remains underdiagnosed and undertreated:8
*The Awareness, Care and Treatment in Obesity MaNagement – an International Observation (ACTION IO) Study is the first international study to investigate barriers to obesity management among people with obesity and healthcare professionals in 11 countries worldwide. A total of 14,502 people with obesity and 2,785 healthcare professionals completed the survey.7
One in three New Zealanders are living with obesity, with higher rates amongst Māori and Pacific Peoples.9 General practice health professionals including general physicians, are well placed to provide weight management healthcare due to the frequency with which they see their patients - allowing time to assess, measure, intervene, and monitor weight. However, there remains a lack of effectively delivered weight management interventions. Key barriers identified include time constraints and barriers related to stigma and sociocultural influences.10,11
More information and support are required: for people with obesity, so they better understand the health implications of obesity; and for general practitioners, so they can better understand the sociocultural experience of obesity. Weight management may also require a more systemic approach including not only general practice, but also the wider primary care team, public health campaigns, and it should include culturally appropriate programmes for Māori and Pacific Peoples. Programmes should also be tailored to suit the needs of rural people.10,11
Understanding energy balance is crucial to understanding the science of obesity.12 Altered energy balance contributes to the pathophysiology of obesity.12 In individuals with no malabsorption issues, stored energy in the body increases only if total energy intake (from food/drink consumption) exceeds total body energy expenditure.12
Body energy expenditure can occur through physical activity, basal metabolism and adaptive thermogenesis.12 The body has complex homeostatic mechanisms which attempt to resist both weight loss or gain.12 Overly simplistic views initially determined that obesity resulted from food availability and acts of will.12 However, there are a number of molecular pathways involved in energy imbalance which contribute to obesity. These include the effects of the central nervous system on behaviour such as feeding and physical activity and also the action of the neuroendocrine system which controls the secretion of hormones such as leptin, insulin, oestrogen, and growth and thyroid hormones.12
Adapted from Spiegelman BM, Flier JS. Cell. 2001;104(4):531–543.
Many aspects of our environment can contribute to the development of obesity, including exposure to oversized food portions, lack of physical activity due to high amounts of screen usage and easy access to unhealthy food.13
Some people are genetically predisposed to developing obesity, depending on their family history.13 The regulation of body composition appears to be under genetic control, with twin studies reporting the heritability of BMI to be around 70–80%.14
Energy balance is a complex mechanism centrally regulated by the brain, with input from peripheral hormonal signals released from the gastrointestinal tract, pancreas and adipose tissue, which are integrated to regulate appetite and energy expenditure.15
Stress, boredom and psychological disorders are linked to overeating and can contribute to the development of obesity.13,16
Where a person lives, the society in which they live and their income can also influence their chances of developing obesity.17,18
In this short video, hear from Professor Carel le Roux as he discusses the importance of recognising obesity as a chronic disease.
Obesity can put your patients at risk for many lifelong complications.3,4 Click here to read more about the obesity risk calculator, and to quickly calculate your patients’ individual risk for obesity-related complications.
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