Obesity is a serious, chronic, relapsing recurring disease, and should be treated as such. To help us better understand, let us consider a thought experiment.
Imagine a woman recently diagnosed with breast cancer meeting with her oncologist. She is overwhelmed and suffering. Should the doctor include discussion of her motivation to follow or adhere to the recommended treatment?
The problem with our focus on motivation in obesity management is that it places responsibility of successful treatment on the shoulders of the patient, which is patently absurd in the context of cancer care and is additionally stigmatising, discriminatory and burdensome in the context of obesity. Where patient motivation is considered to be of key importance, patients will defacto experience stigmatisation, discrimination, shame, self-blame and guilt when treatment is unsuccessful. This is ethically inappropriate and entirely unfair, since we know that weight management failure and weight regain is driven by complex neuroendocrine homeostatic regulation of fat mass and is NOT due to lack of motivation.
The WHO recognised obesity as a disease in 1948. The AMA followed in 2013 and the CMA in 2015. More recently, we see that the European Commission categorises obesity as a major non-communicable disease. When obesity is understood as a disease rather than the all too familiar construction of obesity as a matter of personal choices and individual responsibility, EVERYTHING CHANGES. When the biological processes of adaptive and active fat-mass maintenance and preservation are recognised by clinicians, EVERYTHING CHANGES.
It is time for a new paradigm. It is time for all of us to provide treatment for patients with obesity and its complications based on scientific insights, moving beyond the broken narrative around patient motivation. It is time for us, as doctors, to take responsibility for the narrative we share with our patients, respecting the Hippocratic oath. It is time for us to act with full knowledge and integrity to provide respectful and appropriate care for our patients.