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 19th, 2008 at 7:08 pm
I’ve been saying this for years! I’m so glad someone else is finally seeing this.
August 21st, 2008 at 9:58 pm
I think that there are many “non-fat” people out there who are also exhibiting the symptoms of undermoving, and some that exhibit “overeating” without becoming fat.
September 3rd, 2008 at 7:18 am
[...] with adults, overeating and “undermoving” are symptoms of underlying familial, cultural, societal and environmental challenges faced by kids, adolescents [...]
October 10th, 2008 at 6:45 am
[...] outlined in previous blog postings, obesity is perhaps best considered a “sign” of chronic positive energy balance and as [...]
July 1st, 2010 at 8:04 am
I commend you for thinking beyond the idea that excess adiposity/obeisity is simply a matter of positive energy balance (more inputs via eating than outputs via exercise). It is actually, but not in the way that we commonly think of it ( eg. obesity= intake-output).
A better way to conceive of it is as the metabolic derangement that it clearly must be. I believe this to be the case for most cases of “common obesity.
When you see that obesity occurs because of a metabolic issue which shifts the body’s energy balance toward energy/fat accumulation, rather than fat mobilization and metabolization, then it stands to reason that “overeating” and “undermoving” are the RESULTS of growing obese, not the CAUSE.
Should we not then be addressing the cause, as you have mentioned?
Thanks for an excellent and informative site!