Obesity, once viewed through the lens of simple caloric excess and lack of physical activity, is now recognized as a complex chronic disease requiring a multifaceted treatment strategy. For people struggling with obesity, the traditional advice of “eat less and move more” has often fallen short, leaving many feeling defeated, misunderstood, and trapped in a cycle of failure. Recent advancements in treatment approaches are shifting the paradigm, focusing on personalized care, empathy, and the importance of psychological and physical support. This comprehensive and individualized approach aims not just to reduce weight, but to significantly improve the overall quality of life, addressing the root causes of obesity and empowering patients to reclaim their health.
The Defeat of the Obesity Struggle
In the consultation room, people with obesity often present a picture of emotional and physical exhaustion. According to Cristina Porca, a dietitian-nutritionist at the University Hospital Complex of Ferrol in A Coruña, Spain, patients frequently arrive feeling defeated. After years of dieting, exercise, and constant advice to eat less and move more, they often find themselves back at square one. The emotional burden of not being able to lose weight or maintain progress can make patients feel as though they are fighting a losing battle.
“The first step is to listen to the patient,” Porca explains. “We start with behavioral therapy, where we try to understand the patient’s journey and how they feel about their obesity. From there, we tailor the approach to suit their needs and ensure that the changes they make are sustainable.”
Obesity is not a one-size-fits-all condition, and no universal treatment exists. Different people experience obesity in different ways, and treatment should be as diverse as the individuals seeking help. Porca stresses that treatment should be highly personalized, as every patient’s body, history, and goals differ.
The Goals of Treatment: Improving Quality of Life
While weight loss is often a primary concern for patients, the ultimate goal is to improve quality of life. This includes reducing the risk of diseases such as diabetes, hypertension, fatty liver, and even certain types of cancer associated with excess weight. However, for many patients, the desire to lose weight is tied to more personal, day-to-day aspirations. Some wish to be able to climb stairs without feeling breathless, others want to be able to play with their grandchildren, or to wear clothes they haven’t fit into for years.
Porca encourages patients to reflect on their motivations for weight loss. The answers vary greatly, and every reason is valid. Some patients find that revisiting their personal motivations helps reignite their commitment to the process when they feel they’ve plateaued. Success is measured not only in pounds lost, but in small victories such as improved mobility, better self-esteem, or simply feeling more comfortable in their own skin.
A Personalized Approach to Treatment
At the University Hospital Vall d’Hebron in Barcelona, Andreea Ciudin, an endocrinologist and coordinator of the obesity unit, also emphasizes the need for a more nuanced approach to treating obesity. “We don’t focus on weight alone. The key is understanding the distribution of fat, muscle mass, and metabolic activity,” she explains. The traditional metrics like body mass index (BMI) are no longer the primary focus; rather, the goal is to understand the patient’s individual physiology and metabolism to design the most effective treatment plan.
One of the first steps in treatment is assessing the patient’s metabolic rate and fat composition. Some individuals burn calories more slowly due to biological factors, while others may not have a sufficient response to satiety signals from the brain. In these cases, people might eat more than they realize, seeking pleasure from food rather than nourishment. Understanding these underlying factors is crucial for removing the feelings of guilt that often accompany weight struggles. For many patients, hearing that their obesity is not entirely their fault is a profound relief.
The Three Pillars of Obesity Treatment
Successful treatment for obesity rests on three foundational pillars: psychological support, physical activity, and nutrition. These aspects must be addressed in tandem, as they are all interlinked and essential for sustainable weight management and overall well-being.
Psychological Support: Understanding the Patient’s History
Psychological support is key to understanding why an individual is struggling with obesity. According to Porca, every patient’s relationship with food and exercise is unique. It’s essential to explore their personal history, including past attempts at dieting, lifestyle habits, emotional triggers, and their social and professional environment. Questions like, “Why do you want to lose weight?” and “What are your goals?” help create a roadmap for treatment.
This empathetic listening approach allows professionals to gain insight into the patient’s psychological and emotional landscape, which can significantly impact the treatment process. The goal is not just to implement a diet or exercise plan, but to address any underlying emotional barriers that might hinder progress.
Physical Activity: Building Muscle Mass
Exercise is a crucial component of obesity treatment, and it is especially important for building muscle mass. Increasing muscle mass offers a variety of health benefits, such as enhancing metabolism, improving physical function, and reducing the risk of obesity-related diseases. Strength training, in particular, is a critical aspect of physical activity for obese individuals.
Dr. Ciudin explains that muscle tissue is a metabolically active organ that plays a significant role in burning calories. “Muscle mass is essential for protecting and sustaining the body throughout life,” she says. “A well-maintained muscle mass helps regulate energy expenditure and prevents the accumulation of excess fat.”
Even small amounts of physical activity can have profound effects on health. As little as one minute of exercise can double the time spent being inactive, and even light exercise offers numerous benefits. However, strength training is emphasized as a particularly powerful tool, more so than cardiovascular exercises, because it not only helps with fat loss but also improves overall health and functionality.
Nutrition: A Flexible, Individualized Approach
When it comes to nutrition, there is no single solution that works for everyone. Porca notes that the best approach is one that is flexible and personalized, taking into account each patient’s preferences, lifestyle, and health needs. While some individuals may benefit from the Mediterranean diet, others might find success with intermittent fasting or a plant-based diet.
The key is flexibility. Patients need to adopt eating habits that they can sustain in the long term, without feeling deprived or restricted. The nutritionist’s role is to help the patient develop a healthy, balanced relationship with food. As with physical activity, a personalized approach is essential. It’s not about prescribing a universal diet but about finding what works for the individual.
Monitoring Progress: Beyond Weight Loss
Once the re-education process begins, it’s crucial to assess not just weight loss, but also muscle retention and overall health. If a patient loses weight but also loses muscle, it suggests the treatment approach is misaligned. If they lose only a small amount of fat but maintain muscle mass, it is seen as a success. This approach helps keep patients motivated by focusing on long-term health outcomes, rather than short-term weight fluctuations.
The role of muscle in managing obesity cannot be overstated. As specialists like Porca and Ciudin emphasize, muscle mass is essential for long-term success. It not only helps prevent further weight gain but also protects the body from a variety of metabolic complications associated with obesity.
The Role of Support Networks
One of the most significant challenges in obesity treatment is maintaining motivation. The process of habit change is often slow and fraught with setbacks. For this reason, support networks are crucial. According to César Bustos, a specialist in physical activity, having a support system can make all the difference. “Patients often come with a history of failures,” he explains. “What we try to offer is reassurance, a safe space where they can set realistic goals and make incremental improvements.”
Support groups, such as those offered in some obesity units, allow patients to share their experiences, offer encouragement to one another, and bond over their shared struggles. “They find strength in the group dynamic,” says Porca, “and many continue to meet even after their treatment ends.”
The Importance of Comprehensive Care
Obesity treatment requires a comprehensive, interdisciplinary approach. This includes not just dietitians and nutritionists, but also psychologists, physical trainers, and medical specialists. Each member of the team works together to create a tailored treatment plan that addresses the patient’s physical, emotional, and psychological needs.
With the help of modern technologies such as bioimpedance and ultrasound, specialists can more accurately assess fat distribution and muscle health, which provides a more detailed understanding of a patient’s condition. This allows for a more targeted and effective treatment plan, one that goes beyond weight loss and focuses on the broader goal of improving the patient’s health and quality of life.
Conclusion: A Lifelong Journey
Obesity is a chronic disease, and its treatment is a lifelong journey. It is not about quick fixes or temporary solutions but about adopting sustainable changes that promote long-term health. As obesity specialists continue to refine their approaches, patients are gaining new hope. By focusing on personalized, empathetic care that addresses all aspects of obesity – from nutrition to physical activity to mental health – we are moving towards a more effective and compassionate way of helping people with obesity.
In the end, the goal is not just to lose weight, but to build a healthier, more fulfilling life, free from the burden of guilt and frustration. With the right support, individuals can make lasting changes and achieve a higher quality of life, regardless of the number on the scale.
