1. Weight regain is exceptionally common in obesity via lifestyle changes — Dr Kevin Hall while at NIH before it was gutted had modeled how for every kg of weight loss there is an avg 25 kcal decrease in metabolic rate and 100 kcal increase in appetite. This is driven by hormonal and neurological changes in the hypothalamus.
2. Obesity is a chronic complex and relapsing disease. Every intervention whether lifestyle, drug , or surgery meets the brains defense against weight loss. Drugs and surgery operate by reducing the power of that defense described in #1. When you stop the drug that treated the chronic disease, the manifestations of the disease return
3. Obesity as a disease is not intuitive to understand. Without education and training, a physician falls back on beliefs they learned in society such as “obesity is a behaviour”. This is at the root of toxic bias and stigma which has caused harm in countless physician patient interactions.
Just as an internist calls upon an EP specialist to offer expert advice, education, and management on atrial fibrillation, a cardiologist could spend some time learning from an obesity specialist and appreciate that perhaps they have insufficient understanding to offer an informed opinion on a topic
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