THE BLOG

Not One (Plus) Size Fits All

04/24/2015 08:35 EDT | Updated 06/24/2015 05:59 EDT
AP

When it comes to treating weight problems, even experts believe that similar methods can be applied almost universally: Put your patients on a diet, have them engage in regular exercise, and, if all else fails, recommend some surgical procedure. What gets rarely looked at are the differences between overweight individuals that may have led to their unhealthy weight gain in the first place. Only one such study has recently been published, and the results are eye-opening.

For the study, scientists from the universities of Sheffield, England, Harvard, United States, and Toronto, Canada, analyzed medical data of over 4,000 overweight or obese men and women in terms of common and distinguishing characteristics. In the end, they came up with six "categories" or "types" that helped them better understand their subjects' eating behaviors and lifestyle choices.

The first group was identified as "heavy drinking males" whose excessively high alcohol intake resulted in weight problems. Getting members of this category to limit their consumption of alcoholic beverages would obviously be an important step toward successful weight control.

The second group, named "younger healthy females," consisted of women who were generally healthy except for their weight issues. Eating patterns and exercise levels were viewed as largely acceptable but were interspersed with bouts of binge eating and occasional heavy drinking, which, again, contributed to weight gain. Remedies hereto would be similar to their male counterparts.

A third type was called "the affluent and healthy elderly," seniors who enjoyed retirement life a bit too much and paid the price with an unhealthily expanding waistline. Tuning it down a little would be the appropriate strategy.

Another group of older individuals was diagnosed with one or more chronic health conditions like diabetes and high blood pressure, in addition to being overweight. Those "physically sick but otherwise happy" people were often unaware of how their weight aggravated their other ills. Counseling with the aim of diet and lifestyle changes could lead to major improvements in such cases.

Mental dysfunctions like anxiety and depression were also found to be increasingly damaging to people as they grew older. The "unhappy, anxious middle-aged," as the researchers named this group, often showed a close connection between their inner feelings and their outer appearance, especially in terms of weight. As psychological disorders oftentimes manifest themselves physically, equal attention must be paid to both the roots and symptoms before any progress can be hoped for.

Lastly, the research team focused on those whom they found in the "poorest health." The prevalence of weight problems and chronic illnesses was especially high in this group, and eating and lifestyle patterns were predictably dismal. Overweight and obese patients of this type require intensive care and should be treated with the most effective methods. Because of the severity of the health conditions typically found in this category, the researchers saw here justification for the clinical weight loss approaches now widely in use.

Obviously, attempts like these to find patterns in complex phenomena have their limits. There might be numerous additional factors leading to weight gain that have not received enough attention in this particular study. But its central take-away is that the overweight and obese are not a homogenous part of the population with the same health needs, says Dr. Mark Green of Sheffield University, the lead author of the study report, in a press release about his findings. If we don't come up with better solutions and more customized, or as he calls it "bespoke," forms of treatment, we will continue to fail serving those who need our help most.

As a dietitian and health counselor, I couldn't agree more. After all, that is what one-on-one counseling entails. But, unfortunately, the system is not set up for this sort of effort. For instance, health insurance companies favor short-term treatments like weight loss surgery over open-ended approaches, including diet and lifestyle coaching. We can only hope that studies like this will eventually bring a different view to the agenda.

Food and Health with Timi Gustafson R.D.

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