Family physicians can treat obesity. The science is extensive; the art of treatment is exciting. This blog, for family physicians, debates the major issues in successful treatment of obesity.

• Neil Peace

  Dr. Neil Peace is a family physician who has had a special interest in treating overweight and obese patients since 1982. He studied medicine at Queens University, Kingston, Ontario, Canada, and now lives in Sydney, Australia. His medical practice in Sydney deals exclusively with treating overweight and obese patients, and he takes a scientific approach to treatment. Dr. Peace believes that family physicians can and should be primary managers of their obese patients.

Weighing in With Neil Peace

Weight Control Is Applied Physiology

Neil Peace, MD, General Practice, 07:52PM May 17, 2010

Success at weight control requires a long term view. Family Physicians, as "applied physiologists" are perfectly placed to help patients take this long term view. I firmly believe that doctors must lead the attack on obesity.

Knowing how the body works metabolically and the brain in particular, allows one to construct tactics to fool the physiology.

Obesity results from genetics out of sync with the environment. Success at weight control depends on understanding the physiology of glucose metabolism and the hormones of food seeking. These hormones and brain centres cannot be changed. The are in the hard drive. But understanding the physiology allows the creation of tricks to circumvent the drives to seek food, eat food and eat extra. Knowing the physiology allows one to overcome the body’s relentless drive to lay down body fat.

The brain uses only glucose for fuel (with rare exceptions). This explains much of our behaviour towards food seeking. If too long a time has passed since the last meal then the brain will be struggling to find enough glucose. This sets off alarm bells. The brain is central to survival.

Those alarm bells wake up a posse of hormones. The hormones mount their horses and charge into action. "Must save the brain" is the rallying cry for Leptin and Ghrelin (Leprechauns and Gremlins). They initiate intense food seeking. The patient overindulges.

As Family Physicians (applied physiologists) we can warn patients to eat often enough to avoid this hormonal over reaction. How often to eat to avoid this "charge"? It varies but I usually start by suggesting patients eat three hourly – whether hungry or not. I can hear the nutritionists throwing up their hands in horror. "Only eat when hungry" is their catch cry. Well – it hasn’t worked.

By eating before hunger sets in, food seeking hormones are kept quiet. The tendency to over indulge is reduced.

I believe the application of physiology is the path to weight control and this implies a long term view.

How do we convince patients to take this long term view? Patients have had decades of quick fix weight loss scams. Hundreds have come and gone. There will be many more before we get it right.

It would help if governments mandated that weight loss plans must have the same scientific proof as they expect for say a new blood pressure medication.

This would eliminate false advertising. The patient would have a chance of taking a long term view. Then we could practice our applied physiology for weight control.

Free market folk will point out that such restriction of advertising is contrary to the freedom of speech. Indeed it is but if that principle were fully applied we would have complete freedom to deceive the public on smoking, alcohol and many other areas where truth in advertising is applied.

I say, let’s get weight control out of the hands of the quick fix merchants and back into the hands of the applied physiologists – the Family Physician.

What do you think?

Comments are closed.