Why we need to rethink treating obesity with physical activity

More Americans than ever are living with obesity. The number of adults with the condition has skyrocketed 200 percent over the past 40 years. Obesity continues to contribute to a number of public health concerns such as its associated comorbidities and healthcare costs in addition to legitimate concerns about overall population health in the face of novel health threats like COVID-19.

However, as the number of Americans struggling to manage their weight continues to grow — 72 percent of the country lives with overweight or obesity — so has our clinical understanding of this complex but treatable condition. We know that there are hormonal and metabolic differences between people who live with obesity and those who do not. We know that there is a range of effective treatment options for obesity, and while it certainly includes behavior modification and cognitive therapies, we can also explore pharmacological and surgical interventions. We also know that there are limitations to the effectiveness of physical activity on weight loss and obesity management.

Given all that we now know about obesity, it is vital that clinicians and other healthcare professionals make it a priority to educate themselves on best practices for effectively integrating physical activity into obesity treatment plans.

We need to re-examine the role of physical activity in obesity management. Here’s why.

The notion that people can “win” the fight against obesity simply through dieting and exercise was taken to a new level with the introduction of The Biggest Loser to the cultural landscape. Contestants experienced dramatic weight loss while appearing on the show — just as we might expect to happen when patients with obesity are prescribed high levels of physical activity along with around-the-clock monitoring — but maintaining highly intense exercise regimes is unsustainable for most people with overweight and obesity. Additionally, a key insight from a long-term study of Biggest Loser contestants tells us that physical activity plays a larger role in maintaining weight loss than it does in catalyzing it.

Certainly, that doesn’t mean that physical activity plays no role in the weight loss journey. But it does mean that we should exercise caution in thinking about physical activity in terms of isolated exercise — not only is it an ineffective weight loss treatment for patients with obesity, but it reflects an outdated understanding of the metabolic mechanisms behind weight loss.

We know that sitting for long periods of time can negatively impact insulin resistance, but breaking up those periods with short walks can reduce insulin and glucose responses. With that in mind, a more effective — and sustainable — approach would dispense with “eat less, move more” and instead encourage patients to “sit less, walk more.”

What healthcare professionals need to know about incorporating physical activity into obesity treatment.

Here’s what we do know about physical activity — it can power a number of positive health outcomes. Exercise can improve lipoprotein levels, blood pressure, insulin resistance, mood and brain function and cardiovascular health in patients with obesity.

Healthcare professionals should keep the following best practices in mind when collaborating with patients on obesity treatment plans:

Keep patients grounded: Create realistic expectations of weight loss results, if any, based on individual patient activity programs. Help patients start to take a longer-term view of the weight loss journey to stave off feelings of burnout or frustration with the process. And level-set about the risk of sore muscles after starting a new exercise program.

Slow and steady wins the race: Patients often begin the treatment process with a great deal of enthusiasm which can inspire positive behavior changes, but it can also create the risk of exercise-related injury from doing too much, too fast. Help patients learn their individual exercise level and collaborate on finding ways to support and gradually increase the intensity.

Get things going: Starting a new exercise program can be a major hurdle to overcome. Help patients make the first step by connecting them with an easy-to-follow, actionable regimen that incorporates physical activity into their everyday lives. An easy place to start is by advising patients to walk a certain number of steps each day and gradually increase that footprint over time.

Reframe it: As discussed, physical activity delivers a number of health benefits beyond weight loss. Keep the myriad positive outcomes of physical activity top of mind for patients and help them to understand that exercise is just one part of a broader plan of care to improve their overall health. This insight can make it easier for patients to prioritize physical activity everyday.

Grow your obesity medicine knowledge: Healthcare professionals can better meet the needs of this rapidly growing segment of Americans by deepening their understanding of obesity medicine. The Obesity Medicine Association (OMA) provides a number of resources to encourage this endeavor, including The Obesity Algorithm®, Obesity Treatment Proficiency Badges™, ABOM certification preparation materials and more. OMA is also hosting a series of virtual courses on the fundamentals of obesity treatment — an informative primer on evidence-based approaches for evaluating, diagnosing and treating obesity.

The number of Americans struggling with obesity may be growing — but so is our knowledge of how to effectively treat the condition. Healthcare professionals who bring this knowledge into their practice areas can play a more active role in guiding patients with obesity to better health outcomes.

For more obesity medicine resources, or to become an OMA member, please visit: www.obesitymedicine.org.

Angela Fitch, MD, FACP, FOMA is the Associate Director of the Massachusetts General Hospital Weight Center and faculty at the Harvard Medical School. She is board certified in obesity medicine, internal medicine and pediatrics. Dr. Fitch serves as Vice President of the Obesity Medicine Association and previously served as Secretary-Treasurer.