According to obesity expert and University of Melbourne professor of medicine Joseph Proietto the high failure rate of weight-loss programs could be explained by growing evidence that an obese person’s body is programmed to regain any weight that is lost. He said that authorities are wasting money on campaigns urging people to exercise and eat healthy food since obesity is “physiologically defended”.
He wrote in an opinion piece in The Medical Journal of Australia in which he said weight loss in obese people only led to changes in energy expenditure and hunger-controlling hormones that encouraged weight gain. He said, “It is likely that it is these physiological adaptations that make it so difficult to maintain weight loss… Importantly … in those who are already obese, public health messages encouraging people to eat healthy food and exercise are unlikely to have a long-term impact on their weight.”
Professor Proietto said the weight-control clinic he ran at the Austin Hospital was overwhelmed with demand, with a two-year waiting period. But the hospital was funded to do no more than 20 gastric banding operations a year. He said political leaders were ignoring the biological reasons for obesity by focusing on lifestyle messages and providing only limited funding for bariatric surgery, which had been shown to achieve long-term weight loss. He added, “All the money is put into giving messages on television, but actually that doesn't work - you can't convince someone not to eat who is hungry… If a good tablet came along it would not make it on the PBS [Pharmaceutical Benefits Scheme] because everybody says obesity is a lifestyle disorder only and all you have to do is change your habits… We don't need tablets to lose weight - but we do need them to keep it off.”
On a brighter note he said the important point was to prevent obesity, particularly in children, but more resources were needed for people who were already obese. He said gastric banding surgery could reverse obesity-related conditions such as type 2 diabetes and obstructive sleep apnea. “'We must help the long-suffering obese in their struggle to maintain a reduced weight…In the absence of safe, effective pharmacological agents that can be used long-term, bariatric surgery is the most successful intervention for sustained weight loss. Why is it not more often conducted in public hospitals?”
Three studies of overweight patients treated with a very low energy diet or a structured weight loss program for at least three years found that while participants lost an average of up to 22 per cent of their weight within the first two years, by five years the loss had been pegged back to as little as 5.5 per cent, or had even disappeared completely. In contrast, trials of bariatric surgery -- which can involve either a plastic band being placed around the upper stomach to suppress appetite - found weight reductions of between 21 per cent and 38 per cent up to 10 years after the procedures.
Other experts disagree with Professor Proietto saying bariatric surgery is a last-resort measure that does not address the complex causes of obesity. Obesity Policy Coalition senior policy adviser Jane Martin said the surgery was not feasible as a population-wide solution to obesity because it was expensive, risky and not always appropriate. “It's time for the government to implement policies that tackle the key drivers of obesity, including protecting children from pervasive junk-food marketing, implementing traffic-light labeling on processed foods, and taxing unhealthy foods together with subsidizing healthy foods for those on low incomes,” she said.
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