Global Epidemic: More People Obese Than Underweight

Learn what’s behind the obesity epidemic and how to manage it from Michael Snyder, MD.

Medically reviewed in May 2021

It’s not news that obesity is a national problem, but a study published in The Lancet reveals it’s a global problem too. For the first time in history, there are more obese people than underweight people in the world. We talked to Michael Snyder, MD, a bariatric surgeon with Rose Medical Center in Denver, to learn more about the growing obesity epidemic and what he thinks needs to be done to curb it.

What do these findings mean to you?
Dr. Snyder: In my opinion, the “war on obesity” has been a total failure. The take-home message is that “prevention” does not work when applied to the broader population. People know how to lose weight, but by and large, it is not being done. As a doctor, this means that it is time to move away from prevention and towards treatment.

What treatments would you suggest?
​Dr. Snyder: Obesity is not the same for everyone. If your are overweight with a body mass index (BMI) between 25 to 30, pretty much any diet or exercise plan will work. But if you are obese, with a BMI of 30 or higher you have to bring in some extra tools. They may be as simple as more aggressive and regimented dietary and behavioral management, such as working with a dietitian or a bariatric medical specialist, or in some cases, a bariatric surgeon. In this situation, treating weight gain like a medical problem is critical.

If your BMI is 40 or higher, nothing really works except for aggressive management. Studies show that only 3-5% of people with a BMI over 40 who lost weight naturally were able to maintain that loss for five years. The only proven option for someone to lose weight and keep it off if they have a BMI over 40 is bariatric surgery, but that doesn't mean everyone needs bariatric surgery.

What does this study mean for obesity management in the future?
​Dr. Snyder: Body mass index (BMI) should be considered a vital sign because weight and its health ramifications are just as important as blood pressure’s effects on the heart. Your weight affects so much more than your looks. In fact, being overweight could up your risk for diabetes, hypertension, sleep apnea, heart disease and stroke. We’re already seeing nursing homes slowly filling up with younger people who are incapacitated by weight and not the usual diseases of “old people.” And, in my opinion, diabetes related to weight will bankrupt our healthcare system in this generation.

What can we do to reverse this trend?  
​Dr. Snyder: We need to make treatment for weight loss and obesity a priority, and start treatment as early as possible. Also, lifestyle and nutrition modification should be a covered medical expense. For example, if you have diabetes, every medical plan covers diabetic education—whether it's for a registered dietitian or professional education program. Why is it not the same for our general health and weight management? It should be. Weight management should be a covered benefit to teach people how to manage their diet and behaviors. In my patients, a cornerstone of their care is based on dietary management, so I employ a number of registered dietitians. Quite frequently, the insurance will pay tens of thousands of dollars for weight-loss surgery, but won't pay $70 for my patients to see a dietitian to actually learn how to maintain their weight loss. I find that absurd.

Why doesn’t weight-loss surgery work for everyone?
​Dr. Snyder: Every single patient that gains his or her weight back after bariatric surgery has the same story. They weren't compliant. Does that mean that they're stupid? No. Does that mean they're ignorant? No. It either means they weren't taught how to do the right thing, or they didn't persistently do the right thing. Anyone can lose the weight for that one moment in time, but to maintain the desired weight takes work.

See More from Dr. Snyder:
When should I consider weight loss surgery?
What should I expect after weight loss surgery?
How do I choose the right bariatric procedure for me?

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