When behaviour meets biology: if obesity is a chronic medical disease what is obesity management?

Patient engagement in the design of an intervention to prevent muscle loss in individuals with knee osteoarthritis and a body mass index (BMI) ≥ 35

“…Disentangling this perceived connection with weight loss is critical to emphasize the known benefits of exercise for OA‐related health (Davis et al., 2020). Further, qualitative studies identify that patients with a large body size are self‐aware of the benefits of weight reduction for knee OA (Bunzli et al., 2019; Carmona‐Terés et al., 2017), but they also have lived‐expertise regarding the difficulty of sustained weight loss (Hall & Kahan, 2019; Vallis & Macklin, 2021). This could lead to disengagement from an intervention based on prior negative experiences if they perceive weight loss as the primary goal.…”

“…This includes avoiding labels that can be perceived as stigmatising (Puhl et al., 2012) (Table 4: “ Now that I'm obese [I hate that word]” ). Further, including descriptions for terms (i.e., exercise: resistance‐based to build muscle mass and strength; nutrition: strategies to promote muscle building nutrient intake) could clarify the objective of the intervention modality choice and reduce inadvertent perceptions of a ‘move more, eat less’ weight‐focussed approach (Vallis & Macklin, 2021). Expanding the intervention timelines beyond 12 weeks may also improve self‐efficacy for ongoing self‐management.…”

“…This emphasis on weight‐reduction may overshadow the value and importance of nutrition and exercise for improving metabolic health, physical function and contributing to OA‐related pain relief. Optimising body composition (maintaining or increasing muscle mass while reducing adiposity, without weight change necessarily) may be a more pragmatic and beneficial approach, particularly as an individuals' control over their body weight is limited (Vallis & Macklin, 2021), and weight regain after weight loss is pervasive due to biological factors (Hall & Kahan, 2019). This weight‐loss‐and‐regain pattern can shift body composition ratios of muscle and fat mass, predisposing to the development or progression of sarcopenic obesity (Godziuk et al., 2018) (a serious health condition of low muscle mass and function with excess fat mass; Donini et al., 2020).…”

Adherence to Treatment Recommendations in Chronic Disease: What Is (Im)Possible? Expert Conclusions from the 30th ECOG Workshop 2021

“…If we frame adherence in obesity management as relational, the clinician has the opportunity to use communication skills to help the patient or parent reframe obesity from the “achieve goal weight by eating less, moving more using willpower” to obesity as a chronic medical disease, in which weight is not a behaviour, weight loss is determined more by biological and environmental than behavioural factors (such as set point, or settling point theory [33]) and success is measured by health, function, and quality of life [30]. Nonadherence in obesity management can be related in part to the patient or parent experiencing disappointment about not achieving unrealistic expectations.…”

“…This is because the typical person/family views obesity and its management from an unrealistic perspective. Specifically, the dominant narrative in the public eye is “I can reach my goal weight by eating less and moving more using willpower” [30]. Framing obesity management in the context of a relational dynamic (a change-based relationship) allows this false narrative to be exposed and reframed.…”