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January-A 2021, Volume 71, Issue 1

Primary Care Diabetes

Barocrinology

Sanjay Kalra  ( Department of Endocrinology, Bharti Hospital, Karnal, India. )
Gagan Priya  ( Department of Endocrinology, Fortis Hospital, Mohali, India. )
Nitin Kapoor  ( Department of Endocrinology, Christian Medical College, Vellore, india )

Abstract

The authors propose "Barocrinology", a novel terminology in medical literature, to comprehensively describe the rapidly expanding field of obesity medicine. This new term highlights the need to appreciate the role of endocrine physiology in the evolution of obesity, insights into its complications and changes in the hormonal milieu following weight loss therapies, including bariatric surgery.  This term would not only reduce the stigma associated with obesity in affected individuals but also give them a better appreciation of its biological origin rather than self-criticism. This paper also undermines the importance of a multi-disciplinary approach needed in this field for achieving practical and sustainable goals, individualized to each person.

Keywords: Barocrinology, Obesity Medicine, Multi-disciplinary approach

 

Introduction

 

Obesity, and its associated complications, have emerged as a major threat to human health. The obesity pandemic continues to spread. Though regional trends vary, there has been an increase in the prevalence of obesity in every country of the world.1  Global age-standardized prevalence of obesity has increased in children and adolescents as well.2 Though obesity is preventable, more than 1.9 billion adults, 18 years and older, are overweight. Of these over 650 million were obese.3

 

The Challenge

 

Obesity medicine is that field of medicine which cares for persons with obesity, using a comprehensive, evidence-based approach. The four pillars of obesity medicine have been listed as nutrition, physical activity, behaviour and medication.4 This description, however, is incomplete. There is widespread agreement that current assessment tools, such as body mass index, are not appropriate5,6 The stigma associated with obesity is so pervasive that it impacts health care providers as well.7

As in any field of medicine, intervention in obesity can be planned only after an exhaustive assessment of the etiopathogenesis, clinical features, potential impact of uncontrolled obesity, and possible outcomes of treatment of the syndrome. This is possible only if the treating health care professional has an in-depth understanding of the biochemistry and physiology of weight metabolism.  This, in turn, demands detailed knowledge of the endocrinology of weight homeostasis.

 

The Solution

 

Obesity care is proffered by health care professionals from varied backgrounds. While each medical, surgical, and paraclinical discipline does bring its own strength to the clinic, the primary care physician has to be fully versed with the nuances of each subject, including endocrine physiology and pathology. This helps in formulation of appropriate management plans, and results in optimal therapeutic outcomes. To facilitate this, we propose the use of the word ‘barocrinology’ to define and describe the science of obesity management.

Barocrinology is a portmanteau, derived from ‘baro’ (Latin= weight) and endocrinology. The term conveys the pivotal role of endocrinology and metabolism in the evaluation, treatment and follow-up of obesity. The endocrinologist, being well versed in the basic and clinical science of obesity, is best suited to assess each individual for suitability for specific interventions, especially bariatric surgery. Barocrinology is an all-inclusive term. It does not negate the role of lifestyle modification, medical nutrition therapy or surgery in obesity; rather, it encourages the active use of these interventions in a person-centered, endocrinology-led team effort to manage obesity. Thus, the primary care physician becomes an integral part of the obesity care team.

The word ‘obesity’ is often associated with stigma and self-shame.7 Using the term barocrinology will help reduce the “judgmental” view of obesity as a self-created disease, and facilitate a viewpoint which approaches it as a medical syndrome like various other conditions. Use of this term will help focus attention upon this important field of medicine, and enhance the quality of care offered to individuals living with obesity.

 

References

 

1.      Blüher, M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol 2019; 15, 288–298. doi:10.1038/s41574-019-0176-8

2.      NCD Risk Factor Collaboration (NCD-RisC): Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017; 390: 2627-2642

3.      Obesity and overweight. Available at:  https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Cited on 1 December 2019

4.      What Is Obesity Medicine? Available at: https://obesitymedicine.org/. Cited on 1 December 2019

5.      Kapoor N, Furler J, Paul TV, Thomas N, Oldenburg B. Ethnicity-specific cut-offs that predict co-morbidities: the way forward for optimal utility of obesity indicators. J Biosoc Sci. 2019 ;51:624-626

6.      Arora M, Barquera S, Lambert NJ, Hassell T, Heymsfield SB, Oldfield B, et al. Stigma and obesity: the crux of the matter. The Lancet Public Health. 2019;4: e549-50.

7.      Kapoor N, Kalra S, Kota S, Das S, Jiwanmall S, Sahay R. The SECURE model: A comprehensive approach for obesity management. J Pak Med Assoc. 2020 Aug;70:1468-1469s.

 

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: