March 11, 2015

Obesity cannot be cured with just diet and exercise

obesity options


Conservative measures of exercise and diet have traditionally been recommended as the first-line of treatment of obesity, given its simplicity and ease of prescription, or at least its perceived simplicity and ease.

However, the current level of medical evidence seem to suggest otherwise.

Compensatory behavioural adaptations to conservative measures of weight-loss are well-known and recognised (Resistance to exercise-induced weight loss: compensatory behavioral adaptations. Med Sci Sports Exerc. 2013 Aug;45(8): 1600-9). Some of these involve having a bigger appetite or reduced physical activity after exercise or dieting, which will limit the efficiency of conservative weight-loss programmes.

The root of this problem could very well lay with the way we as humans are wired, having a biological inbuilt mechanism to resist starvation. Some might refer even to the set point theory as an inbuilt weight “thermostat” that limits how much weight can be effectively lost.

In the February 2015 issue of The Lancet Diabetes & Endocrinology Journal, Dr Christopher Ochner from the New York Obesity Nutritional Research Center in New York, writes that while it is possible to lose weight with conservative measures over a few months, 80-95% will eventually regain that weight lost. He also recognises that there are probably deep innate biological mechanisms that trigger behaviour that limit the effectiveness of exercise and diet. As such, his group questions the age-old recommendation of eating less and moving more to lose weight.

In a recently conducted meta-analysis (medical studies generally regarded with the highest level of credibility) of 11 randomised controlled trials comparing bariatric surgery versus conservative treatment (Bariatric surgery versus non-surgical treatment for obesity: a systemic review and meta-analysis of randomised controlled trials. BMJ 2013 Oct 22;347), it was concluded that bariatric surgery leads to greater weight loss and higher resolution rates of type 2 diabetes and metabolic syndrome.

Dr Ochner expounds that if these biological mechanisms are not addressed, at least in part, conservative measures in weight loss are very likely to fail. At this current moment, weight-loss measures that involve biological and behavioural mechanisms are limited to surgery (bariatric and metabolic surgery), certain medications and vagal nerve blockage procedures.

Dr Ochner concludes that “Obesity should be recognised as a chronic and often treatment-resistant disease with both biological and behavioural causes that require a range of medical interventions including biologically based interventions such as pharmacotherapy or surgery as well as lifestyle modification. Ignoring these biological factors and continuing to rely on behavioural modification will surely result in the continued inability to treat obesity effectively and the premature death of millions of individuals each year.”


To find out more on bariatric surgery and how it can benefit your metabolic health, contact the Clinic for Digestive Surgery at +65 6570 2702 to speak to our Clinic Nurse. Alternatively, drop us an email at, or fill up the enquiry form at We will attend to you at the soonest opportunity.

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