“All means are good to stigmatise obesity,” says Hanen Samouda. As a researcher specialising in obesity and body composition at the Luxembourg Institute of Health (LIH), she is fighting for obesity to be recognised as a chronic disease with many factors (genetic, psychological, neurophysiological)--and against the misconception that it is solely the result of personal choice and poor lifestyle habits.

According to a survey on the health of residents conducted in Luxembourg in 2019, the proportion of obese adults has increased between 2014 and 2019, from 15.6% to 16.5%. The school medical service reported 4.3% obesity and 7.5% overweight among primary school children in the 2019-2020 school year. Adolescents in secondary school are 9.9% obese and 9.3% overweight.

However, there is a lack of resources to study obesity, which is recognised as a global public health priority. The study on children is not representative of the whole country, since it only concerns young people who had a medical examination during the period. “We lack the budget to carry out a general population study of children,” says Samouda.

The BMI, an incomplete instrument

In addition, the instruments generally used in these studies are now proving to be obsolete or incomplete. This is the case with the body mass index (BMI, the weight/height ratio), the study’s main criteria: it is wrongly considered to be the benchmark for defining obesity, says Samouda. “A high weight does not mean anything.”

In collaboration with Jérémie Langlet of the LIH, she recently developed a --undetectable by BMI, but essential for detecting obesity--which has the advantage of being very easy to use.

The new Canadian clinical practice guidelines for obesity in adults are the benchmark for effective treatment of obesity. They are also officially supported in Europe by the European Association for the Study of Obesity (EASO). They recommend classifying obesity according to its many causes, and not according to weight status.

“Weight is only the expression of the problem. Losing weight does not address the underlying causes,” says Samouda.

Many factors

The factors behind obesity are very diverse, from genetics (70-80% of our weight is determined by our genes) to neuronal aspects (due to a disturbance in the brain that no longer correctly controls food intake or the sensation of hunger), via mental health, the socio-economic environment (some people cannot access a healthy lifestyle) or the influence of food marketing.

It is therefore a question of considering the metabolic, physical and psychological aspects--or lack thereof--in order to determine a personalised treatment for obesity according to the specific needs of the patient.

“We need to stop working on the weight and focus more on the causes and complications,” says Samouda. Weight loss alone is often not maintained in the long term. And “yo-yoing with your weight is also a health problem,” says the LIH researcher.

Three recognised therapies

Although work to develop treatments is still in progress, three therapies are currently recognised: the cognitive-behavioural approach (which enables the brain to be better connected with the rest of the body, particularly the stomach, to reduce guilt and to better manage feelings of hunger), bariatric surgery (sleeve gastrectomy, gastric bypass or gastric band, which enable a faster feeling of satiety, but which have serious side-effects), and pharmacotherapy.

Several drugs have been put on the market, including two by the Novo Nordisk group (Saxenda and Wegovy), which are administered in the form of daily or weekly injections and act on the sensation of satiety and hormonal imbalance--but which are not covered by social security in Luxembourg.

“Between nothing at all, a restrictive diet and surgery, a drug can be a good alternative,” says Samouda. “It regulates the neurophysiological process and is more effective in the long term.”

Stigma as a catalyst for the disease

Recognition of obesity as a disease would therefore make it possible to treat the phenomenon in a way that is commensurate with the problem. And to avoid stigmatising those affected, which worsens their situation by becoming a “catalyst for the disease” and leading to increased psychological stress, depression and anxiety. And, ultimately, an increase in weight gain and obesity.

But this paradigm shift will be difficult, says Samouda. “We don’t accept to normalise obesity. Nor are we willing to overcome our prejudices that equate it with laziness and lack of willpower. But we will have to if we want the situation to improve. In high-income countries such as Luxembourg, the trend is stagnant, but at a very high level. In low and middle-income countries, the trend is still rising.”

This story was first published in French on . It has been translated and edited for Delano.