Finding the cause of obesity, beyond willpower

Research goes into successful weight loss

In today's society, individuals who are obese face an immense amount of public scrutiny, much of it painful, most of it unsolicited. Simplistic advice, unrealistic solutions and uninformed prejudices are often proffered by friends and family, often inflicting more mental anguish for the individual.

"There's an assumption in our society that obesity represents a lack of self-control," said Dr. Jim Levine, an endocrinologist at the Mayo Clinic and an expert in weight management interventions. Crucial to understand is that obesity is a multi-faceted and highly complicated medical condition amplified by a variety of social, psychological and environmental factors. It goes well beyond an obese person's willpower or perceived lack of, Levine said.

"Every scientist will tell you that a person's risk or predisposition for developing obesity is strongly connected to a person's genetics," he said. Exactly how genetics affects our body is a burgeoning science. Levine suggested several theories.

Genes might affect appetite in such a way that an obese person might not experience the feeling of fullness or satiety. Without that trigger, an excessive amount of calories are consumed with subsequent weight gain. Or their energy expenditure processes might be skewed for unknown reasons. Losing weight requires a bare minimum of calories, which is typically not sustainable. There are some answers beginning to reveal themselves, but far more longitudinal research is needed.


Many studies have shown that obesity treatments using behavioral therapy to improve diet and physical activity can lead to weight loss, but more often than not, the loss is not maintained. In many cases, a person gains back not only what they lost but more.

It is precisely this group of morbidly obese people with medical complications such as diabetes that prompted a sense of urgency for a more effective means of inducing significant weight loss as well as a means for weight maintenance over the long term.

By the early 1990s, it was determined that gastric restrictive or bypass surgery was a highly successful interventional procedure. The size of the stomach is surgically reduced from the size of a football to a golf ball by sealing it off with surgical steel staples. Then, a section of the small intestine is attached to the golf ball-sized stomach pouch, effectively bypassing the rest of the stomach. Known as the Roux-en-Y procedure, the surgery limits the amount of food that an individual can consume, and the food that is consumed can't be absorbed as well. The end result is successful, sustained weight loss in more than 90 percent of all patients. Thousands of operations have been performed and almost as many lives have been drastically improved.

Levine has been privy to several individuals who have undergone the procedure at Mayo Clinic. He performs their medical evaluation and discusses their medical history before surgery. It is a task he takes seriously and with compassion.

"I've had patients tell me that I'm the first doctor who has shown interest in their health and actually looked them in the eye," he said. "Being obese has left these people with such self-loathing. They think about their obesity constantly; it's always affecting them."

The preparation is rigorous and includes far more than the surgery itself. Besides the medical evaluation, the person will meet with dietitians in the Nutrition Clinic and receive an intensive psychological evaluation. Several treatment options are explored such as conventional therapy, the use of prescription medications or surgery.

"It's a group effort to decide whether surgery or another option is appropriate for each person," Levine said. If surgery is the determined route, then the final step is to meet with the surgeon.

Post-surgical evaluation is constant for each person, he said. But the results are dramatic. "Lives are forever changed," Levine said.


Ann Walker is a personal trainer and kinesiologist and has a master's degree in exercise physiology.

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