Don’t tell my spouse; I think I’m in love! I was so thrilled to be listening to Dr. Carel le Roux(1), and I’m excited to share this conversation with you today, too. This short episode of Sigma Nutrition Radio presents what I suspect could be a really powerful paradigm shift in our thinking on understanding the nature of obesity and how to approach medical treatment from a place of science and compassion.
Dr. le Roux begins by explaining that obesity is a disease that is caused by the unthinking parts of our brains, and that treatments aimed at changing only someone’s thoughts will be unsuccessful. Obesity, he explains, has the signs and symptoms of excessive hunger and reduced satiety, which are controlled by the unconscious parts of the brain, and that these symptoms must be addressed in order to reduce the health complications brought on by obesity. He flips the script, explaining that we should not think of obesity as a disease caused by overeating, but rather that “the disease of obesity causes overeating.” This is a profound paradigm shift, taking the onus off of increased body fat (and the person who has it) and onto the need to treat the root cause of that increased body fat, the experience of uncontrolled hunger and reduced satiety.
He goes on by defining obesity as “excess adipose tissue that causes a deterioration of health.” This framework, he explains, gives us a clear pathway to treatment that addresses either helping people experience less hunger and/or feel more satisfied by their meals. I also note that it integrates some of the concerns brought in by the body positive community that not all folks with higher levels of adipose (fat) tissue experience adverse health effects. I like that his definition includes this requirement in order for it to count as a disease state–it is not the fat alone that makes it an illness, it is the “deterioration of health.”
Speaking from my own perspective, this focus on identifying obesity as a disease of hunger and satiety rings completely true. The most powerful tools that I have employed over the years that resulted in a smaller body size was learning how to eat in ways that helped me feel full, to be really satisfied with my meals. Through careful observation of myself, thoughtful experimentation (on myself!), and learning more about the science of hunger and satiety, I have discovered what works for me so that I feel genuinely satisfied after a meal and so it lasts several hours until my next one. Whenever I deviate from those dietary boundaries, I find myself eating more, sometimes feeling out of control and like a bottomless pit. If I am understanding Dr. le Roux correctly, he would call this a nutritional therapy that has helped to treat my obesity. The underlying illness is still there–I can still trigger this disconnection between satiety and how much I eat when I make different eating choices–but I have figured out what treatment works for me (most of the time, anyway).
As the conversation continues, Dr. le Roux explains how various treatments have differing levels of success for different people. His calm, rational explanation that we begin with the least invasive treatments–perhaps a nutritional therapy or exercise prescription–and, if unsuccessful, slowly build towards more invasive treatments–medications, and eventually bariatric surgery, if appropriate and desired–seems thoughtful and compassionate. Conversations about obesity treatments so rarely include such a methodical, non-values-laden approach. However, as Dr. le Roux points out, we would not think twice on taking such an approach for other complex diseases such as high cholesterol.
I really love that he directly addresses what he calls the “self stigma” of patients experiencing obesity, the tendency to blame ourselves when a treatment is unsuccessful. And I hear in his approach a real desire for medical practitioners to put the onus back on themselves–that the treatment of obesity should not be seen as an individual battle undertaken alone by the person experiencing obesity but should be given a medical approach, like any other chronic illness.
No 30 minute conversation (or 800 word blog post) can cover all the intricacies of such a complicated topic like obesity, but I feel that this conversation is an essential one in helping us contextualize obesity treatment from a practical and compassionate point of view, and I really appreciated hearing it.
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(1) Oh, and here’s the link to Dr. le Roux’s website, if you feel like taking a look.