When I first started to treat overweight and obese patients at the U.C.L.A. Diabetic Clinic years ago there was little interest or concern for fat people. At that time obesity wasn’t recognized and accepted as a disease and there were few treatments or programs and even fewer physicians who wanted to be involved in the treatment of obese patients. Rates of failure were high and morale among patients and physicians was low. Today the term overweight individuals, rather than fat people is more respectful of a disease condition and those who suffer from it, with less of a stigma and bias against the obese patient.
As treating physicians, we knew little about the treatments for obesity-little more than the admonition to eat less and do more exercise; and maybe the use of some questionable and dubious medications. Today we know more, have better, safer and more effective treatment tools and have a greater compassion for obese patients. Now after many years of treating, managing and caring for the obese patients I better understand and appreciate the fact that it is easier to take the fat off the man than it is to take the man off the fat. Changing an individual’s behavior and urge to eat highly palatable fatty foods is harder than to lose those excess pounds of fat. Yes, it is easier with today’s sophisticated medical and surgical interventions to remove excess pounds of fat from an obese individual than it is to have them change their ingrained life style eating behaviors. And the commercial food industry and its marketing and advertising efforts only make the situation worse. Currently we have an environment that promotes high calorie, highly palatable, large sized, readily available cheap food, snacks and sugar loaded beverages and drinks. All to be eaten in a sedentary setting with ever increasing time pressures, anxieties and frustrations. These factors have resulted in a population where about 75% of Americans are either overweight or obese and 20% of our children are obese.
But years ago, back in the Diabetic Clinic I remember treating an obese man, weighing about 285 pounds, with type 2 diabetes, hypertension, elevated cholesterol and degenerative osteo-arthritis in his lower back and knees. He asked me “Doc why am I so fat and what can I do about it? You know I have tried hundreds of diets, tried pills, powders and programs to lose weight, but nothing worked and I’m still fat, and I hate being fat. Now I have diabetes an I’m on insulin, but my sugars are out of control and I feel miserable, bloated and depressed.” And he sounded as depressed as he looked, frustrated and despondent. The the chief resident of the group of interns and residents rotating through the Diabetic Clinic also had a feeling of frustration. He told the patient, “ look, we have many obese patients with diabetes and just like you, they eat too much, too often, too fast and too much of the wrong foods. And now because your blood sugars are too high we have to increase your insulin dosage.” The group then stepped outside his hospital room and discussed how much more insulin he needed to control his blood sugars, 10,20, or even 30 units of more insulin. While the group was debating how much more insulin he needed, it suddenly struck me that what this man needed was less fat, not more insulin. I thought why not have him lose some of his excess fat to lower his insulin resistance. This will allow the insulin that he has to work more effectively to bring his blood sugars into his muscle cells to be metabolized for energy more easily and thus lower his blood sugar levels. The excess fat in his muscles, liver and pancreas block and interfere with the body’s normal use of insulin. With less fat and less interference, his own insulin can work better to keep his blood sugars in a normal range. I also knew that using more insulin would make him hungrier with an increased craving for refined sugars in juices, sodas and snack foods. Ironically using more insulin could make his obesity worse and keep him bloated with water retention. Clearly I thought that by losing excess fat and increasing his aerobic activity, this would help manage his diabetes more effectively than more insulin. I suggested this option, but the chief resident said “Ok where are you going to refer him for his continued care? There are no obesity clinics here, dietary advice from a dietician falls on deaf ears and there are no physicians in this or his community that treat or even want to treat fat people.
That is when I decided that more needed to be done to help treat obese patients. I knew I would be able to help them. I decided to dedicate my professional life to the treatment of obesity and became an obesity medicine specialist.
While clinicians now have better and more treatments, little headway is being made against the rising rates of obesity. Many physicians think that it is not the patients fault for becoming obese, and to some degree this is true, but it may also be their fault for staying obese. I believe that both a personal responsibility to make the necessary life style eating behavioral changes along with the appropriate use of medications to blunt the metabolic factors that promote hunger and eating are needed to effectively treat and manage, the overweight condition for the long term. Both patient and physician must work together using, knowledge, experience, expertise and compassion.
I believe an effective medically based weight management program should combine weight loss and satiety enhancing medication with modification in eating patterns and habits. Such a program should focus on and stress:1) eat smaller portions; 2) eat in a structured manner (2-3 meals within 10–12-hour window of time for eating without snacking between meals or after dinner; 3) eat slower, be not the first to start eating nor the first to finish eating; and 4) because food quality is important, choose foods lower in calories and limit refined sugar, treats and snacks, and alcohol. Be patient and dedicated, even with and after the use of the new GLP-1/G1P injectable medications, you will still have to eat in a more mindful and controlled manner. Because losing weight is hard and keeping it off is even harder, I have developed 2 helpful products, Attenuate and Attenuslim, that will help to reduce appetite, decrease hunger, curb carbohydrate cravings and help to mobilize fat cell breakdown in the abdominal, hip and waist areas to cause smaller abdominal, hip and waist sizes. These non-stimulating and non-pharmaceutical natural organic agents can be found at: attenuatepro.com