The treatment of obesity: a contemporary view

We stand today at the threshold of major changes in our policies on the treatment of obesity. These treatments, surgical for severe obesity, behavioral for lesser degrees of obesity, produce predictable weight losses with almost complete safety but poor maintenance of these losses. New findings on the distribution of body fat have profound implications for treatment. It is upper body obesity, particularly the visceral fat depot, that conveys most of the medical risk of obesity, and upper body obesity is a problem primarily afflicting men. Paradoxically, most persons coming for treatment for obesity are women, driven by the merciless stigma that attacks women for their obesity. Two major changes in our policies on the treatment of obesity are strongly indicated. First, we must encourage men to enter treatment for obesity in numbers commensurate with the serious risks of their obesity. Second, we must make every effort to decrease the stigma of obesity for women. Lay self-help organizations such as OBESITAS can play a key part in this endeavor. It can help to apply legal sanctions against discrimination where such laws exist and advocate such laws where they do not. It can educate the public and it can use its immense creativity to develop new methods of reducing stigma.