1.
Overweight/Obesity is a disease
state that has reached epidemic
proportions (65% of the population) that
ultimately results from a constant state of consuming more energy in the form
of food than expending energy in the form of physical activity.

2.
Overweight/Obesity
directly causes multiple other medical conditions.

These co-morbidities can be categorized in the
following way:

1. Metabolic co-morbidities

i.
Diabetes

ii.
Hypertension (high blood pressure)

iii.
Hyperlipidemia (abnormal cholesterol values)

iv.
Vascular Disease

v.
Gout

vi.
Gallbladder Disease

vii.
Infertility in women

2. Mechanical co-morbidities

i.
Degenerative Arthritis

ii.
Obstructive Sleep Apnea Syndrome

iii.
Restrictive Lung Disease

iv.
Exacerbation of Asthma

v.
Exacerbation of Gatroesophogeal Reflux Disease (GERD)

vi.
Venous Stasis (leg swelling)

3. Social co-morbidities

i.
Low self-esteem and social isolation

ii.
Vocational and Educational Discrimination

4. Miscellaneous co-morbidities

i.
Elevated risk for certain Cancers:

1. Breast

2. Uterine

3. Colon

4. Kidney

ii.
Elevated Surgical and Obstetrical Risks

iii.
Elevated risk of death from all causes

3. There are Disorders that cause or contribute to
   overweight/obesity:
1. Eating Disorders

i.
Binge Eating Disorder (B.E.D.)

2. Endocrine Disorders

i.
Thyroid Disorders

ii.
Cushing’s Syndrome

3. Psychiatric Disorders

i.
Depression

ii.
Stress Disorders such as PTSD

iii.
Schizophrenia

iv.
Sleep Disorders

4. Medications that can contribute to overweight/obesity:
1. Medications for Diabetes

i.
Sulfonylureas

ii.
Glitizones (Actos, Avandia)

iii.
Insulin

2. Medications for Neuropsychiatric Disorders

i.
Antidepressant Medications

1. SSRI’s

2. SNRIs

3. Tricyclics

ii.
Mood stabilizer Medications

1. Antipsychotic
Medications

2. Anticonvulsant
Medications

3. Medications for Hypertension; Beta Blockers
4. Long-term use of Systemic Corticosteroids for
   Inflammatory conditions (Prednisone and others)

5. Overweight/Obesity and its co-morbidities usually coexist
   with other physical and mental health problems in any given individual.
   Therefore, in order for overweight/obesity treatment to be optimal, it
   must be individualized taking these other conditions into
   account.

6. Clinically significant permanent weight loss, defined as a
   5 to 10 % reduction from original weight, reducing the negative health
   consequences of overweight/obesity, is only rarely been accomplished by
   lifestyle interventions, such as diet and exercise, alone. A significant percentage of the total
   number of prescription and over the counter medications used in this
   country is for the treatment of the co-morbidities of obesity/overweight,
   yet they do absolutely nothing to help individuals lose weight.

7. The rational and clinically supervised use of prescription
   medications to assist individuals permanently lose weight can play an
   important role in the treatment of overweight/obesity. This approach, combined with diet and
   exercise, has been shown to be up to 4 times more effective in helping
   individuals permanently achieve a clinically meaningful weight loss than
   diet and exercise alone.

The medical approach to
directly treating overweight/obesity not only improves the general health and
well-being of these individuals, but ultimately cuts down on the total number
of medications required to treat the negative health consequences
(co-morbidities).

8. Weight loss medications are not intended to replace
   lifestyle interventions such as a high fiber, low fat, calorie restricted
   diet and daily exercise. Rather, by reducing abnormal cravings and
   appetite and improving satiety, and, in some cases metabolism, these
   medicines simply improve the chances in any given individual that these
   Lifestyle Interventions are successful in helping them permanently lose
   weight.

This is Part One in a series of articles on the topic of
Medicalizing Overweight and Obesity, so make sure to look at the next issues
for the continuation.