Take the stigma out of obesity

Abstract

Social exclusion, stigma, guilt, and shame have been the cornerstone problems of obesity 1. This guilt and shame caused by societal stigma leads to binge eating, depression, and social exclusion 2. These social sequelae have been fostered by a mistaken general assumption that one size fits all when it comes to weight control, which has led to prejudice, hostility and inappropriate treatment 3. Given the very wide metabolic variation that does occur between individuals, any approach obviously must be tailored to each individual's unique body metabolism. Most weight management approaches consider calories in and calories out since a chronic imbalance in this area leads to weight gain, but individuals are treated by public health professionals as though these differences do not exist. While Resting Metabolic Rate (RMR) comprises 50%-80% of energy expenditure in adults 4 , this key measure of metabolism is seldom used in treatment decisions, nor in advising patients of the possible origins of their weight problems. For the past 10 years, technology has advanced to the point that indirect calorimetry of RMR can be measured cheaply and readily 5. Metabolic Factor (MF) measure was first introduced by Davis et al. 6 This new metric is simply calculated by dividing RMR by current weight. For example, an individual with an RMR of 2,000 and a weight of 200 will have a MF of 10. Davis et al 6 found differences in MF based on people's weight. Obese people had an average MF (with standard deviation in parenthesis) of 8.3 (1.5) while the MF of overweight individuals was 10.6 (1.5) and of normal weight people was 12.8 (1.9). These results point to the possibility that MF may have significant influence on an individual's weight, especially considering the strong negative correlation between MF and weight (r =-0.63). People with a lower Body Mass Index (BMI), between 30 and 40, had slightly higher Metabolic Factors of 8.3. Another study used information taken from a German database of 2,105 people 6. Their overall sample had a Metabolic Factor of 9.3. Individuals with a BMI less than 18 had Metabolic Factors of 11.2 while it was 10.4 for BMI 18-25, 9.1 for BMI 25-30, and 8.1 when BMI was over 30. These results point to Metabolic Factor as a possible strong contributor to a person's weight. According to Foster et al 7 of 80 obese women with an average BMI of 38.9, the Metabolic Factor for this group was 7.6. Studies continue to show that obese people have much slower metabolisms, typically fifty percent slower