As reported by BBC news, specialist health professionals say it is time for obesity to be regarded as an illness caused by genetics, biology and how we live today
New research adds to growing scientific opinion that “healthy obesity” does not exist. The findings show those who are significantly overweight have a 66% higher risk of developing chronic kidney disease, compared with those of a normal weight.
Many people with obesity say not only do they have to live with prejudice and stigma, but they struggle to find treatment.
Sarah has lived with obesity her entire adult life. The 39-year-old mum has a Body Mass Index, or BMI, of over 40, which means she is medically classified as having “severe obesity” and is overweight enough for her health to be at risk.
“People think you’re unintelligent, that you’re lazy, that you eat too much, that you’ve done this to yourself. That it’s a choice,” she says. “I just want to scream and say none of those things are right.”
Sarah has spent most of her life trying to control her weight through diet and exercise, and says her obesity is something that she thinks about every day.
Growing up in Jersey, in the Channel Islands, Sarah was a “normal-sized” girl, until the end of primary school when she began to develop before some of the other girls in her class. By the time she went to an all-girls secondary school, the changes of puberty meant she started to feel different from many of her friends.
In her early teens, she was aware her mum had regularly struggled with her own weight and had tried lots of diets, so as Sarah’s weight increased, she did the same.
At 16, she decided to go on an 800-calorie-a-day milkshake diet. Over the summer before starting her A-levels, she says she dropped from a size 14 to a size 10.
At the time, it made her feel “brilliant”. But, in hindsight, she realises this was the start of years and years of yo-yo dieting.
Sarah was around a size 12 when she started university. But when she graduated three years later, she had grown to a size 20. The student lifestyle – drinking and eating late – meant she couldn’t keep on top of her weight.
But unlike when she was 16, this time diets weren’t working. It was the start of a struggle to regulate her weight which Sarah says has remained with her to this day.
Scientists have found that people’s genetic background means their weight changes differently, even if they eat the same amount of calories.
After university, Sarah started working in the pharmaceutical industry. She was performing well as a sales person, selling a diabetes drug. But she was taken aback after her boss told her that when he first met her he remembers thinking, “You better be a bloody good sales rep, looking the way you do, trying to sell a diabetes drug”.
Sarah now says it should be against the law to make comments about body shape and size.
By the time she was 30, Sarah had severe obesity and was desperate to do something about it for the sake of her mental and physical health. She embarked on a year-long project with a personal trainer and completed an Olympic-class triathlon – swimming 1.5km, cycling 40km and running 10km. She also lost eight-and-a-half stone (55kg).
Around this time, she had some tests which looked at her genetic make-up. The results found two important things:
she possesses a variant of the FTO gene, which is associated with weight gain and increases the risk of obesity
she has a mutation of the MC4 receptor which causes obesity
Shaw Somers, a consultant surgeon who specialises in weight-loss operations, has been treating people with severe obesity for many years. He says people like Sarah, who have an inherited set of certain genes, are much more likely to develop obesity compared with those who don’t.
But obesity is not just about genetics, he says. It is also about psychology, inequalities and the food environment we all live with.
Historically, he says, people with these genetics would have done well in a famine, but with today’s plentiful, high-calorie food they will put on weight “without strong determination and support”.
Dr Denise Ratcliffe, a clinical psychologist who supports patients through bariatric surgery, says people’s past experiences can come into play. She says that many of the people she sees, have experienced trauma, abuse or neglect, for example, which leads to a dysfunctional relationship with food.
“I think there’s something about the psychological experiences people have, and the relationships that they start to form with foods, that becomes almost like a perfect storm.”
Both the genetic and psychological components of obesity can be amplified when there is easy access to fatty, sugar-laden foods, which are available cheaply and conveniently.
Sarah’s friend Jed has lived on an estate in Hull all his life. He lives with obesity, and thinks areas like his can have a big effect on the health of those living there. Across the road from his house, he remembers the parade of shops once having a greengrocer’s and a butcher’s – now eight of the 20 shops are fast-food outlets.
“We’ve got a chicken place, we’ve got a burger place, we have got a fish shop, we’ve got a kebab shop, another kebab place, another chip shop, and a Chinese,” he says.
Jed says that he recently signed a petition to try to prevent another takeaway from opening.
“If you look at any area in your city, which is at a low level of socio-economic standing, I guarantee there’s going to be more takeaways. We don’t need to kick areas like this down. We need to lift them up.”
After training for the triathlon and losing eight-and-a-half stone, Sarah continued to train regularly and eat well. But she noticed that gradually she started to become heavier. Whatever she did, it made no difference.
Dr Abd Tahrani, a senior lecturer in obesity medicine at the University of Birmingham, says there are a lot of people who are “biologically pre-designed to conserve energy”, which is stored as fat. He explains that signals from the hypothalamus – the part of the brain that controls appetite – bombard the person with feelings of hunger and a desire to eat, that are almost impossible to fight.
So even if the person successfully loses several stone by dieting, their body remembers its baseline weight and strives to return to it.
Studies from GP records in the UK showed that the annual chance of achieving normal weight in people with morbid obesity is one-in-700 to one-in-1,000.
As Sarah started to research obesity, she realised that after a lifetime of blaming herself, she understood that it was actually her body “working against her”.
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