Rebuttal: Is the treatment of obesity futile?

I wish to challenge the argument that the treatment of obesity represents a failure from the standpoint of public health.¹ This argument is based on a premise that ignores the considerable variations in the health of individuals with identical body mass indexes (BMIs) and it assumes that effective treatment consists of significantly and permanently reducing the BMI of every person who is obese. Diabetes prevention that incorporates lifestyle changes leads to the maintenance of moderate weight loss and lasting benefits after 1 year, which shows that treating obesity in these at-risk patients is, in fact, effective from a public health standpoint. However, identification of these patients is important; one-third of the obese population does not present with metabolic disease. Also worth mentioning is the safe and effective treatment of sleep apnea. I believe that BMI should not be considered an isolated therapeutic target; rather, it should be one of several factors used to determine the best therapeutic strategies for obese patients.

I would also like to challenge the argument that we should place our hope in prevention. While theoretically valid, it has little relevance for physicians. I believe that it is difficult to define our role in the prevention of obesity, which is still in the early stages of development. Most of the measures being proposed are socioeconomic in nature and we are a long way from having defined effective strategies. For all of these reasons, I prefer to place my hope in the improvement of therapeutic interventions for weight management and clinical care of the diseases associated with obesity.

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