Obesity Research: Is it Missing the Boat?

Recently working on some CMEs for medical license renewal and reading a thorough course on state of the art care for weight loss reduction in obese patients. The author goes to great lengths describing how the “obesity-as-a-disease” model finally seems to be taking root in healthcare systems. The upshot is a unapologetic push for the use of anti-obesity medications (AOM) and in the most severe cases, what’s now called metabolic-bariatric surgery (MBS).

All other approaches are simply de-emphasized for lack of research evidence, which means behavioral modification, nutritional counseling, and physical activity may and should be included in weight loss efforts, but they do not seem to play a very large role in facilitating weight loss. While the author reviews a lot of the research on these staples offered by so many healthcare professionals, he is nonetheless able to show how the data are far more convincing for the use of AOM and MBS.

My disappointment with the course, however, is more about the lack of any coverage on the pioneering work of Dr. Vincent Felitti on the treatment of obesity. I had the pleasure of meeting Dr. Felitti at a crime victims’ trauma assessment and treatment conference in the early 1990s. At the time, we were both in midst of learning about or addressing in our clinical practices the outsized role of emotional processing skill in his obese patients and my sleep patients.

Ever since, I’ve followed his work and have been routinely disappointed by the lack of coverage he gets in treating obesity, using a very intensive combination of physiological (modified fasting model) and psychological (depth psychodynamic model) methods. The hyperlink accesses a pdf from 2010, when he presented a fascinating history of how he got to where he was at that point.

If you know someone with serious weight issues who has tried and failed various methods, they may want to look closely at Dr. Felitti and colleague’s theories.