For almost three decades, The Obesity Society, a leading scientific organization dedicated to the study of obesity, has worked to increase the evidence-based understanding of the causes, prevention, consequences and treatment options for what has truly become an epidemic in this country.

 

Data from the National Center for Health Statistics from 2006 finds two-thirds of all adults in the United States are overweight (BMI ≥ 25 but < 30) or obese (BMI ≥ 30) with 70.5 percent of men falling into these categories and 61.6 percent of women. The epidemic crosses gender lines, all racial and ethnic groups, ages and education levels.

 

The prevalence rate for being overweight or obese has increased steadily over the past five decades but has slowed slightly since 2004. Of the states participating in the Behavioral Risk Factor Surveillance System in 1990, 10 had a prevalence of obesity less than 10 percent, and no states had prevalence rates equal to or greater than 15 percent. By 2008, only Colorado had a prevalence of obesity less than 20 percent. The majority, 32 states, had a prevalence equal to or greater than 25 percent; and six states (Alabama, Mississippi, Oklahoma, South Carolina, Tennessee and West Virginia) had a prevalence of obesity equal to or greater than 30 percent.

 

Overweight and obesity comes at a heavy cost physically, emotionally and financially to both individuals and society. Unhealthy weight is a risk factor for diabetes, cardiovascular disease and cancer … among many other conditions. A higher mortality rate has been ascribed to being overweight and obese. Economically, the condition is taxing the healthcare system and resulting in billions of dollars in lost productivity.

 

In the final quarter of 2009, The Obesity Society gathered in Washington, D.C. to present the latest research and to discuss the latest tools and strategies to try to reverse recent trends and return more Americans to a healthy weight.

 

Martin Binks, PhD, clinical director and CEO of Binks Behavioral Health and a member of The Obesity Society, said that he … like many of his colleagues … considers himself a generalist in the field and believes a multi-disciplined approach is needed.

 

"It is a convergence of medical, nutritional, fitness and behavioral and psychological components we bring to this issue," he noted. "We're looking at it from the individual biological and metabolic point of view all the way up through population-based studies."

 

Binks, who is also an assistant consulting professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, stressed the 'right approach' to take for a patient truly varies from individual to individual. "No one treatment fits everybody," he said. "There are many treatments that are scientifically valid. My approach to obesity management is you take every valid treatment option and figure out what combination works best for the person sitting in front of you."

 

However, he continued, whatever course is ultimately selected is sure to include intervention on a variety of levels including lifestyle and behavioral modifications to achieve long term success.

 

A huge frustration for Binks and colleagues are the numerous companies promising the public a "magic bullet." He likened these advertisers to snake oil salesmen. "Among medical conditions, obesity is one that's been most subjected to unsubstantiated methods to fix it," Binks stated. "The public is given a lot more exposure to the disreputable treatments than to the evidence-based reputable options, but I do think that's beginning to shift a little."

 

While acknowledging the task at hand, Binks said he did feel some optimism in shifting public perceptions and a growing awareness by policymakers and leaders that overweight and obesity must be addressed. "I think the healthier messages are filtering through more and more in certain venues. I think we're chipping away at the public, but it's an uphill battle.'

 

To give physicians more tools in their little black bag to address the issue of weight, Binks said The Obesity Society is in the beginning stages of developing a physician-credentialing program. In light of the complexity and significance of the problem worldwide, there has been a call to develop knowledgeable and skilled physicians trained in comprehensive obesity care. Since care spans multiple specialties and professional associations, The Obesity Society has taken a lead role in coordinating a collaborative process toward certification.

 

"Providers should never underestimate the power of their white coat," said Binks. "Patients do listen to them." He added patients really look to their healthcare providers to help them filter the many weight loss messages in our society and separate good science from myth.

 

He added that on the limited time frame of an office visit, asking the patient what they perceive to be the biggest barrier to weight loss could be a very good conversational gambit. "I call it 'picking the domino.' Patients are very smart. They know why they don't succeed," he said.

 

"There are emotional contributors to most people's eating issues, but they aren't necessarily emotional disorders," Binks continued, adding that when a physician does suspect a deeper issue, then a patient should be referred to a qualified mental health provider. For the most part, though, he encouraged providers to help patients address, recognize and hopefully resolve longstanding emotional barriers and triggers to eating.

 

He also said it's important for physicians to listen to their patients concerns and help them set realistic goals. Binks noted that just because someone drops an excessive and possibly unsafe 12 pounds in a week 'on the ranch' of one of television's most popular shows, it doesn't mean a patient has failed because they lost one or two pounds this week in the real world. This, he continued, is actually a safe and sustainable goal.

 

"Instead of telling the patient what their goal should be, ask what is possible," Binks suggested, adding this is another excellent way to open dialogue about weight. He added it's important to drop "the idea you have to lose 100 pounds to be successful. Instead, get them to take one step toward a healthier approach. It's a combination of providing information about realistic goals and a more Socratic, patient-centered approach."

 

Binks said it is also critically important to celebrate along the way. "The public's expectations about what they hope to achieve sets them up for disappointment," he said. "Too often we hear, 'the doctor says I need to lose 60 pounds.' The person will lose 10 and then hit a bump. Instead of celebrating that 10 pounds, they will give up because they didn't get to the bigger goal."