While I am taking a brief break from clinics and other obligations (including daily blog posts), I will be reposting past articles, which I still believe to be relevant but may have escaped the attention of the 100s of new readers who have signed up in the past months.
The following was first posted on 08/19/08
Many readers of this blog are familiar with the ongoing (endless?) discussion about whether or not obesity is a risk factor, a disease, a condition, or simply an extreme of the normal “bell curve” of body weights. Today, I want to throw in another term into this discussion. In fact, the more I think about it, the more I am convinced that we should look at obesity as a clinical sign - not unlike edema.
In the same manner that edema reflects the excess accumulation of fluid, obesity reflects the excess accumulation of body fat. As edema is a clinical sign of a perturbation of fluid homeostasis, excess fat accumulation is indicative of a perturbation in energy balance.
In a patient with edema, we can of course opt to simply provide symptomatic treatment by restricting salt and water intake, but my guess is that most experienced clinicians will likely make an effort to understand whether the fluid retention is a result of abnormal cardiac function, renal failure, venous or lymphatic stasis, vasodilatory drugs or a list of other possible causes of fluid retention.
Similarly, in a patient with excess body fat, we can simply prescribe “symptomatic treatment” by restricting food intake or increasing activity, or we can make an effort to truly understand the factors that are causing the patient to overeat or “undermove” (apologies for coining this term, but I kind of think it conveys the point). Obviously, whether or not the overeating is a result of peer pressure, hunger (meal skipping), depression, binge-eating, olanzapine, sugar-addiction, MC-4 receptor defect, or a craniopharyngeoma may well influence the choice of treatments.
Similarly, whether or not the “undermoving” results from lack of time, unsafe neighbourhoods, obstructive sleep apnea, anxiety disorders, depression, back pain, fibromyalgia, plantar fasciitis, vital exhaustion or quadroplegia will (hopefully) help determine the most appropriate and effective management strategy.
The idea that all people with excess body fat should simply eat less and move more is not unlike the notion that all people with edema should simply restrict their fluid intake and cut the salt.
If obesity is simply a “sign”, then “overeating” and “undermoving” are just symptoms!
The differential diagnosis of overeating and undermoving is complex and can involve sociocultural, psychological, medical and iatrogenic causes.
Let’s get more sophisticated in our diagnostics - hopefully our ability to address the underlying causes will follow.
AMS
Edmonton, Alberta
In The News
August 11th, 2009 at 8:06 pm
Nice to see a doctor thinking along these lines.
Have you read Gary Taubes book, or watched his presentation to Grand Rounds at Dartmouth-Hitchcock? You may find it interesting: http://www.dhslides.org/mgr/mgr060509f/f.htm