The 6 Types of Obesity — How Patterns Can Guide Treatment

When it comes to treating weight problems, even some experts believe that similar methods can be applied almost universally: Put your patients on a diet, have them engage in regular exercise and, if all else fails, recommend some surgical procedure. What is rarely considered are the differences between overweight individuals that may have led to their unhealthy weight gain in the first place. But one recent study, published in the Journal of Public Health, had eye-opening results.

Weight Problems Develop for Multiple Reasons, Study Finds

Researchers from Harvard, the University of Toronto and the University of Sheffield in England analyzed medical data of over 4,000 overweight or obese men and women in terms of common and distinguishing characteristics. In the end, they came up with six "categories" or "types" that helped them better understand the study participants' eating behaviors and lifestyle choices.

The first group was identified as "heavy drinking males," whose excessively high alcohol intake resulted in weight problems. Helping members of this category to limit their consumption of alcoholic beverages would be an important step toward successful weight control.

The second group — "younger healthy females" — consisted of women who were generally healthy except for their weight issues. Eating patterns and exercise levels were viewed as largely acceptable but were interspersed with bouts of binge eating and occasional heavy drinking, which, again, contributed to weight gain. Remedies hereto would be similar to their "heavy drinking male" counterparts.

A third type, called "affluent and healthy elderly," consisted of seniors who enjoyed retirement life a bit too much and paid the price with an unhealthily expanding waistline. Tuning it down a little with portion control, more exercise and eating out less would be the appropriate strategy.

Another group of older individuals was diagnosed with one or more chronic health conditions such as diabetes and high blood pressure, in addition to being overweight. The fourth group, "physically sick but otherwise happy" people, were often unaware of how their weight aggravated their other illnesses. Counseling with the aim of diet and lifestyle changes could lead to major improvements in such cases.

Mental dysfunctions such as anxiety and depression were also found to be increasingly damaging to people as they grew older. The "unhappy, anxious middle-aged," as the researchers named this group, often showed a close connection between their inner feelings and their outer appearance, especially in terms of weight. As psychological disorders often manifest themselves physically, equal attention must be paid to both the roots and symptoms of the issues before real progress can be made.

Lastly, the research team focused on those whom they found in the "poorest health." The prevalence of weight problems and chronic illnesses was especially high in this group, and eating and lifestyle patterns were predictably dismal. Overweight and obese patients of this type require intensive care and should be treated with the most drastic methods. Because of the severity of the health conditions typically found in this category, the researchers saw justification for the clinical weight loss approaches such as surgical procedures and prescription medications now widely in use.

Obviously, attempts to find patterns in complex phenomena such as obesity have their limits. There might be numerous additional factors leading to weight gain that have not received enough attention in this particular study. In a press release, the lead author of the study, Dr. Mark Green of University of Sheffield, said the central takeaway is that the overweight and obese are not a homogenous part of the population with the same health needs. If we don't come up with more customized, or, as he calls it "bespoke," forms of treatment, we will continue to fail serving those who need our help most.

As a dietitian and health counselor, I couldn't agree more. After all, that is what one-on-one counseling entails. But, unfortunately, the system is not set up for this sort of effort. For instance, many health insurance companies do not favor open-ended approaches such as diet and lifestyle coaching. We can only hope that more studies examining those who are overweight and obese will eventually bring a different view to the agenda.  

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Timi Gustafson
Timi Gustafson, RD, LDN, FAND, is a clinical dietitian and author of the book, The Healthy Diner: How to Eat Right and Still Have Fun, which is available on her blog, Food and Health with Timi Gustafson R.D.. Follow Timi on Twitter, Facebook, and Google+.