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Arguments Against Obesity As A Disease #5: Reduces Personal Responsibility



diet journalIn my miniseries on arguments that I often hear against calling obesity a chronic disease, I now turn to the objection that declaring obesity a disease would reduce or even abolish personal responsibility.

The argument being, that the term “disease” carries the connotation of being inevitable and will thus reduce motivation in patients to do anything about it.

This is complete nonsense!

When has calling something a disease ever taken away an individuals “responsibility” to do what they can to avoid or ameliorate it?

Take for example type 2 diabetes – a very avoidable and modifiable condition. Calling diabetes a disease does not mean that the individual can do nothing to prevent it or that, once it occurs, the patient can do nothing to change the course of the disease – of course they can and should and often do!

Or take people with a high risk of heart disease or lung disease or bone and joint disease or even cancer – in no instance do we expect less of patients to do their part in helping manage these conditions just because we call them “diseases”.

There is even a term for this – it is called “self-management” – a key principle of chronic disease management.

The course of almost every chronic disease can be changed by whether or not patients change their diet, follow their exercise program, monitor their symptoms, take their medications, come in for their visits – all a matter of “responsibility” if you so wish.

So just how exactly would calling obesity a disease take away from any of this?

Frankly, I cannot help but sense that people who use this argument most often, are erring on the side of “shame and blame” and probably still see obesity largely as a matter of personal “choice” rather than the complex multifactorial problem that it actually is.

Indeed, the opponents often appear “morally” opposed to the very notion of accepting obesity as a disease, as it now gives people the “excuse” to not do anything about it. Sorry, but this whole line of arguing reeks of nothing less than weight bias and discrimination.

As far as I can tell, calling something a disease often leads to exactly the opposite response – when obesity happens (and it can happen to anyone), it places a tremendous mental, physical and social burden on the people who get it – no matter what you call it.

People living with obesity have no greater or lesser “responsibility” of contributing to the self-management of their disease, than people living with hypertension, diabetes, depression, heart disease, or cancer – people living with any disease should be doing what they can – why would obesity be any different?

@DrSharma
New Orleans, LA

4 Comments

  1. But, really, just how preventable is T2DM? I’ve always read that in twin studies, if one twin develops T2DM there’s something like an 80% chance of the other twin developing it, too. Everything I’ve read says that you can mitigate it, you can delay the onset, but that prevention isn’t always possible.

    One of the things I keep reading over the past 20-odd years is that insulin resistance is exacerbated by obesity but that doesn’t always mean it’s a cause. It’s clear that some related conditions, such as PCOS or Addison’s, can increase weight and cause insulin resistance, but in many people it sneaks up out of nowhere.

    I follow the Reddit diabetes forum and while anecdotes still aren’t data, I’m always surprised at how many people say, “I was just diagnosed with T2DM. A year ago I realized I’d put on 30 lbs, so I dieted and exercised and took it all off. I’m skinny now, so why did I get this disease?!”

    You’ve probably seen the TED talk by the surgeon who is very active and suddenly found himself in that same situation, gaining weight for no apparent reason despite a healthy diet and lots of exercise, and then developing T2DM. It is, again, anecdotal, but the talk amazed me for three things: At the beginning he talks about how he had nothing but contempt for fat patients for causing their own problems; how he figured out something I’ve heard for many years, that blaming obesity for T2DM is often putting the cart before the horse; and at the end when he says he now understands how obesity isn’t so simple and then starts crying when he admits his shame for the way he treated his former fat patients.

    That still moves me.

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    • Yes, great talk. But the same could be said about obesity – how preventable is it really? Twin studies should that heritability of body shape and size is extremely high. So is the impact of having a positive history of obesity. The point here is that there is really no difference between obesity and most other chronic diseases.

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  2. I have recently lost around 80 lbs. Changed my lifestyle, eating habits and the way I look at “dieting”. I am not on a “diet”. I eat fish, vegs, fruit, nuts. Consume only natural sugars and no pastas, breads. I look at this as what I want to eat, not what I have to eat. Weighed myself at the beginning and only check every 2-3 months, as I find weighing more frequently is more frustrating. Go by the size of my clothes and how they feel on me. Right now down 3 sizes. Walk every day. Feel happier and physically better than ever. This is what is working for me.

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  3. It is true that calling obesity a “Chronic Disease” that one has to “manage” does not absolve an individual from personal responsibility. However, I wish to discuss a matter of perspective and semantics…

    Telling someone they have to “manage a chronic disease” sounds very negative, clinical and devoid of hope, joy and inspiration. I myself have lost 100 lbs, and have kept it off for five years. Technically, you could say that I do manage a chronic disease. Every day I watch what I eat, I loosely monitor my weight, I exercise nearly daily and I have to make corrections in all of these if I notice a change in any of them.

    However, looking at what I do on a daily basis as “management of a chronic disease” is to strip all of the emotion, joy, success and triumph I have had on this journey. In other words, if I actually viewed my activities as “managing a chronic disease” I may never have started!

    I think the message should be this – if one wants to lose and keep weight off one will have to make significant and consistent lifestyle changes. It will be tough at first, but get easier and you will discover the many benefits of “managing your weight loss” as you continue.

    To strictly say that weight loss is managing a chronic disease is the same as saying “breathing manages the chronic condition of life”. Thought it is true, it kind of takes the joy out of living.

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