Is Obesity A Disease?
Last week the American Medical Association, the most influential organisation of doctors in the US, declared obesity a disease. Right or wrong?
What The Dictionary Says
The AMA’s decision made the rounds all over news sources and commentators are pretty much divided about it being right or wrong. Some say that obesity can’t be classified as a disease and is a behavioral problem, others that it impairs the body’s function and therefore fulfills the criteria.
Before discussing this we should maybe find out what those criteria are. We all, me included, have an idea what “disease” is, but when you get right down to it, it becomes rather hazy. According to a dictionary, it’s “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.”
That already seems to strengthen the second group’s position, but we run into a problem: what are the “distinguishing signs and symptoms” of obesity? While many overweight and obese persons suffer from similar problems (diabetes, joint pain, high blood pressure etc.), by no means all do.
To get around that, the AMA decided that a BMI of 30 or above is the sign and spells for enough possible trouble ahead, no matter if you are otherwise healthy or not. That by itself is an entire side discussion in the larger picture.
What Will Your Doctor Do?
But, to put this in shorthand, the AMA advises its members to treat their obese patients as suffering from a disease and that they, in line with the Hippocratic oath, better address it. Now how will the doctors go about it?
On the one hand, it seems that way too many had trouble telling their patients about their weight problem. From what I read in the Los Angeles Times, more than 50% of obese patients never had their doctors ask them about their weight. Apparently for many doctors it so far was perfectly ok to tell an overweight patient that he has diabetes and needs medication, but not how he got that diabetes in the first place. If having the formal handle of “obesity is a disease” encourages those doctors to finally tackle the subject, great.
“I have the duty to inform you that you are obese.”
On the other hand, what is your doctor then supposed to do? How will he treat you? Take three exercise sessions and see me in a week? How many doctors are truly qualified and willing to give out nutritional and fitness advice? It would be, from their point of view, quite a deviation from their normal course of action.
What Will You Do?
Then of course the patient, you, is not simply a subject being a treated, but also a person defining himself. If your doctor goes and says “you suffer from obesity,” how will you react? Will you take it as a hint to make those lifestyle changes or will you define yourself as “ill”? If the latter, it is a small step to put obesity in the mould all of other illnesses: not self-inflicted but happening to you.
But obesity, in the very vast majority of cases, is self-inflicted – without consuming too much food, you can’t go fat, and the decision to consume too much is, after all, made by you. Defining obesity as a disease could therefore have patients see themselves as not responsible for their predicament.
Good? Bad? Who Knows?
I’m torn on what my view on this should be. Recognizing obesity as a disease may raise more awareness for an issue that is on the fast track of becoming the biggest health problem in very many societies. But it is anyone’s guess what will happen now. It could make obese patients more passive and have weight loss drug makers and bariatric surgeons rejoice, or it could lead to educating patients about their personal responsibility. All roads are open.
Pictures courtesy of Jasleen Kaur and “Spirit-Fire“.
16 Comments
I agree with you I’m torn. I have always thought Drs needed to be more educated or proactive in promoting exercise and good nutrition.
And some, from my experience, actually have to start with themselves.
I wonder how overweight doctors will react to this development 😉
“Defining obesity as a disease could therefore have patients see themselves as not responsible for their predicament.”
That’s the caveat I’m also uncomfortable with.
I think this motion can seem a little absurd when you consider the ramifications of its logic. Wouldn’t this allow people to excuse their inability (as opposed to incapability) to cease other unhealthy habits? I’ve heard “alcoholism” termed as a disease, and to a certain extent you do experience an actual “state” of symptoms not directly tied to the consumption of alcohol itself – by that I mean, you develop a whole slew of independent symptoms, like mental addiction, impaired mental functioning, substance dependency, etc. It crates this necessary to engage in the habit. At that stage, alcoholism is arguably compatible with the definition of a disease (provided EC’s article).
Obesity is more challenging for me to accept – it’s directly contingent on excessive energy consumption. If a disease “impairs normal functioning and is typically manifested by distinguishing signs and symptoms”, is obesity not the symptom of overeating? Does it develop into a condition independent from over-consumption of energy like alcoholism with alcohol? I mean, when I’ve been very sedentary for a long period of time, I feel more easily tired (even when inactive), fatigued, and irritable, and my mood overall poorer (just less happy and self-confident, not necessarily moody). Other peoples’ productive endurance is just that much better than mine, but that can be changed through life style behaviors, right? Or is it a disease? I just can’t experience the same stimulative motivation as others – I suffer from acute laziness. If I develop a higher risk for cardio-vascular problems and diabetes, do I prepare with medication?
Yep, that is exactly where all those complications are. There are some mental illnesses, for example, where people deliberately hurt themselves – that is self-inflicted, but not quite voluntary, methinks.
If, in other words, there are mechanisms that make some people overeat and that are outside of their control, then all doctors really can do is refer those patients to behavior therapy.
Given the dislike “traditional” doctors have of psychiatrists, let alone psychologists, that would be another interesting scenario.
To understand the conclusion of the American Medical Association first you have to understand what to be a Doctor became in this NEO LIBERALIST CAPITALIST society of ours.
BIGGER PICTURE TIME.
To be a DOCTOR in our society is not about HEALTH anymore, the same way that to be a lawyer is not about justice anymore.
It is all about money and how to make more of it. And how does this particular industry makes money? By PALLIATING the situation. mitigating the symptoms of those hopeless defenseless people’s illnesses. MIND YOU not curing them.
ROCHE, BAYERN, PFIZER, etc… they all make money out of people being unhealthy. Why on earth would they want people to have HEALTHY HABITS? any CEO would tell you that this is just a bad idea.
Now we are humans and by nature we differ from animals bc when we see a ball rolling on the ground we look at where the ball came from. WE GO FOR THE SOURCE, animals will follow the ball and totally ignore the “Where it came from” question.
The CORPORATION CONTROLLED SOCIETY OF OURS wants us to do the same.
They made the American Medical Association look at the ball.
To think about solving the problem in its source in due time will be considered illegal. Nowadays is just frown upon.
Obesity is a consequence, just like most if not ALL things in life.
As the wise man says: “In nature there are no rewards nor punishments JUST consequences”.
I will have to ponder the last sentence.
Your understanding of the complex biochemical processes involved in obesity is very poor. Obesity is NOT about will power. Energy balance is affected by many INVOLUNTARY factors.
“The body has a mind of its own regarding your weight” – their collective words- as Dr. Jeffrey Friedman, Dr. Michael Rosenbaum and Dr. Liebel have shown.
Lose even 10 % of your body weight and your body responds aggressively by lowering total energy expenditure by 25 %.
Unfortunate gut flora is a major factor in weight gain. Obese people have very different strains than that of thin people.
Stop stigmatizing obese people. Obesity is as heritable as height and studies on international samples of monozygotic twins reared apart show that GENES have a MONUMENTALLY ENORMOUS say in what we weigh- far more than any will.
Voluntary factors have extremely limited ability to affect body weight. This is especially true over the very long term. Google ” Dr. Jeffrey Friedman Factors Affecting Obesity”
Fat cells are disregulated with obesity. NONE of this contradicts thermodynamics. Only the ERRONEOUS udnerstanding of its actual scope and reach. Yes, it is valid for life, however this law says NOTHNG about WHY somebody is obese- the many causes. it is IRRELEVANT.
You need an education.
And you need to link the research that backs up your claims. What you wrote has little to do with what the mentioned Drs. do. Dr. Rosenbaum, for example, has this to say about inheriting obesity:
“It is not that our genetic makeup is changing to make us fatter. “Progress” has resulted in an environment in which many genetic tendencies that conveyed distinct advantages to our ancestors are no longer good for us. […]These genes become maladaptive in an environment that offers an unbridled opportunity to consume calorically dense foods and participate in a sedentary lifestyle.”
http://www.pbs.org/wgbh/nova/body/weight-loss.html
So yes, when trying to lose weight you have to fight against your body’s urge to keep its weight. But nobody actually questioned that and it also doesn’t mean it can’t be done. Restricting calories is precisely what Rosenbaum and Leibel did to have people lose weight in their studies of leptin:
“In the current study, Drs. Rosenbaum and Leibel gave leptin to people who had lost weight to see if the hormone could help overcome their bodies’ tendency to gain the weight back. They sequestered four people, one of whom was overweight, in the hospital and reduced their weight by 10 percent with a strict diet and prescribed amounts of activity. As predicted, after weight loss, each person needed 20 percent to 25 percent fewer calories to maintain their lower body weight, their muscle efficiency increased, and they had lower leptin levels due to fat loss.”
http://www.cumc.columbia.edu/publications/in-vivo/Vol1_Iss9_may15_02/bulge.html
It is hard to lose weight, it may even be harder to maintain that weight, but it definitely can be done. I choose to not believe that I’m powerless against my genetic or whatever urges and I hope you don’t either.
YOU have a KINDERGARTEN understanding of an extremely complex biological phenomenon. I am in direct contatc with Dr. Leibel AND Dr. Rosenbaum. And Dr. Jeffrey FRiedman as well.
YOu have no idea what you are talking about. 80 to 90 % of the variance in obesity can be ascribed to GENETIC factiors. There are MANY obese poeple who have great habits and REMAIN fat.
NONE of this contradicts “thermodynamics.” Down this road you do not want to go with me. I have looked at this every single day for many hours since 2008. Christopher Jarzynski and Dr. Gavin Crooks , Dr. Lawrence Krauss and Dr. Tyson ( as well as numerous M.I.T. and Harvard physics professors) PERSOANLLY told me that obesity is a BIOCHEMICAL MATTER and that people such as yourself are ABUSING the First law to blame obese poeple.
It does NOT say whay YOU think it does. YOU make EXTRAPOLATIONS. The Firs Law has a VERY limited scope and reach . It does NOT at all address the causes of obesity whatsoever.
As you know I wrote an opinion piece on this. I do not think it is a disease, but I do think addiction plays a major role.
Yes, addiction could be another factor. I know that when I felt down back when I was overweight, I at least had a tendency to make up for it by eating when I felt depressed. That way, eating becomes a form of medication.
Maybe you have also seen my article about overweight persons potentially not eating more only in depressed, but also in an elated mood.
Elation always took my appetite away, that is until I treated the elation 🙂
Hahaha! 😀
There are MANY ways to fatten mice WITHOUT having them consume more calories than the controls. At least four other studies with mice demonstrate this.
YOU are a SCAMMER.
Lastly, as Dr. Leibel has said, “the body has a mind of tis own regarding body weight.”
It will DROP total energy expenditure by 25% if you lose even 10 % of your weight. The effect does NOT go away.
If YOU were better read, you’d know this. DR. Friedman has noted our genes CAN CHANGE in 30 years. WATCH his lecture, FOOL.
“The caloric hypothesis is FAR too simplistic to explain the regulation of body weight, which is highly complicated, by itself.”
Dr. Garret Fitzgerald
I SPEAK to him.
http://www.uphs.upenn.edu/news/News_Releases/2012/11/fitzgerald
You have a kindergarten understanding of obesity.
EDUCATE YOURSELF.
Watch Urgelt’s Obesity Video.
I think I have enough of being insulted by you.
As for your link: note that Dr. Paschos talks about “excess” calories. I’ll have to contact him myself to find out if he means to imply that weight gain would even happen when eating at TDEE.
Razwell is of course completely right. Losing weight is IMPOSSIBLE without a gastric by-pass or the like, let alone keep it off. Amd Evilcyber is a prime example of that.
Sarcasm off