Physicians weigh in on weight management and obesity

A century ago, essential nutrient deficiencies was a major health concern. Today, that problem has dramatically decreased and another has emerged. The focus has shifted from a nutrition shortage to the issue of excess. 

“Advances in nutrition science, technology and manufacturing have largely eradicated nutrient deficiency diseases, while simultaneously facing the growing challenges of obesity, non-communicable diseases and aging,” said the authors of “Optimal nutrition and the ever-changing dietary landscape: a conference report,” published in the European Journal of Nutrition.

Indeed, half of all American adults have one or more preventable, diet-related chronic diseases, including cardiovascular disease, type 2 diabetes, and obesity, according to the Dietary Guidelines for Americans. 

What’s more, a number of studies have found that obesity begins in the womb. “The obesity epidemic has spared no age group,” said Matthew Gillman, Professor, Nutrition, Harvard T.H. Chan School of Public Health, adding that efforts to prevent obesity must start even before birth.

The World Health Organization estimates that over 340 million children and adolescents 5-19 years old are overweight or obese, with the epidemic linked to more deaths worldwide than those caused by being underweight.

Another troubling report by the Centers for Disease Control found that an estimated 1 in 5 children in the United States, ages 12-18, are living with prediabetes, upping their risk of developing type 2 diabetes, chronic kidney disease, heart disease and stroke.

The statistics are disturbing -- but perhaps not surprising, with adults setting a poor health example for youth. It is estimated that 40% of American adults have obesity and 18% have severe obesity, painting a confusing picture of what a healthy weight may look like. 

American adults are not exactly beacons of health

The apparent social norm is only expected to worsen. A new study led by researchers associated with the Harvard T.H. Chan School of Public Health predicts that by 2030, about half of the adult US  population will be obese and about a quarter will suffer from severe obesity. 

The study also forecasts that in 29 states, more than half of the population will be obese and all states will have a prevalence of obesity higher than 35%.  At the moment Colorado, the thinnest (or perhaps better put, least fat) state, has an obesity rate of 23%.

"Prevention is going to be key to better managing this epidemic," said lead author Zachary Ward, programmer/analyst at Harvard Chan School's Center for Health Decision Science.

The authors said they hope their obesity study guides policy makers when making public health decisions, such as applying a sugar tax on beverages. Over half (56%) of the doctors in a recent Sermo survey supported imposing a tax on sugar sweetened beverages to combat obesity. 

Putting off care 

A different study, published in the journal Clinical Obesity, surveyed 2,000 people with obesity, 395 health-care providers and 150 employers in Canada to examine attitudes toward obesity and hurdles in its management. 

The study found that people with obesity struggle with their weight for up to a decade before they seek help from a health-care professional.

"Everybody falsely believes obesity is simply people eating too much and not moving enough, and so all you have to do is eat less and move more and you'll be cured," said lead author Arya Sharma, who is chair in obesity research and management at the University of Alberta and medical director of the Alberta Health Services Provincial Obesity Strategy.

“Bigger systemic changes need to occur in order to help individuals with their weight management and overall health,” said Erin Fitzgerald, SVP of Marketing at Sermo. 

Sermo recently conducted a RealTime survey that polled more than 500 US physicians across 27 specialties. The survey examined their thoughts on diet and nutrition, as well as advice for short-term weight loss, long-term optimal health. 

“Specifically, 85% of the Sermo doctors polled in this survey think insurance companies should be required to cover dietician visits, from a preventative perspective. And 65% think employers should give employees an exercise hour as part of their regular paid work hours.”

Weight is complex—even for doctors

While most people with obesity know it is a serious illness, few understand the complexities of treatment. 

“Nutrition research has gone through a necessary evolution, starting with a reductionist approach, driven by an ambition to understand the mechanisms responsible for the effects of individual nutrients at the cellular and molecular levels. Ultimately, this approach will culminate in a full understanding of the dietary landscape—a web of interactions between nutritional, dietary, social, behavioral and environmental factors—and how it impacts health maintenance and promotion,” said the authors of the study published in the European Journal of Nutrition. 

Fitzgerald told NutraIngredients-USA that the Sermo Survey suggests that inconsistent information has led physicians to arrive at varying approaches in nutrition. “While doctors are well-versed in health aspects of certain foods and methods of eating, as shown by this survey, there are still many answers where the doctors polled are either unsure or split down the middle on what they recommend. While we cannot speak for the physicians themselves, this aspect of their answers suggests there is still more to learn for both clinicians and patients. Part of the current state of confusion and conflicting advice in nutrition is simply that it is quite hard to research. Finding other methods of reliable research can help the population, doctors included, be more knowledgeable in successful nutrition programs.”

Diet

“We found that the highest percent of doctors voted for the Mediterranean diet for short-term weight loss, long-term optimal health, and personal diet. Intermittent fasting was the third most voted for in each category, as well,” Fitzgerald told us.

She added that surprisingly, just 4% of doctors recommended the Whole 30 diet for short-term weight loss and only 5% recommended the ketogenic diet for long-term optimal health.

Additionally, the majority of physicians (64%) recommended a combination of both plants and meat for optimal health, as compared to those who recommended just plants (27%) and just meat (9%).

Zeroing in on the numbers

Specifically, the survey found that the best diet for short-term weight loss was Mediterranean diet (31%), with ketogenic (20%) and intermittent fasting (17%) close behind, as compared to DASH (11%), vegan (5%) and Whole 30 (4%). 

The best diet to follow for long-term optimal health according to the survey is the Mediterranean diet (51%) when compared to DASH (16%), intermittent fasting (7%), ketogenic (5%), Whole 30 (5%) and vegan (6%).

Getting personal

Diet heavily influences the gut microbiota, with growing research suggesting that the composition and function of the gut microbiota influence the host's metabolic response to diet. 

“Recent research discusses the importance of the microbiome in breaking down toxic food compounds and synthesizing vitamins and amino acids,” Fitzgerald added that personalized nutrition tailored toward each individual’s gut microbiome may be the key to managing weight and health.

“Overall, Sermo physicians have high hopes for the future of personalized nutrition when looking to the next decade in the United States, following suit with the trend towards personalized health care. This shift is especially important, as 69% of physicians predict that more than half of the US will be obese by 2030. To help combat this epidemic, the majority of physicians do believe we are close to being able to offer personalized nutrition. When looking into the ‘crystal ball of US nutrition’ from a doctor’s perspective, 53% believe highly personalized nutrition based on an individual’s genetics, metabolism or microbiome will be available within the next 5-10 years.”