Obesity: disease or lifestyle choice? An interview with Carel Le Roux

Posted On: 14th June 2019

“We now treat obesity like all other chronic diseases, and we understand the value of meal replacement strategies which helps change the symptoms of hunger and lack of satiety in a subpopulation of people with the disease of obesity. For these people losing weight is effortless as the meal replacements addresses the underlying biology of the disease.”

Carel Le Roux, professor of metabolic medicine at University College Dublin, proposes in his interview that officially recognising obesity as a disease will change our understanding and approach to treating it. This, he argues, would allow medical professionals to examine obesity in separate stages: causes, symptoms, and complications. Once the symptoms of obesity are targeted, there is a greater chance of successful weight management.

So, what would be achievable if other countries were to officially recognise obesity as a disease? Portugal officially classified obesity as a chronic disease in 2014, but still remains the only country in Europe to do so. Doctors in the UK have been outspoken in their convictions that obesity should be designated a disease and should no longer be considered a lifestyle choice – they called on the government to enforce this reclassification so that patients can receive specialist care.

Classifying obesity as a chronic disease would allow the creation of formal policies to improve care in the medical field, so that preventative measures can be put in place. Le Roux also believes sufficient legislation is an essential step towards tackling the stigma of obesity, a statement echoed by the President of the Royal College of Physicians: “It is important to the health of the nation that we remove the stigma associated with obesity”. This stigma, Le Roux argues, only compounds the problem. Not everyone has control over their lifestyle; access to healthy food, exercise and information around nutrition has become something of a privilege.  Furthermore, many well-known conditions are lifestyle-related, such as heart disease, yet patients suffering from these conditions are not blamed to the extent that diabetes patients often are. Often not triggered by lifestyle factors, diabetes can be caused by health inequalities, genetic influences and social factors – all causes that are largely out of the patient’s control.

The decision to prescribe total meal replacement diets (TDRs) on the NHS is a positive sign that the medical field recognises obesity as a disease that can be treated and controlled by healthcare professionals. Professor Jonathan Valabhji, National Clinical Director of Diabetes and Obesity for the NHS in England said: ““Our work so far in this area has been producing really positive results and today’s announcement will allow us to go even further –  it will help patients who have Type 2 diabetes to achieve remission and importantly, help more of those who are at risk to not get it in the first place.”

Le Roux’s approach to TDRs is very simple: If a patient is responding well to a diet approach, it is beneficial to continue; if a patient does not seem to respond well, then the medical professional may look at modifying the diet or considering alternative options. Members of TDMR Europe take care to carry out extensive consultations with people who wish to lose weight in order to design a tailored weight management programme that works for them. In choosing the right option, different factors should be taken into account: the amount of weight to lose, the general health and fitness of each individual and the cost-effectiveness of the proposed solution, as well as personal preferences