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Fighting obesity epidemic trickier than it seems

By Dawn Brazell
Public Relations
Weight gain can be clever.

Tonya Turner, a registered dietitian with MUSC’s Weight Management Center, likes to mix berries into her protein shakes for a quick, nutritious addition to her diet. For more information on the programs at WMC or how to get a nutritional consult, call 792-2273 or visit For her shake recipe, visit

A pound or two gained each year during the holidays that never get shed. Not getting enough sleep. A virus. All these are factors that research is showing can be culprits in the creeping obesity epidemic in the nation.

Patrick M. O’Neil, Ph.D., director of MUSC’s Weight Management Center, hopes the New Year will bring more awareness about the causes and effects of obesity and that MUSC staff and employees will take steps to adopt healthier lifestyles and become more vocal advocates for legislative change. There needs to be a push to get more comprehensive insurance coverage for weight-loss programs, especially given the costly impact of obesity-related diseases, he said.

With as much as is known now about the complex causes of obesity, the condition shouldn’t be depicted as a moral issue or character flaw. There are some state legislators who would like to add an insurance surcharge to state employees with a higher BMI (body mass index), but that is an issue on which medical professionals should take a strong stand, he said.
“It’s a slippery slope because if you do that, then you could take people who might have some combination of dietary and genetic factors that predispose them to breast cancer or something else and what are we going to do with them? I think it’s inappropriate, and it’s misplaced.”

It also puts the state health plan in the position of penalizing patients for having a condition where the prevention and treatment methods are not covered by the plan, he said. Most people don’t realize how even a small loss in weight can positively influence general wellness.

“We see improvements in the various health problems associated with obesity —elevated blood sugar, triglycerides, cholesterol and so on—among people who come through our Focus program where the average weight loss is about 10 percent.”

O’Neil said one of the difficulties with dealing with obesity from a policy standpoint is the condition’s complexity. Obesity is a result of a collision of factors including genes, environment and personal behavior, he said.

“We have an environment today that is much more fattening than the world  people lived in 50 years ago. We have much more readily available high-calorie and sometimes high-fat items everywhere. Portion sizes have increased greatly. People are bombarded with food stimulus and inducements to consume high-calorie products. We also live in an environment that requires, on average, much less physical activity than was the case a couple of decades ago.”

O’Neil said obviously people have to control what they eat and drink and how active they are.

“But let’s be realistic how much harder it is if we’re living in an environment that triggers a lot of innate tendencies that have been important to the survival of the species. It makes it difficult for a person to make healthier choices.”

There also are genetic factors at work that scientists are only recently beginning to identify, showing that it’s harder for some to manage their weight than others.  

“People differ in their responsiveness to food cues. I think there’s an inadequate appreciation of those differences. A nonsmoker doesn’t know what it’s like to have a smoker’s brain and how it feels to that smoker when they have that first hit of nicotine. I don’t think it’s reasonable to assume that the way I react to a taste of chocolate is the way you respond.”

Other differences show up with exercise.

There’s a combination of genetic factors that affect people’s response to exercise, said O’Neil, citing a recent Pennington Biomedical Research Center study.  Participants were placed on the same fitness training regimen for a 20-week program done three times a week at set intensities monitored by trainers with measurement taken of maximum oxygen intake (VO2 max).

“It wasn’t that some were more compliant than others, but they had varying fitness gains, and people with certain genetic variants showed very little improvement.”

Given the stigma attached to obesity and the resulting discrimination, O’Neil hopes all the new obesity research will raise awareness and encourage more treatment and support for obese patients.

“We’re really just starting to develop an appreciation that it really is harder for some people to manage their weight at a healthy level than it is for other people. There certainly is an element of the management of obesity that requires participation and cooperation of the patient, but that is not saying that obesity is the fault of the patient.”

The change in attitude requires more education of the public and being open to other possibilities, he said.

“It’s much more complicated than we know. There’s actually a virus that’s been identified that’s associated with obesity. We’re never going to find out that it’s not important for people to be active and vigilant about their weight, but I think we are finding out that there’s more to the story than simply pushing back from the table.”

Friday, Jan. 14, 2011
