We don’t have a cure for obesity. While many will diet, exercise, and thus, lose weight – keeping that weight off is where the real struggle lies. In this compelling and humorous talk, Dr. Sharma explores the complex biology behind weight loss and regain, and why obesity should be managed as a chronic disease rather than as a personal failure.
Arya M. Sharma is Professor and Chair in Obesity Research and Management at the University of Alberta as well as Medical Director of the Alberta Health Services Provincial Obesity Strategy. In 2005, he spearheaded the launch of the Canadian Obesity Network, which has remarkably transformed the landscape of obesity research and management in Canada. His research focuses on innovative approach to managing obese patients and includes the development of the Edmonton Obesity Staging System.
This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at
I practice medicine at a center that specializes in the treatment of obesity the people who come to see us have all struggled with excess weight for a long time many of them have severe health problems they have diabetes they have heart disease their bone and joint problems and that's different from one to the next but there's one thing that all of our patients have in common and that is that they've all lost weight before not once not twice over and over again because every time they lose weight the weight just comes back and it doesn't matter how hard they struggle it doesn't matter what diet they go on it doesn't matter what exercise program they follow it doesn't matter whether they lose the weight fast or slow the way it always comes back and so by the time that I get to see them they feel like they're the biggest losers and they asked me dr. Sharma there must be something wrong with me there must be something wrong with my metabolism every time I lose weight it comes back now I know that my patients are not alone with this problem let me ask you so anybody here has ever lost weight come on be honest yeah is anybody put it back on again yeah it's almost everybody because we know that out of 20 people who go on and lose weight it doesn't matter how they do it 19 are going to put the weight back on and so the question is why is this so difficult you know why is losing weight one thing but keeping it off is where the real struggle is now we understand that there's a complex neurobiology that regulates our body weight and we understand that this complex neurobiology also defends us against weight loss and it's complex you know this is not calories in calories out that's that's six I'm talking physiology and the way that I think about physiology is it's your biology messing with physics and so for a long time I was looking for a way how do I explain this to my patients how do I get my patients to understand what they're really up against every time they go out and try and lose weight that's what I want to show you today I want to show you what it actually takes to lose 50 pounds and keep them off and to help me with this demonstration I'd like to welcome Alex here to the stage and she just volunteered before my talk she doesn't know what's awaiting her give her a warm welcome okay all right step forward all right so Alex here's what I want you to do I want you to take this one end of this band and the other end so that you can hold it like this okay all right why don't you just do that that's good okay yeah it's maybe a little bit optimistic okay one more all right fine and I want you to hold it like this okay all right good so well I want you to picture is this is this is Alex's weight and it's 250 pounds and I have no idea how Alex got to be 250 pounds this could be genetics maybe she is an emotional leader maybe she has a stressful job maybe it's not enough slave culture work shifts maybe and I hope not it's PTSD depression maybe alex is on medications that make a hungry all the time it doesn't matter because anybody who's put on weight is going to be up exactly the same problem that alex is up against so Alex you ready to lose 50 pounds yeah all right great so I'm sure that out there you're going to have a couple of suggestions for her one of the things that she could possibly do to try to get some of that weight off exercise how much exercise you think what's your recommendation 30 minutes any you can do 30 minutes a day all right so she's going to start doing 30 minutes of exercise a day and guess what she's starting to get here what else poor me eat healthy okay maybe cut your calories a little bit right maybe cut our calories by 500 that's good that's working what else could she do get better sleep yeah we learn a lot about sleep see she's getting skinny right there she's losing weight in front of our eyes and I you know what I look at that I say you know that's maybe 50 pounds right so what does Alex now have to do to keep the weight off now she just needs to keep pulling on the rubber band that's all okay so you just keep falling and that's how you're going to keep the weight off because here's the thing see see I don't know how she got to 250 pounds it doesn't matter but she's up against the same challenge that anybody's up against who's put on weight and is going to try to lose it because what you're seeing here that tension in that rubber band that's her body trying to get the weight back and the body's got lots of tricks that neurophysiology we talked about it's increasing her appetite it's slowing her metabolism and in fact even her muscle gets more fuel efficient so she can now that she's lost the weight she can do the same amount of exercise but burn fewer calories and so the tension you see that's just her body warning the calories are wanting the body weight back and she's going to have to keep pulling on that and she's doing a great job we're just gonna let her stand there and keep on because because you see that's the problem the problem is right now there's about a billion people in this world men women children living with obesity and we don't have a cure now I wish that we even had some way to prevent this from happening in the first place but if we if you get the prevention going that's still not going to help the people who have the problem and all the people who have the problem you know they're going to try to lose weight I'm going to diet they're gonna exercise and most of them are going to put the weight back on Alex how you doing great so I know this is depressing now you guys are getting depressed you know my patients get very depressed when I tell them this and I'm very depressed but when I look at this you know I you know I just see another chronic disease now look at my patients with diabetes you know they come in just wing some of that weight back on already you know my patients with diabetes come in you know we start them off and died they do their exercise to take their medication you know check your blood sugars come in for regular check-ups and guess what the blood sugar levels go down and the risk for that be for for heart disease and all the complications Goes Down it's great but guess what happens when they come off their diet guess what happens when they stop their exercise or they stop their medication or they stop coming in for visit blood sugar goes back up all the problems come back I look at my patients are high blood pressure it's the same story you know they come in they start their low salt diet to start their exercise program to take their medications they check their blood pressure levels they come in for regular visits we bring the blood pressure down great reduces their risk for heart attacks and strokes now guess what happens when they stop exercising when they come off they die they come off their medications guess what risk goes back up that's chronic disease every chronic disease you stopped the treatment that's what happens the disease comes back and obesity you stop the diet you stop the exercise you stop taking your medications you get your bariatric surgery undone guess what weights coming back and that is exactly why the Canadian Medical Association the American Medical Association they've all now come up and said you know once you have obesity you've got to look at as a chronic disease because it behaves like a chronic disease it's not about shame or blame it's about accepting the fact that the problem you're up against it's like the same problems that anybody is up against who has a chronic disease and so when I tell my patients and what I want to tell you today if you yourself or someone you care about as obesity tell them to get professional help tell them to get help from a doctor from a nurse from a dietitian from anybody who's trained as a health professional to manage chronic disease because the principles of chronic disease management they are well known they're established patient education self management regular monitoring regular check-ups coming up with a realistic treatment plan that you can actually stay on and we do that for patients who have diabetes we do that for people living with heart disease we do that for people living with high blood pressure and that ladies and gentlemen is exactly what we need to be doing for people living with obesity thank you so much and give her a big hand thank you