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Arguments Against Obesity As A Disease #10: Affects Too Many People



flu epidemicAnd finally, to end this miniseries on the arguments I often hear against calling obesity, is the objection based on the idea that there are simply too many people living with obesity to apply the label “disease” to. Doing so, would mean that over 7 million Canadians would wake up to find themselves living with a disease.

Related to this argument, I also often encounter the argument, that calling obesity a disease would turn these 7,000,000 Canadians into “patients” thereby completely overwhelming our healthcare system that would now be called about to provide treatments to all these people. I hear from payers and policy makers that providing treatments for obesity as a disease is simply not practical because of the number of people who have it.

As I think about it, both arguments are rubbish.

Firstly, the definition of disease has nothing to do with how many people are affected. Thus, I have never heard anyone say that we need to stop calling diabetes a disease because it affects 6 million Canadians or we need to stop calling depression a disease because 2.5 million Canadians will be affected during the course of their lives.

No one would ever suggest we stop calling the flu a disease just because it affects millions of Canadians leading to 12,200 hospitalizations and 3,500 deaths in Canada each year.

So arguing that we must not call obesity a disease because that would be declaring far too many people as “diseased”, is simply irrelevant.

Even if a disease affects 100% of the population causing important health problems and complications, we’d still be calling it a disease.

As for overwhelming the healthcare system – I would say obesity is costing the health care system whether you call it a disease or not. We will still have to pay for all the health issues directly related to people having obesity – from diabetes to heart disease to joint replacements to cancers. It’s already costing billions of healthcare dollars. Except that we are now spending those dollars on the complications rather than on preventing and treating obesity itself.

Again, if there was any other “disease” threatening to overwhelm the healthcare system, our response would certainly not be to simply stop calling it a “disease” – that would make no sense at all.

This concludes my miniseries on arguments I often hear against calling obesity a disease (there are some I hear less often).

Next week, I will turn to arguments that support the idea of calling obesity a disease – so stay tuned.

@DrSharma
Toronto, ON

2 Comments

  1. the biggest reason for not calling obesity a disease is that it put the onus of responsibility for doing something about it in the hands of medical doctors, rather than changing so many things in society. No amount of treatment or for that matter, personal willpower, can address the rising tide of food that we find in every nook and cranny of our lives, the constant advertising for food (junk or not), the expense of healthy food, the government’s complicity with the food industry and the misinformation put forth by those trying to make a buck off their fellow human beings. Doctors are ill equipped, time short, prejudiced agsinst obesity and many are not particularly skilled in helping their patients. Efforts are stopping the obesity epidemic require a lot more than the support of doctors, who by their nature, deal with disease.

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  2. Ahh, I was waiting for this.

    First, I’m going to make the disclaimer: This is a very US point of view. Health care in The Magical Land of Canadia is much different. Some of these issues likely do not apply as such. But at the core, this again goes to what I’ve repeatedly said in my comments here: There’s a problem with doctors who see a fat person and see “fat patient” instead of “human being.”

    Some time ago I wrote a “patient POV”-type article for a BioEthics journal on the subject of “Should obesity be called a disease?” [I regret submitting the article, not because of what I wrote, but because I didn’t research ahead of time to find that the journal is behind a paywall. An ethics journal!]

    At the time I said, NO. And I’m still not fully over to YES.

    My biggest fear is that WLS becomes the next medical fad, like botox or off-label use of medications have the side-effect of weight loss.

    I’ve heard of doctors who take 2-3 week classes in a new area to pick up the latest fad and rake in some money.

    Can you imagine surgeons being told, “Well, you’re already certified for surgery. Take this two week class and start making lots of money with WLS!”

    I can.

    Surgery is dangerous in general. The more fat you are the more risks there are from things like general anesthesia. I know you know the risks, both short term and long. Most people don’t.

    As one weight loss surgeon online put in his release form, “If you believe this surgery will restore you to complete and normal health you are mistaken. You are trading one nutrition problem for another problem.”

    He also says, “Remember that those who had the surgery and say it was the best thing that ever happened to them are the ones who are alive to tell you their side of the story. You’re getting only part of the picture no matter what you learned from a friend, a TV news magazine, or on the internet.”

    Enough fat people have died from seeking the Magical Fix for obesity. I’m worried about how many more could die from a surgeon who sees fat people not as someone to help but as more money in the bank.

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