About obesity

Obesity is a chronic, relapsing and often progressive disease. Many health authorities around the world have agreed upon this for years, including the World Health Organization, the American and Canadian Medical Associations, and the World Obesity Federation.  While much of society has been slow to embrace this, we at the Nordic Obesity Alliance are here to help spread knowledge and understanding of obesity as a disease to support both patients and professionals in the prevention, treatment, and management of overweight and obesity it the Nordic region.  

How do we define overweight and obesity?

The World Health Organization defines overweight and obesity “abnormal or excessive fat accumulation that presents a risk to health.” Since this can be hard to measure, we often use the Body Mass Index (BMI) in practice.  A BMI above 25 is considered overweight, and a BMI above 30 is considered obese. Since the BMI is a simply an equation using height and weight, many say that the BMI itself is not enough to give someone a diagnosis of overweight or obesity. Instead, we need to ask if this elevated BMI is provoking negative health outcomes in order to diagnose them with overweight or obesity.   

As an alternative to BMI, we can use waist circumference or waist-to-hip ratios as a base for diagnosing someone with overweight or obesity. A waist circumference ≥ 70cm in women or ≥94 cm in men is considered overweight, and ≥88cm in women and ≥102cm in men is considered obese. When using waist-to-hip ratio, the WHO defines abdominal obesity as >0.85 in women and >0.90 in men.

Why is obesity considered a chronic disease?

Why is obesity considered a chronic disease?

According to Merriam-Webster, a disease is “a condition…that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.” In obesity, this impairment comes from excess adipose (fat) tissue disturbing the normal function of metabolic pathways. The reason it’s considered a chronic disease is because our bodies are wired to store the fat that we have, making it not only hard to lose weight but keep it off.  As with other chronic diseases, no one treatment works for every patient, and efforts should be made to collaborate with patients to find the treatment(s) that will work best for them.

What causes obesity?

Contrary to popular belief, calories-in/calories-out is not the only contributor to how much we weigh. From genetics, hormones, and even bacteria in our gut, to the effects of stress, sleep, medications, and even dieting itself, there are at least 36 factors that both contribute weight gain and make it hard to lose weight.  One of the factors that people tend not to think about is that many of are surrounded by “obesogenic” environments. This means that the environments we live in lead to obesity.   For example, healthy foods are often more expensive than unhealthy foods, leading many people to choose unhealthy, processed foods simply because that’s what they can afford.  These foods are also quick and easy to prepare, which makes them attractive in our fast-paced lives. We also know that these processed foods can be addictive, further fueling weight gain. So while many like to think that weight is a simple matter of eating less and moving more, the disease of obesity is far more complex than this would let on.

Are overweight and obesity common in the Nordic countries?

Despite the popular notion that the Nordic countries offer a picture of health, overweight and obesity affect over 55% of adults throughout the region.              See individual country statistics for Denmark, Finland, Iceland, Norway, and Sweden. Not only has this disease become more common in adults, it has also become more common in children. The prevalence of obesity in children aged 5-19 ranges from 6.7% in Sweden up to 9.9% in Iceland. There are many efforts underway to help reverse the upward trend of weight around the region, but in order to do that, we need to understand more about this complex disease.  

How does obesity affect health?

Excess weight affects people’s health in many ways, not just physically but also mentally and socially.  Physically, it increases the risk of additional diseases and conditions such as type 2 diabetes, heart disease, cancer, infertility, sleep apnea, fatty liver disease, some types of arthritis, gastroesophageal reflux disease (GERD or heartburn), and more.  It can even be a risk factor for some contagious diseases, like we’ve seen with COVID-19.  Mentally, it can lead to depression, anxiety, disordered eating/eating disorders*, and low self-esteem, especially with the weight stigma and bias people in larger bodies often face.  Being stigmatized and discriminated against have consequences that go beyond mental health implications. These including avoiding school for fear of being bullied, not getting hired or promoted for a job, or not receiving the healthcare one needs because rather than treat the issue at hand, the patient is told to “just lose weight.” 

Furthermore, many of the physical, mental, and social outcomes of excess weight often feed into a loop that contributes to even more weight gain. If you have arthritic knees, you are less likely to be active. If you have depression or diabetes, you may be on medication that causes weight gain.  If you have been made fun at school, you may not want to join in a soccer game at recess. And if you’ve been treated poorly by healthcare personnel, you may be too hurt to ask for help again.  So what can we do?

 

How is obesity treated?

There are a number of ways that we treat obesity today. While the media likes to sell quick-and-easy weight loss schemes, managing obesity requires finding sustainable, holistic methods that will work for the individual patient.  The first step for some patients will be to stop weight gain, while others will be ready to start the weight loss process. 

Treatment options most often include lifestyle changes around eating and physical that may be used in conjunction with various prescription medications and/or surgical options. Some patients may find it helpful to work with a mental health professional as part of their care team to help the emotional contributors to obesity such as stress and various mental illnesses.  This is especially true if someone’s weight and health challenges stem from past or present trauma, disordered eating/eating disorders*, or emotional eating.  Mental health professionals can also be helpful when working with people who have been stigmatized or discriminated against due living with a bigger body.  

The best case for most patients is to work with a team of specialists that can provide support in all areas, including doctors, dietitians, nurses, psychologists, and other healthcare professionals. In addition, many patients find it helpful to have peer-to-peer support through group meetings or other activities.  Whomever the patient works with, it is important to remember that everyone is on their own journey, and no one’s weight loss treatment will look exactly like someone else’s.

*The difference between eating disorders and disordered eating is not clear-cut, but it is often distinguished by level of severity.  This includes the level of obsessive thoughts and behaviors around food, body image, and other factors, as well as how much these thoughts and behaviors affect day-to-day functioning.  Someone exhibiting disordered eating behaviors may not qualify as having an eating disorder, but their thoughts and behaviors around food and body image are still problematic. Read more about this topic here.

Is the goal of obesity treatment only weight loss?

Not at all!  The main goal of treating any disease is to improve the patient’s health, and obesity is no different.  While weight loss is a big piece of this, the more important thing is to focus on healthy behaviors vs weight loss itself. This includes not only healthy eating and physical activity but also habits like getting enough sleep and managing stress, all of which have benefits in and of themselves regardless of weight loss.  

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It’s also important to note that relatively small amounts of weight loss (5-15%) have big health benefits. This is particularly important for patients with additional diagnoses, such as diabetes or hypertension, or those at risk for developing comorbidities From blood sugars to cholesterol levels, from mobility to fertility, there are many examples why treating the disease of obesity means treating other diseases and conditions at the same time.  

Given that weight loss leads to many different improvements in health, work with patients to discuss what their health goals are. Do they want to lose weight? Do they want to get off certain medications? Do they want to run a 5K in 6 months?  Having goals outside of just weight can put the focus back on health and healthy behaviors rather than a number on the scale.

What are weight bias, stigma, and weight-based discrimination?

Weight biases are negative attitudes or beliefs about someone based on their weight.  Weight bias can lead to weight stigmas, which are “social stereotypes and misconceptions about obesity.”  Unfortunately, society associates many negative stereotypes with people who have obesity, including laziness, lacking intelligence, being non-compliant (“that patient didn’t lose weight, clearly he’s not listening to me…”), or lacking willpower. 

Weight stigma can lead can then lead to weight-based discrimination. We see this in all aspect of society.  People with obesity are less likely to get hired for or promoted in a job.  They are less likely to receive appropriate care from healthcare professionals.  Kids with overweight or obesity are more likely to be bullied.  The list goes on and on. 

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Some people quite wrongfully believe that weight stigma, discrimination, and shaming will ultimately lead people who live in larger bodies lose weight.  However, the opposite is true. Fat shaming only causes more harm, making people more unhealthy both physically and emotionally.  So rather than push people with overweight and obesity down, we need to work in all aspects of society, including healthcare, to support them and treat them with the respect and dignity that everyone deserves.

What can we do to support people with overweight/obesity?

There are many ways to support people who have overweight/obesity. Medical professionals can educate themselves both on the proper treatments for the disease of obesity and on proper ways to treat their patients with respect and dignity.  In society, we can not only raise awareness of both obesity as a disease but also bring to light the weight stigma and discrimination people face.  We can also support policies that promote healthy environments, such as building more green spaces in cities or creating healthy food programs at schools. What are other ways you can think of to support people who live

Nordic Obesity Allians

We at the NOBA are excited to unite the expertise, ambitions, and developments within the care and treatment of overweight and obesity across the Nordic region in our efforts to collectively support those who struggle with excess weight.   To learn more about us and our work or to join us in our mission, please see the links below.

 

Text Laura Eggerichs

Laura Eggerichs is a Registered Dietitian and Certified Specialist in Obesity and Weight Management from the United States living in Sweden. She first began working in bariatric nutrition in 2008 and has helped thousands of people implement behavioral changes to achieve their weight and health goals.