Obesity Is An Appetite Issue
It is easy to be simplistic
about a complex and prevalent issue such as obesity but there are many thin
people who are prepared to stand up and state the obvious about obesity but do
not have the slightest idea of the anguish suffered by people with the
complaint.
A large industry has
developed which relies on fat peoples’ inability to lose weight. This
industry deliberately misses the main obvious point.
The obvious fact about obesity is that it can be reversed if energy intake is
less than energy required and this is easily achieved by reducing the former
and/or increasing the latter.
So why don’t all fat
people just eat less? Easy, say the thin people, who have no idea what
persistent hunger is like.
Appetite, or the lack of suppression
of appetite when sufficient food has been eaten, is an ever present problem.
It is agreed that there are
other issues such as lifestyle change but these are not the main ones.
Many people find that they
lose weight when they take appetite suppressant medication - well what a surprise.
The problem with appetite suppressants
lies in their history.
The appetite suppressants
that have caused the notoriety of the type are those that were closely related
to amphetamines. They had the same appetite suppressant effect but unfortunately
they also shared the stimulant effect and depression side effects when
withdrawn. There was also a significant addictive element.
Therefore, quite reasonably,
all amphetamine related appetite suppressants were withdrawn.
Subsequently, the
void left by the withdrawn appetite suppressants has been filled by more acceptable
alternatives, one of which appears to be having exceptional results.
Unfortunately there is a
huge legacy of bias against appetite suppressants by general practitioners. It is
possible that this is driven by residual fear that we have because of the bad
old drugs. However, I believe that it is just good old fashioned prejudice -
the prejudice of thin people who are unable to understand the difficulty that
fat people have when trying to resist a permanent and grinding desire to eat.
This prejudice appears to
state that helping people with a problem is in some way wrong and that people
who are overweight are that way because they are weak-willed and that they
should just pull themselves together. To give help is just to subscribe to a
slob’s charter.
There are other areas of prejudices
where logic and clinical evidence are ignored in order to feed prejudices or
save money. The main one is in the reluctance to prescribe statins (cholesterol
lowering drugs) to those with an elevated cholesterol who need them . However, I digress.
In summary, obesity is a
problem (possibly not as big a problem as we are told) which is treated with
ignorance and a lack of skill and sympathy by those who should make the effort
to be conversant with the facts before they effectively condemn anybody with a
weight problem.
If we accept that most fat people
are fat because they are persistently hungry one step would be taken away from
the prejudice that blights our management of this problem.