Treat obesity as chronic disease, not lack of will — paper

By Patricia B. Mirasol, Reporter 

OBESITY should be recognized and treated as a chronic disease, according to a consensus paper for the management and care of obesity in South and Southeast Asia. 

“By fundamentally recognizing obesity as a chronic disease, we aim to shift a variety of erroneous beliefs that, for example, obesity results from solely a lack of willpower leading to poor lifestyle choices, or that it should be regarded merely as a risk factor for other conditions, to acknowledging the science of obesity,” said Dr. Tham Kwang Wei, lead author of the consensus and secretary of the Asia-Oceania Association for the Study of Obesity (AOASO), in an Oct. 20 statement.  

“When we approach obesity as a chronic disease with a propensity for relapse and progression,” Dr. Wei added, “we not only enable the provision of a whole-systems approach for effective prevention and treatment for the long-term, but also shift the focus on PwO [people living with obesity] and combat the stigma and discrimination associated with weight, which impedes PwO in seeking appropriate care.”   

Titled “Obesity in South and Southeast Asia — A new consensus on care and management,” the paper released Oct. 19 lists 42 preliminary recommendations developed by medical experts from the Philippines, Bangladesh, Brunei, India, Indonesia, Malaysia, Singapore, Sri Lanka, Thailand, and Vietnam. 

“We have not really solved the problem of chronic energy deficiency [a condition characterized by low body weight and possibly limited physical capacity due to food deprivation], and yet we added on overweight and obesity to our problems,” said Dr. Mia C. Fojas, one of two Filipinos on the panel and an endocrinologist and senior lecturer at the University of the Philippines-College of Medicine. 

Chronic energy deficiency and obesity and overweight were at almost equal prevalence three decades ago, she said at a recent press briefing. 

The Philippines, she added, is drawing up its clinical practice guidelines for obesity. 

“Our culture in one that revolves around food, we are proud of our food. Our diet is also high in carbohydrates with high rice consumption, for example,” Dr. Fojas said in an e-mail to BusinessWorld. “Also important to note is the general notion that being overweight is ‘healthy,’ specially in children, these probably coming for the times when malnutrition was prevalent.” 

Enough cultural and social demographic similarities exist to justify a shared effort in treating obesity, according to Brian Oldfield, co-chair of the consensus and president of AOASO, which led the development of the consensus through a grant from the Southeast Asia office of pharmaceutical company Novo Nordisk. 

“It is our hope that with clear definitions and recommendations, we are one step closer to optimum care for people living with obesity in South and Southeast Asia,” Mr. Oldfield said in a statement.  

Obesity is a complex, progressive, and relapsing chronic disease that affects adults and children. It is caused by factors such as metabolism, dietary habits, and psychosocial conditions such as stress and depression. It is not caused by inadequate willpower, according to the consensus.  

Challenges specific to South and Southeast Asia are the double burden of over- and undernutrition, the varied quality of obesity care, cultural nuances, and stigma.  

The World Obesity Federation predicted that the prevalence of obesity worldwide would double between 2010 and 2030. This is likely an underestimation in South and Southeast Asia, the consensus pointed out, as adults and children of Asian descent experience obesity at lower levels of body mass index (BMI) compared to the cut-off points for global estimations.  

In the Philippines, the BMI cut-off points used to identify overweight and obesity are 23.0 kg/m² and 25.0 kg/m², respectively. The global standards are 25.0-29.9 kg/m² for overweight, and 30.0 kg/m² and above for obesity.   

Obesity prevalence among Filipino adults aged 20-59 years old was at 9.3% between 2018 to 2019. The prevalence for overweight and obesity for Filipino children aged 10-19 years was 11.6% by 2019.  

The consensus was presented at the International Congress of Obesity in Melbourne on Oct. 19. It was submitted in Obesity Reviews in July and is still awaiting publication.