They weigh the same, but one is thriving while the other is suffering. One of them just needs a little bit of support, while the other one needs a proper rescue before it is too late. What if obesity is not just about how much you weigh, but about what your body is trying to tell you?
Let me introduce you to Maria and Jack: they both have the same BMI, but completely different lives. Maria is a mother of three children and a full-time teacher, but she’s not completely happy with how she looks. She’s tried a few diets and likes to go hiking and running in her free time. But most importantly, she is healthy. So, no major health problems. On the other hand, there is Jack. His BMI is the same as Maria’s, but he becomes tired from simple movements like climbing up stairs, and he’s unemployed. He’s been diagnosed with diabetes, and his heart specialist believes that his heart is not pumping enough. So it’s very weak. He’s been unemployed for a few months. And what hurts more is that he does not feel that he could play with his kid football anymore. So there are two people. They have the same number on the scale. When they step on the scale to check their weight, they are the same. But something is not right.
Preclinical obesity Vs. clinical obesity
In the last few decades of working in medicine, we know that obesity is generally defined by your weight. So your GP or doctor will ask you to step on the scale. They check how much you weigh, and they will calculate your body mass index. They will say whether or not you are obese or not obese. Now in medicine we define obesity as either preclinical obesity (somebody like Maria who does have some weight but are not affected by the excess fat in their organs or they don’t have any kind of disability from the weight) or clinical obesity (Someone like Jack who has excess fat that can cause diabetes, heart diseases or impact his basic functions like movement).
Unfortunately there is a belief held by most of the people including people who have obesity that it is it’s something to do with your responsibility to lose weight. So, as a person with obesity, you have to lose weight because you need to eat less or do more sports. However, while it is true that a person with obesity needs to try and make a change in their life to improve their condition, it doesn’t mean they are fully responsible, as much of this can come down to genetics and being caught in a vicious cycle of suffering and self-pleasure to ease their discomfort. Change can vary in terms of difficulty and discipline from person to person. They might need to have other interventions to help them lose weight apart from the usual advice of eating less and walking more. They might need medications. They might even need surgery to get them back on track and help them win the battle against obesity.
The next steps
Now, let’s return to Jack. He’s now definitely better. He’s seeing a team that does understand his condition. A team that specialises in weight loss. They know how to support and help him, and they’ve been offering him the right treatment for his obesity. He’s learning a lot about his illness, and he knows that it is not a failure from his past. He’s winning on the illness, and he is rewriting his story. This is not just the story of Jack. It’s the stories of millions of people who suffer from obesity who’ve not been given the right advice. They don’t have the right knowledge about their condition, and maybe there have been loads of delays in them seeking medical help when it is needed, simply because they’ve been going the wrong directions from people they trust around them, whether they are relatives, friends or even, in some cases, health care professionals.
Now, if you are watching this and thinking, “So, where do I fit in this?” Remember that obesity is not your fault. But now, we finally have a way to understand it and to treat it. But how do you know if you have clinical obesity or if your body is just still coping well despite the extra weight? In the next video, I will show you exactly how we, as doctors, assess this. So you will know what size you need to look for, and how you know which category you are falling into, so you know what actions you need to take.