Arguments For Calling Obesity A Disease #5: Access To Care
Continuing in my miniseries on arguments in favour of calling obesity (defined as excess or abnormal fat tissue that impairs health) a disease, I turn to the perhaps most important reason of all – access to care. Currently, few health care systems feel obliged to provide individuals presenting with obesity treatment for their condition (beyond a few words of caution and simplistic advise to simply eat less and move more). Most health plans do not cover treatments for obesity, arguing that this is simply a lifestyle issue. In some countries (e.g. Germany), health insurance and health benefit plans are expressly forbidden by law to cover medical treatments for obesity. Although long established as the only evidence-based effective long-term treatment for severe obesity, many jurisdictions continue to woefully underprovide access to bariatric surgery, with currently less than 4 out of 1,000 eligible patients receiving surgery per year in Canada. Pretty much all of this can be blamed on one issue alone – the notion that obesity is simply a matter or personal choice and can be remediated by simple lifestyle change. Declaring obesity a disease can potentially change all of this. As a disease in its own right, health care systems can no longer refuse to provide treatments for this condition. In the same manner that no health system or insurance plan can refuse to cover treatments for diabetes or hypertension, no health system or insurance plan should be able to deny coverage for treatments for obesity. As a chronic disease, obesity care must now be firmly integrated into chronic disease management programs, in the same manner that these programs provide services to patients with other chronic diseases. How long will it take before this becomes accepted practice and funding for obesity treatments rises to the level of funding currently available for treating other chronic diseases? That, is anyone’s guess, but no doubt, declaring obesity a disease finally puts patients living with this condition on an equal footing with patients living with any other chronic disease. @DrSharma Edmonton, AB
Arguments Against Obesity As A Disease #6: Stigmatizes People Living With Obesity
Continuing in my miniseries on arguments I often hear against calling obesity a disease, I will now deal with the issue of stigma and discrimination, namely that declaring obesity a disease stigmatizes people who may be healthy. I have already dealt with the issue of not using the terms “obesity” to describe people of size, who are perfectly healthy. Thus, using the actual WHO definition of obesity (the accumulation of excess or abnormal body fat that impairs health), this term should not used to describe people who do not experience health problems from their body fat. That said, how exactly does obesity stigmatize people who actually have obesity (using the above definition and not simply BMI)? No doubt, obesity is a highly stigmatised condition, but so are numerous other diseases including depression, addictions, HIV/AIDS and many others. While much has been achieved in destigmatizing these conditions, obesity still lags far behind. This problem cannot be addressed by refusing to call obesity a disease – it can only be addressed by getting people (including friends and family) to understand the complex and multi-factorial nature of this disorder and the rather limited treatment options that we currently have available for people living with this disease. It is not calling obesity a disease that promotes weight bias and stigma, rather, it is the fairy tale of “choice” and the overly simplistic “eat-less move-more” propaganda that stigmatises people living with excess weight by promoting discriminatory stereotypes and the notion that they are simply not smart or motivated enough to change their slovenly ways. In contrast, acknowledging that obesity is a disease with a complex psychosociobiology, if anything, can actually help move us towards destigmatising obesity in the same way that depression has been destigmatised by reframing the issue as a matter of “chemicals in the brain” (which incidentally would also apply to most of obesity). Thus, not only should calling obesity a disease help reduce stigma but also hopefully go a long way in reducing wight-based discrimination in everything from access to care to disability legislation. @DrSharma New Orleans, LA
Arguments Against Obesity As A Disease #5: Reduces Personal Responsibility
In 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… Read More »
European Perspective on Obesity as a Chronic Disease
This morning at the European Obesity Summit in Gothenburg, Sweden, I attended a session hosted by the EASO Patient council on the issue of whether obesity should be regarded a disease. This is an important discussion because it directly effects the issue of access to care for Europeans living with obesity. Currently, legislation and policies around obesity as a disease vary widely among the EU member countries. This may have prompted the recent submission of a written declaration to the European Parliament 0037/2016 submitted under Rule 136 of the Rules of Procedure on the recognition of obesity as a chronic disease. As this declaration notes, “Obesity is complex and is caused by many different factors, including medical, cultural and socioeconomic dynamics. This being the case, there is an urgent need to recognise obesity as a disease in order to ensure better mobilisation of resources when it comes to the prevention, treatment and care of the disease.” and calls on the Commission and the Council to work towards a harmonised Europe-wide recognition of obesity as a chronic disease. While this declaration is not binding for the European Parliament and it is unclear what it actually means for individuals member countries, the push for recognition of obesity as a disease, which has important policy implications in terms of access to medical care and treatments as well as potential implications for other aspects including anti-discrimination and disability legislation, will hopefully serve Europeans living with obesity well. @DrSharma Gothenburg, Sweden
Obesity As A Chronic Disease Is Not Doom And Gloom
The last time I checked, my TEDx talk “How To Lose 50 Pounds And Keep Them Off“, had over 3,500 views on its first day! While that is far from going “viral”, I do admit that it’s a lot more than I expected. Although the overwhelming response and comments were positive, some viewers appeared frankly disappointed, not to say frustrated by the notion that obesity, once established, behaves like a chronic disease. This may in part be due to the fact that, despite all evidence to the contrary, many people continue to believe (as suggested by the diet, fitness and weight-loss industry) that “permanent” weight loss is within anyone’s reach (it isn’t) and reaching your “dream weight” means winning the battle (it doesn’t). But, I also believe that some of the frustration that comes with seeing obesity as a chronic disease for which we have no cure (which happens to be the definition of “chronic disease”), stems from the notion that living with a “disease” is terrifying and hopeless (it isn’t!). In fact, most of what we deal with in our health care systems are “chronic diseases” – the exceptions being largely limited to accidents, acute infections and some cancers – these we can “cure”, by which I mean that we treat them for a given period of time after which they ceases to exist and the patient can be considered “cured”. Unfortunately, as important as these “cures” may be, they constitute a rather small proportion of what goes on in the health care system. It is fair to say that for the vast majority of medical conditions, we may have treatments, but most certainly no “cures”. However, this is not as depressing as it may seem. Indeed, it is one of the great achievements of modern medicine that we have turned diseases that would have been fatal in the not too-distant past (e.g. type 1 diabetes, coronary artery disease, HIV/AIDs, breast cancer), into conditions where, with proper treatments, most patients can enjoy decades of meaningful and productive life, despite living with their “chronic” disease. Not that the treatments are always easy or cheap or well tolerated – but, when applied and adhered to properly, they generally do their job of allowing patients to go about their lives in a fairly acceptable manner. So the idea that living with a chronic disease is all doom and gloom is certainly not true – ask anyone living with well-controlled diabetes, hypertension,… Read More »
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