Rebuttal: Is the treatment of obesity futile?

Dr Garrel’s response to obesity is as follows: “The treatment of obesity is simple and need not be time-consuming.”¹ Unfortunately, Dr Garrel does not present any evidence to support his comment. The only study included in his references² on the successful treatment of obesity is plagued—as is much research—by a significant dropout rate. Thus, data at 24 months are only available for 357 of the 1906 subjects recruited. Just 13.9% lost at least 5% of their original weight, the average weight loss at 24 months being 2.3 kg (95% CI - 3.2 kg to + 1.4 kg). That is not much, considering that the patients were followed closely: there were 9 planned visits over 12 months.

Dr Garrel suggests that patients be referred to a multidisciplinary team. I agree with this in principle, but where are these teams, what is their availability, and, most important, what results do they achieve? Unfortunately, Dr Garrel didn’t provide the results for the 6-month intervention at a cost of $2000 to $3000.

I agree with my opponent that an initial loss of 5% to 10% of the patient’s original weight is beneficial, particularly from the standpoint of metabolic health. The point is to maintain that weight loss. Of course comorbidities must be treated, which I do on a daily basis. However, I would prefer to treat the cause of these comorbidities—obesity itself. In that sense, non-surgical treatment of obesity generally is a failure.

If there were “simple” and effective ways to treat obese patients, we would know. Efforts and results achieved by obese patients who are trying to lose weight must be encouraged, but we have to be realistic. Only a small number of patients achieve lasting results. To reiterate, the energetic prevention of excess weight beginning at an early age offers the best hope in the fight against obesity.