Yesterday, in Ottawa, I participated in a Café Scientifique discussion about whether or not obesity is a disease, which naturally also touched on the issue of whether or not obesity needs to be medicalised.
My co-discussant was Jacqui Gingras, Associate Professor at Ryerson University’s School of Nutrition in Toronto. The discussion was elegantly moderated by Mark Tremblay, Director of the Active Healthy Living and Obesity Research Group, at the Children’s Hospital of Eastern Ontario.
While there was no disagreement that excess body fat can indeed pose a health problem as well as no disagreement that the current definition of obesity, based on simple measures of height and weight, is clinically meaningless (as it does not discriminate between those for whom ‘excess’ body fat is indeed a health problem from those for whom it is not), there were nevertheless differences of opinion on whether or not ‘medicalising’ obesity would be helpful.
Although I am the first to agree that health cannot be determined by simply stepping on a scale, it is exactly because things are not that simple, that it does take a trained and knowledgeable health professional to determine for whom excess body fat is a disease and for whom it is not. Indeed, I am fully aware that it often takes extensive medical knowledge and understanding of the rather complex socio-psycho-biology of weight gain as well as clinical skills, experience, and judgement in its assessment, to decide, when the accumulation of body fat poses a health risk and when it does not.
This, interestingly, is no different from the many clinical decisions that health professionals deal with every day. Indeed, figuring out exactly in which cases a symptom, a clinical sign, or the result of a diagnostic test is an indicator of ill-health and in which cases it is merely a harmless ‘norm-variant’, is what makes the practice of medicine so interesting (and complicated). If diagnosing a ‘disease’ was as easy as taking out a measuring tape or ticking off lab values, then anyone could do it.
Indeed, to take specific examples, deciding when a wave on your ECG is a sign of underlying heart disease and when it is not, or when a mole on your skin is a precancerous growth and when it is not, is exactly what doctors go to medical school to learn.
It is exactly because we do not exclusively leave the diagnosis of obesity (which I define as a condition in which excess body fat threatens or affects health) to trained, licensed, and regulated health professionals, that we have created a ‘free-for-all’ where we continue propagating the myth that everyone with a few extra pounds is unhealthy and needs to lose weight. This is the key downside of not medicalising obesity – if only a trained health professional can tell whether or not your weight is affecting your health then someone without this training, should not be making assumptions about your health simply based on your size – indeed, it will hopefully become common knowledge that only your doctor or nurse can tell whether you have obesity or not.
Unfortunately, it is also because we have failed to medicalise obesity, that we do not pay the same attention to training health professionals in the intricacies and complexities of diagnosing and treating obesity as we do for other conditions. Indeed, would all health professionals understand how to properly diagnose obesity, i.e. be able to determine exactly for whom body fat poses a health problem and for whom it does not, we would go a long way in addressing one of the key issues that ‘people of size’ object to, namely assumptions being made about their health simply based on their shape and size rather than on a comprehensive and professional assessment of their actual health status. With proper training, rather than simply telling everyone to lose weight, health professionals will actually be able to target treatments to those who stand to benefit, while warning those, who will not, against any such efforts.
It is also because we have failed to medicalise obesity, that the billion dollar ‘weight-loss’ industry can continue peddling their snake oil and miracle cures – after all if obesity is not a medical condition, they are not practicing medicine, and therefore do not have to comply with professional standards or underly the same regulations that all licensed health professionals have to abide by (or risk losing their medical license). Nor would they be able to continue advertising their products with unproven health claims or ‘results-not-typical’ anecdotes. Rather, they would need to comply by the (at least in Canada) rather strict rules on how health professionals can offer and advertise their services. Indeed, no one fears the medicalisation of obesity more that the weight loss industry, where currently any self-appointed ‘expert’ can peddle with impunity whatever makes them a quick buck – all based on the claim that they are not actually practicing medicine.
It is because we have failed to medicalise obesity, that insurance companies and healthcare systems can weasel their way out of paying for obesity treatments, rather than support such treatments as they do for other ‘legitimate’ medical conditions. Indeed, were obesity fully accepted as a ‘legitimate’ medical condition requiring professional skills to diagnose and manage, we would probably not be arguing about funding for obesity assessments and treatments.
Finally, no one suffers more from the lack of medicalisation of obesity than those who suffer from obesity. As long as we deny them the respect, care, and attention that we afford to anyone else with any other medical condition, we are perpetuating the bias and discrimination that rests on the trivialization of obesity as a simple matter of will power and poor ‘lifestyle’.
All of this requires a redefinition of obesity – a definition not based on shape or size but solely on whether or not your body fat is affecting your health – if it is, you have obesity, if it is not, you don’t.
If only simple things weren’t that complicated.
Big thanks to Zach, Travis, Angela, Megan, Richard, and all the other CON-SNPs for organizing this Café and their kind hospitality.