The emperor’s tailors: the failure of the medical weight loss paradigm and its causal role in the obesity of America

Abstract

During the past century, the medical profession has developed a paradigm for the treatment of obesity, which prescribes specific exercise and dietary goals under the umbrella of 'lifestyle change'. It has three components, all of which evolved from origins that had nothing to do with weight control. First, it is individually prescriptive, that is weight loss is considered the responsibility of the individual as contrasted to a societal or group responsibility. Second, it recommends exercise aimed towards structured, or non-functional, activities with a variety of physiological endpoints. Last, dietary goals are defined by calories, exchanges, food groups and various nutritional components. Diets are usually grouped by these goals. This model is unique to America, it is not working and it has also played a causal role in the obesity it is attempting to eliminate. A new model must be developed, which contains an observationally based societal prescription and links activity with functional outcomes and diets, which are food rather than nutritionally based.

“It’s a balance of just getting things right”:mothers’ views about pre-school childhood obesity and obesity prevention in Scotland

“…Furthermore, it is argued that countervailing social, economic and cultural factors interfere with parent’s decisions and ability to help their children manage their weight [ 1 ], something that was also evident in our data. Such factors are implicated in the more powerful explanation of adult and childhood obesity trends today [ 23 – 26 ]. Indeed, The UK Government Office of Science drew attention to the wide range of factors (and the multiple negative feedback loops linking them) associated or implicated in the rise of obesity levels globally, with the publication of their Full Systems Obesity Map in 2007 [ 27 ].…”

Bariatric surgery and nonalcoholic fatty liver disease

“…Weight loss in obese patients may also stop progression of hepatic fibrosis [53]. However, sustained weight loss through lifestyle measures and pharmacotherapy is difficult [54], and liver fibrosis may progress in up to one-third of patients with NAFLD within 4 years [55].…”

Reducing Societal Obesity: Establishing a Separate Exercise Model through Studies of Group Behavior

“…Obesity, defined as a BMI over 30, has been recognized as a health risk since Hippocrates [ 1 , 2 ], albeit a fairly minor one. That is no longer the case as the National Institute of Health lists obesity and overweight together as the second leading cause of preventable death in the United States, close behind tobacco use [ 3 ].…”

“…Historically, the medical profession has been mainly interested in arresting starvation and malnutrition rather than controlling body weight [ 2 ]. But when the available food supply matched, and eventually overcame, the energy expenditure of the population, there was a transition period where diseases of insufficiency were gradually supplanted by diseases of excess [ 2 , 11 ]. The first medical flags were raised about increasing levels of obesity in the 1930s [ 2 , 12 , 13 ].…”