ClinicalClinical FeaturesEndocrine/MetabolicGastroenterologyMental Health

Obesity – Where are all the Men?

Before I started writing about obesity and men, I had a quick look at my patient list just to confirm when I already knew: my weight management patients are overwhelmingly women. So, is this unique to my practice or Ireland? No, studies from the NHS found that only 10% of referrals to weight management clinics are men. So, where are all the men?

Is it that we don’t know that there is a difference in health outcomes between males and females? No. Actually, Ireland has been a pioneer; obesity was included when we were the first country in the world back in 2009 to publish a National Men’s Health Policy.

Is it that men in Ireland are just less likely to be above a healthy weight? No: Men are more likely to be above a healthy weight or obese. 43% of men versus 31% of women are above a healthy weight. 25% of men versus 22% of women are obese. By age: 65% of adolescent and young men (age 15-24) are a healthy weight. This dramatically decreases to 35% by age 24; fewer than 20% of men are a healthy weight by age 64. Obesity in 51- 64 year old Irish men has risen from 11% to 42% .

Is it that men aren’t referred because they don’t need supports to lose weight? No: A recent NIHR study found that the likelihood of men returning to healthy weight was only 1: 210 compared to 1:124 in women.

Is it just that our use of BMI overestimating the obesity rates in men? In short, probably not. In a recent article, one US obesity expert notes that while BMI is inherently biased, the disease of obesity is only 9 years old! Our current obesity research and treatment guidelines are based on BMI. While our use of BMI is indisputably flawed, BMI does remain, for the moment, an important metric when used with other measures of health, including waist circumference, etc.

Is weight stigma the problem? It is probably a contributing factor. However, both men and women with obesity may hesitate to access healthcare due to weight stigma.

Do men need referral for weight management if it is just a matter of “Eat Less, Move More”? Obesity is a complex, chronic and recurring disease. While lifestyle modification is an essential part in both obesity prevention and management, it consists of far more than that out-dated phrase. Evidence-based lifestyle interventions should consider the patient’s goals, and target sustainable, long-term changes. It may require input from dietitians, physiotherapists, and psychologists. Patients who have metabolic factors such as insulin resistance will need that addressed first. Use of GLP-1 analogues such as semaglutide can -and should – be considered when indicated. Referral to tertiary level, multi-disciplinary bariatric services can also be discussed. Patients deserve to know their evidence-based and safe options out there.

We know there is a difference in obesity between men and women. In short, though, it is still an under researched area. We still have an incomplete understanding as to why obesity rates between men and women are different. The causes are multifactorial, including socioeconomic, environment – including access to healthy food, adequate cooking facilities, exercise facilities and green space – education, cultural, and genetics. Other areas for further study include lifestyle factors in men versus women. For example, studies suggest that men include a higher alcohol consumption and a higher meat-based protein consumption. Further research is also needed to look at more diverse cohorts of men.

When it comes to obesity treatment, studies have found that the motivation for men to seek treatment is to reduce the risk of heart disease and stroke. Men were more likely to engage in programmes promoting healthy

eating and physical activity rather than weight loss groups or any programme using the term “dieting”. Groups that are exclusively for men, programme associated with sports clubs, and programmes that were community based – not health centre based – were more successful at engaging male patients.

Addressing obesity in men is an imperative not only for patient care, but health economics. Globally, healthcare systems will be under pressure as increasing rates of obesity puts further demands on resources. The current estimated cost of obesity to the Irish economy is in excess of ¤1 billion each year, including loss of productivity, increased health service use, and premature death.

As healthcare professionals, what do we do to address this health disparity? We need to provide compassionate, patient-centred, and evidence-based care.

Written by Dr Kate McCann, Lifestyle Medicine Physician, Emdoc Health

Read the full magazine: HPN November

Catch up on our previous features: Clinical Features

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