An Interview with Dr. Arya Sharma (Continued)
There's one caveat here, which I think is important. This is fundamental, but I find that a lot of people don't get this: if mood is the factor that is causing weight gain, treatment is not necessarily going to give weight loss. Let me give you a typical example. If I diagnose binge-eating disorder in someone and that person stops binging, I don't necessarily expect to see weight loss. What I expect to see is that this person will stop gaining weight. What you're actually removing is the driver of weight gain, which means that weight gain stops. It does not mean that when you stop weight gain you end up with weight loss.
That's a very important distinction, because a lot of people think that if they stop doing what is causing their weight gain, they should somehow start losing weight. In fact, a lot of people are really disappointed. Then they say, "Well, you know what, I used to drink soda or I used to eat out a lot, and my weight was going up. Now that I've changed my diet and my life style, why is my weight not going down?" It's not going down because you've only removed what was causing the weight gain. The success of that is that you've stopped gaining weight. But that doesn't mean that you're now going to lose weight. That is your second step. We don't normally think of this as a two-step process. And then of course there's the third step — keeping the weight off!
Joseph: That certainly isn't something that we hear talked about very much. It seems like stopping weight gain is much easier. How would you ballpark your own clinic's success rate in that regard?
Dr. Sharma: We would be hitting 80%, if not more, on stopping the weight gain. In every single case where a patient continues to gain weight, we know there's a problem that we've not yet identified and have not yet addressed.
Joseph: Do you think it is possible to stop weight gain across the whole population?
Dr. Sharma: Absolutely. Preventing weight gain generally does not require a lot of resources. I think prevention of weight gain does not even require 20% of the resources you would require if you were trying to get people to lose weight and keep it off. Losing weight and keeping it off is extremely expensive; prevention of further weight gain is cheap.
If the 70 million obese people in the US could all stop gaining weight — and the other 200 million who don't have obesity but might be overweight — could stop gaining weight, 10 years from now we would have a huge population impact without anybody losing any weight. I think that is very achievable with not a lot of resources. It may not be what the patient wants, because patients all want to lose weight. I don't know how many people will actually pay to simply not gain weight. I don't see that there's a big market there. From a medical perspective, if I were a family doctor, I'd say, "I see you once a year, and every time I see you, you're up two pounds. That's got to stop. Instead of seeing you once a year, I'm going to start seeing you once every three months. Here's all the things that I think could do that could stop weight gain and that's what we're going to be focused on." I think that's very doable.
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Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...