Abstract
For a long time the assumption has been that, although weight reduction was necessary and desirable, comorbidities were far more important and needed treatment even if weight loss was not a treatment goal, preferably with medication. This controversy leads to postponement of treatment, and later on causes very intensive medical treatment, thus, raising the health care costs to unacceptable levels, leading to the medicalization of individuals, and a declining of the responsibility of patients for their health, leaving the question of when to regard their own weight as a problem that should be dealt with up to individuals. The central problem is insulin resistance, which leads to a cascade of health problems. This condition should be diagnosed in primary practice and obesity clinics to ensure a better, tailor-made treatment for patients. Treatment should start at the earliest stage possible, when comorbidities are still reversible and includes a personalized dietary advice and counseling, preferably by a dietitian, to tackle insulin resistance. An exercise program is part of the treatment.
Highlights
For a long time the assumption has been that, weight reduction was necessary and desirable, comorbidities were far more important and needed treatment, preferably with medication, even if weight loss was not a treatment goal
This controversy leads to postponement of treatment, and, later on, causes very intensive medical treatment, Healthcare 2015, 3 raising the health care costs to unacceptable levels, leading to the medicalization of individuals, and a declining of the responsibility of patients for their own health, leaving it up to individuals when to regard their own weight as a problem that should be dealt with
Glucose-clamp studies showed that comorbidities are caused by the presence of combined insulin resistance and hyperinsulinaemia, deriving from the inflamed adipose tissue, which is characterized by increased monocyte infiltration and cytokine production [8,14], Insulin resistance is the result of a long-term process that is encountered by chronic energetic overfeeding, when an abundance of glucose and saturated fat enter the cell, leading to Endoplasmic Reticulum (ER) stress; a low grade flammation process and hypoxia [1,14,15]
Summary
For a long time the assumption has been that, weight reduction was necessary and desirable, comorbidities were far more important and needed treatment, preferably with medication, even if weight loss was not a treatment goal. In several countries overweight is not even regarded as a disease, but as a condition, whereas, e.g., hypertension, dyslipidemia, and type 2 diabetes are considered as real diseases This controversy leads to postponement of treatment, and, later on, causes very intensive medical treatment, Healthcare 2015, 3 raising the health care costs to unacceptable levels, leading to the medicalization of individuals, and a declining of the responsibility of patients for their own health, leaving it up to individuals when to regard their own weight as a problem that should be dealt with. In this article I will explain why we need a shift of paradigm regarding the relationship between body weight and comorbidities
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