Vim & Vigor - Winter 2020 - UVA - 50

50

Obesity is a
disease and
not a lack of
willpower,
says Catherine
Varney, DO,
a UVA Family
Medicine
physician who is
board certified
in obesity
medicine.

Fact 1: 

There are no quick fixes,
but obesity can be controlled.
"Saying to someone 'eat less and exercise more' doesn't
work," Dr. Varney says. "When we're actively losing
weight, our body thinks we're dying, so it will fight tooth
and nail against our best efforts. The closer someone
gets to their weight-loss goal, the harder it becomes. This
is why a lot of people give up. Your body doesn't like
change, so you rarely hear patients say, 'I was overweight
once.' It's always, 'I've struggled with this my whole life.'
What they don't realize is that they're fighting against a
brain that has evolved to want them to eat whenever it
passes by something high-calorie or dense with nutrition
because we don't know when it's going to come again. It
is the cave-man mentality, and we're surrounded everywhere by high-calorie foods but never times of famine."

Fact 2:

Exercise isn't the answer. It only
helps 3 to 5 percent of people to
lose weight, but it is important for maintaining weight
once the pounds are shed, Dr. Varney says. Exercise can
even be dangerous, so it's not always part of her initial
prescribed treatment plan. "For some patients, I don't
prescribe exercise until they lose a certain amount of
weight," Dr. Varney says.

Fact 3:

The best diet depends on the
individual. "What works for one
person might not work for another due to a complicated
system of genetics, metabolism, environment and other
conditions a patient may have," Dr. Varney says. "Still,
studies show that low carb for the first six months is the
best diet for weight loss. But for weight maintenance,
there's not much difference between low fat and low carb."

Fact 4:

PHOTO BY UVA HEALTH

Medications are effective.
Several drugs are approved for
weight loss by the Food and Drug Administration.
Introduced in 1959, "phentermine is one of the most
effective drugs," Dr. Varney says. "It suppresses the appetite while patients are making lifestyle changes and the
body is getting used to how much food is acceptable. It
brings a little increase in metabolic rate and, importantly,
quiets the brain. If you're inside the head of someone
with obesity, you wouldn't believe how much they are
constantly being yelled at to 'eat, eat, eat!' "
Phentermine is FDA-approved only for short-term
use (up to three months), but a recent study showed that
those who took it every day for two years saw no increase
in cardiovascular risk. "Under close watch, we can keep
patients on these short-term drugs for longer. There can

WINTER 2020 VIM & VIGOR

V2_VVWI2088_49-51_Obesity.indd 50

9/21/20 4:33 PM

PHOTO BY GETTY IMAGES

W

ith so much
misinformation
surrounding
obesity, Catherine
Varney, DO, is
careful with her words. First of all,
she clarifies that her patients are
not obese but rather have obesity,
which is a disease and not a lack of
willpower. Second, she says it's clear
that obesity is hurting our health.
"Obesity is the underlying cause
of all these chronic diseases that
we're seeing in primary care: diabetes, high blood pressure and high
cholesterol. There's nothing obesity
doesn't touch-even depression,
anxiety, sleep apnea, PCOS [polycystic ovary syndrome], fertility and
osteoarthritis. If we can get obesity
under control, we can get all these
other things under control," says
Dr. Varney, a UVA Health family
medicine physician who is board
certified in obesity medicine.
After old age, obesity is the main
driver for people needing hospital
care because of COVID-19, partly
explaining why younger people
experienced severe symptoms,
preliminary studies are showing.
While fighting the coronavirus,
some of Dr. Varney's patients had to
be placed face down on a ventilator
to relieve pressure from the extra
weight on their chests that
would make breathing
even more difficult.
"COVID-19 showed
us how this is not
about vanity but how
well we can fight disease," she says.
As an expert who stays
current on obesity science, Dr.
Varney shares the facts-and offers
hope-for anyone struggling with
obesity, which doesn't have to be
someone's lifelong destiny.



Vim & Vigor - Winter 2020 - UVA

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Vim & Vigor - Winter 2020 - UVA - Contents
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