Earlier this year, The Journal of Public Health (April 2015) indicated recognition of six separate subgroups of obese patients in the United States.
This finding is significant because it is a step toward individualizing obesity treatment rather than having a “one size fits all” approach to care.
The subgroups are as follows:
- Younger healthy females
- Young males who were heavy drinkers
- Middle-aged individuals who were unhappy and anxious
- Older people who despite living with physical health conditions were happy
- Older affluent healthy adults
- Individuals with very poor health
While there is further need to individualize care of the obese population, this approach is a step in the right direction.
Recognizing that there is more to weight management than just weight loss can help aid in the long term benefit to individuals over time.
As noted in the above subgroups, there are multiple factors to be considered when reviewing supports that may need to be in place for subjects as they work on achieving a stable weight: addiction management, mental health support, physical health management, etc.
Without having the appropriate supports in place, and without following up with recommended after care to ensure ongoing mental, physical and psychosocial wellness long term, the probability of ongoing success decrease significantly.
Multiple Factors Affect Obesity
At the 22nd European Congress on Obesity this year (May 2015), the importance of addressing multiple factors that affect the likelihood of obesity was addressed even more in depth.
There, it was theorized that obesity could be a “whole brain” disease, meaning that various chemicals and reactions happening within and to the brain interacted in a specific way for a particular individual that predisposed him or her to be more likely to become obese.
As an explanation, not only does the brain provide psychological reasons for concern (e.g. addictive traits, propensity for depression, anxiety, etc.), but also the brain is the source of managing endocrine hormones (such as those that determine hypothyroidism), the receptors that recognize fluctuation of the satiety hormones gherlin and leptin and receives signals from the vagus nerve when the gut indicates that it is full.
Perhaps there will be a time that pharmaceuticals can be personalized to the individual, as hypothesized at the conference.
In this way, medication could be adjusted to the particular phenotype of the person so that the specific causative could be addressed without leading to unnecessary side effects or concerns.
In a recent study published in the European Journal of Clinical Nutrition (July 2015), the relevance of the need for such personalized medications was made clear.
Evidence was found to indicate that there may be long term psychological effects for gastric bypass patients once they reach 10 years post-op.
According to the study, findings indicated a significant increase in quality of life as it relates to physical health; however, mental health symptoms such as neuroticism, fear of intimacy and locus of control deteriorated.
Long Term Effects of Bariatric Surgery
Results remained parallel regardless of the amount of successful long term weight loss the participant maintained during this time period. Study participants that were in a control group that undertook a monitored dietary program did not show the same level of mental health decline, indicating further evaluation may be needed regarding the long term effects of possible nutrient deficiencies experienced with bariatric surgery.
It is quite promising to see that the scientific community is recognizing the need for continuity of care amongst all aspects of healthcare as it relates to the obese community, particularly as it relates to those that chose bariatric surgery, as the effects appear to continue appearing long term.
Ongoing care for this population is necessary to manage the multiple changes that happen in a short period of time, from physical changes, to psychological, to potential social and psychosocial changes as well.
22nd European Congress on Obesity (May 2015) http://www.medscape.com/viewarticle/844410
The Journal of Public Health (April 2015) http://www.medscape.com/viewarticle/843404
European Journal of Clinical Nutrition (July 2015) http://bit.ly/1IhlT3x
Obese family photo available from Shutterstock