By Lisa Dobruskin, MD, FACS
The long-held belief that obesity is caused by a lack of willpower is like a fad diet that promises dramatic results — a myth.
In truth, obesity is a complex disease that involves a multitude of factors.
And like most diseases, it almost always requires medical treatment.
The Center for Bariatric Surgery & Metabolic Medicine at Penn Medicine Princeton Medical Center provides a comprehensive and multidisciplinary approach to weight loss, including the latest surgical procedures.
It’s in Your Genes …
Just as you can inherit genes that can increase your risk for certain cancers, you can also inherit genes that increase your risk for obesity.
To be sure, twin studies demonstrated that the rate of inheriting obesity is estimated to be between 40 to 70%.
Moreover, scientists have identified 300 distinct genes that contribute to obesity and 11 genetic abnormalities that directly cause obesity.
What scientists also know is that there are certain skinny genes (not the kind you wear) that are common among people who are able to maintain a healthy weight with little or no effort.
While there is still more research that needs to be done, doctors have found that obesity involves almost every organ, from your brain to GI (Gastrointestinal) tract, and how your genes are encoded influences feelings of hunger and fullness and how your body metabolizes food.
… And Your Gut
Your gut flora — all the bacteria, viruses, fungi and other microorganisms — that live in your intestines also play a critical role in obesity.
This flora, also known as your microbiome, can affect how your body extracts energy, stores fat, and regulates your appetite and metabolism.
The development or colonization of your microbiome starts at birth or even earlier as you are exposed to different bacteria. Disruptions in the early establishment of the gut microbiome have been linked to various health issues, including obesity.
In fact, studies have found that babies delivered via Cesarian section (C-section) have a greater risk of developing obesity than babies delivered vaginally. This is believed to be because babies delivered vaginally are exposed to more bacteria as they travel through the birth canal than babies born by C-section.
It’s also interesting to note that babies born prematurely are at greater risk of developing obesity than full-term babies. Studies have connected this to a variety of factors including inflammation, early nutritional imbalances and jaundice.
Sleep and Stress are Factors…
In addition to genetics and your gut microbiome, poor quality sleep and chronic stress can also increase your risk for obesity thanks to a hormone called cortisol.
Cortisol, also known as the stress hormone, activates your body’s fight-or-flight response, signaling that you need a quick source of energy (carbohydrates) to escape danger.
When your cortisol levels are high, you’re more likely to gravitate toward refined carbohydrates like bread, pasta and sugary treats, which typically lack nutrients and cause spikes in blood sugar.
These spikes ultimately can trigger hunger and lead to cravings for more carbs. Over time, this pattern can contribute to weight gain and impede attempts at weight loss.
Other external factors that can increase your risk for obesity include chemical exposure, such as through microplastics and ultra-processed food, as well as certain medications. Physical inactivity can also contribute to your risk.
…Dieting Too
Restrictive diets and repeated cycles of weight loss and weight gain don’t usually resolve obesity and can actually make it worse.
This is because when you restrict calories your body fears it is starving and works more efficiently to maintain an abnormally high set point of weight.
Your body becomes more efficient at conserving energy, which means it burns fewer calories at rest.
Additionally, dieting can alter the balance of the hormones that regulate hunger and satiety. Over time, these disruptions can lead to increased appetite and overeating.
Benefits of Bariatric Surgery
Bariatric surgery has been proven to be the most effective and most durable treatment for obesity and many obesity-related diseases, such as diabetes, high blood pressure and obstructive sleep apnea, according to the American Society for Metabolic and Bariatric Surgery.
In general, people who undergo bariatric surgery lose up to 77% of their excess weight within a year after surgery and maintain 50% of that weight loss at five years after surgery.
The two most common types of bariatric surgery are sleeve gastrectomy and gastric bypass surgery.
During sleeve gastrectomy, about 70% of the stomach is removed, reducing the amount someone can eat by 80 to 90%. In addition, sleeve gastrectomy causes a drop in the levels of ghrelin – the hunger hormone – so your appetite is reduced.
During gastric bypass surgery, the small intestine is rearranged so that the lower part of the small intestine is connected to the new stomach pouch. Patients feel full after a smaller portion of food and also absorb fewer calories.
Patients with a Body Mass Index (BMI) of over 40 or over 35 with other health conditions are considered ideal candidates for bariatric surgery.
If you have been diagnosed with obesity, it is important to recognize that it is a disease — one with many risk factors beyond your control. However, treatment is available to help you lose weight and keep it off so you can you can lead a healthier life.
To learn more about the Center for Bariatric Surgery & Metabolic Medicine at Penn Medicine Princeton Medical Center, call (609) 785-5870 or visit www.princetonhcs.org/weightloss.
Lisa Dobruskin, M.D., F.A.C.S., is a board certified surgeon specializing in bariatric surgery, and a fellow of the American College of Surgeons. She is the Medical Director of the Center for Bariatric Surgery & Metabolic Medicine at Penn Medicine Princeton Health.
