Editorial

Many studies show that the odds of maintaining weight loss after a diet or medication use are low [1]. Even after bariatric surgery, it’s common to observe weight regain after a few years [2]. Many factors are involved in weight regain, such as: increased hunger and decreased satiety, increased ghrelin, metabolic adaptations in thyroid axis and cortisol secretion [3,4]. However, I would like to discuss mental aspects of weight regain. Modern western society is food centred. Celebrations, parties, holidays are all based on food and drink. Obese patients are always on a diet, and the doctors stimulate them to try to keep this way as long as they can stand it. I think that may be a problem. Many patients stay strictly on a treatment (diet and medication) for a few months, and totally abandon because they can´t stand it anymore. It is too hard to refuse food so many times: at home, at work, in a social celebration [5,6].

Since obesity is a chronic disease, as recognized by many medical societies, it needs a chronic management [7-9] and by chronic management I don´t think the best alternative is to ask the patients to be on a diet all the time. Doctors should not reprehend their patients when they eat something “not allowed”. If an obese patient is going to a wedding party, do not be proud if he does not eat any piece of cake. Be proud if he eats a little piece! But let it clear he is still in treatment, and the treatment allows some periods “out of diet”, since it is controlled. This way, the patients will feel happier and more satisfied to continue on treatment longer.

My study in my master’s degree was about postprandial response of inflammatory markers to a saturated fat overload. The volunteers should eat two units of bacon and cheese muffin in the breakfast. Normal weight group ate with any problems, but I heard many times from obese group they could not eat this much. Some obese volunteers were excluded because they could not finish the meal, and all volunteers in normal-weight group could. Overweight volunteers did not eat a high fat meal easily, but normal weight did. So, one extra difficult in treating obesity is to show patients that the problem is not in one specific meal or food, but in the whole context. It is not the dessert on sunday that bought all the extra pounds. It is better to eat a dessert on sundays (especially with the whole family seeing) and keep on a healthy, balanced diet the whole week.

In conclusion, when we think of obesity as a chronic disease with chronic management, it is necessary to adjust patients´ and doctors´ expectations, allowing overeat sometimes in a controlled way in order to keep the chronic control.

References

1. Kraschnewski JL (2011) Long term weight loss maintenance in the United States.Int J Obes34:1644–1654.
2. Rogerson D, Soltani H, Copeland R (2016) The weight loss experience: a qualitative exploration. BMC Public Health16: 371.
3. Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, et al. (2011) Long-term persistence of hormonal adaptations to weight loss.Obes Res ClinPract365:1597–1604.
4. LiebeI RL, Rosenbaum M, Hirshc J (1995) Changes in energy expenditure resulting from altered body weight.N Engl J Med 332:621–628.
5. Hindle L, Carpenter C (2011) An exploration of the experiences and perceptions of people who have maintained weight loss.J Hum Nutr Diet 24:342–350.
6. Whale K, Gillison FB, Smith PC (2014) ‘Are you still on that stupid diet?’ Women’s experiences of societal pressure and support regarding weight loss, and attitudes towards health policy intervention.J Health Psychol19:1536–1546.
7. World Health Organization (1998) Obesity: Preventing and Managing the Global Epidemic.
8. EMA Draft Guideline on clinical evaluation of medicinal products used in weight control EMA/CHMP/311805/2014. Available at: https://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2014/07/WC500170278.pdf.
9. OECD Obesity update 2014 Available at: https://www.oecd.org/els/health-systems/Obesity-Update-2014.pdf