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The Weight Of Living

weight-of-livingIn its approach to addressing weight bias and discrimination, the Canadian Obesity Network recently launched the “Weight of Living” (WoL) project on its facebook page.

Modelled on “Humans of New York”, WoL presents images and stories of Canadians living with obesity in all their diversity and variation.

After all, nothing is more effective in breaking down stereotypes and barriers than realizing that people living with obesity are no different from everyone else, in their hopes, their dreams, their challenges, their aspirations – doing their best to cope and overcome what life throws at them.

Rather than promoting a culture of fat-shaming and blaming, the Canadian Obesity Network seeks to destigmatise those living with obesity by encouraging them to share their real stories in their own words.

Thus, this project seeks to dismantle the stereotypes that surround the lives of people who live with obesity, including the notion that everyone who has overweight or obesity wants to lose weight because they are unhappy with themselves.

Many of the stories you will see in the upcoming weeks do not reflect this. The Canadian Obesity Network hopes that, by sharing these experiences, we all will realize that people who have overweight or obese have goals, dreams, and aspirations just like everyone else, and that their weight is not necessarily a barrier to achieving these, nor is it something that needs to be a source of fear and shame.

In contrast to many other “weight-loss” sites, the Canadian Obesity Network will not┬ápublish stories that glorify weight loss journeys, commercial programs or products, or extreme weight loss attempts.

“While we respect the importance and validity of each story we receive, publishing stories like these only serve to reinforce the idea that people who are overweight or obese are living unhappy, unfulfilling lives – and we know you are worth so much more than that.”

Check out the first WoL stories here, here, here, and here

For more information on how to participate in this project click here or send an e-mail to levitsky@obesitynetwork.ca.

@DrSharma
Edmonton, AB

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My Miniseries on Obesity As a Disease

NN Benefits White Paper CoverOver the past weeks, I have presented a miniseries on the pros and cons of calling obesity a chronic disease.

Clearly, I am convinced that the arguments in favour, carry far greater chances of effectively preventing and controlling obesity (defined as abnormal or excess body fat that impairs health) than continuing to describe obesity merely as a matter of ‘lifestyle’ or simply a ‘risk factor’ for other diseases.

That said, I would like to acknowledge that the term ‘disease’ is a societal construct (there is, to my knowledge no binding legal or widely accepted scientific definition of what exactly warrants the term ‘disease’).

As all societal constructs are subject to change, our definitions of disease are subject to change. Conditions┬áthat may once have been deemed a ‘normal’ feature of aging (e.g. type 2 diabetes or dementia) have long risen to the status of┬á’diseases’. ┬áThis recognition has had profound impact on everything from human rights legislations to health insurance to the emphasis given to these conditions in medical education and practice.

People living with obesity deserve no less.

Thus, I come down heavily on the ‘utilitarian’ principle of calling obesity a disease.

When, calling obesity a ‘disease’ best serves the interests of those affected by the condition, then, by all means, call obesity a ‘disease’ – it is as simple as that.

First consequences of the American Medical Association declaring obesity a chronic disease are already evident (see here and here).

We can only hope for the same impact of the Canadian Medical Association declaring obesity a disease – the sooner, the better for all Canadians living with obesity.

@DrSharma
Edmonton, AB

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Arguments For Calling Obesity A Disease #8: Can Reduce Stigma

sharma-obesity-hypothalamusNext, in this miniseries on arguments for and against calling obesity a disease, I turn to the issue of stigma.

One of the biggest arguments against calling obesity, is the fear that doing so can increase stigma against people living with obesity.

This is nonsense, because I do not think it is at all possible for anything to make stigma and the discrimination of people living with obesity worse than it already is.

If anything, calling obesity a disease (defined as excess or abnormal body fat that impairs your health), could well serve to reduce that stigma by changing the narrative around obesity.

The current narrative sees obesity largely as a matter of personal choice involving poor will power to control your diet and unwillingness to engage in even a modest amount of regular physical activity.

In contrast, the term ‘disease’ conjures up the notion of complex biology including genetics, epigenetics, neurohormonal dysregulation, environmental toxins, mental health issues and other factors including social determinants of health, that many will accept are┬ábeyond the simple control of the individual.

This is not to say that other diseases do not carry stigma. This has and remains the case for diseases ranging from HIV/AIDS to depression - but, the stigma surrounding these conditions has been vastly reduced by changing the narrative of these illnesses.

Today, we are more likely to think of depression (and other mental illnesses) as a problem related to “chemicals in the brain”, than something that people can pull out of with sheer motivation and will power.

Perhaps changing the public narrative around obesity, from simply a matter of motivation and will power, to one that invokes the complex sociopsychobiology that really underlies this disorder, will, over time, also help reduce the stigma of obesity.

Once we see obesity as something that can affect anyone (it can), for which we have no easy solutions (we don’t), and which often requires medical or surgical treatment (it does) best administered by trained and regulated health professionals (like for other diseases), we can perhaps start destigmatizing this condition and change┬áthe climate of shame and blame that people with this disease face everyday.

@DrSharma
Edmonton, AB

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Arguments For Calling Obesity A Disease #5: Access To Care

sharma-obesity-doctor-kidContinuing 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

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Arguments For Calling Obesity A Disease #2: It Is Driven By Biology

feastContinuing in my miniseries on reasons why obesity should be considered a disease, I turn to the idea that obesity is largely driven by biology (in which I include psychology, which is also ultimately biology).

This is something people dealing with mental illness discovered a long time ago – depression is “molecules in your brain” – well, so is obesity!

Let me explain.

Humans throughout evolutionary history, like all living creatures, were faced with a dilemma, namely to deal with wide variations in food availability over time (feast vs. famine).

Biologically, this means that they were┬ádriven in times of plenty to take up and store as many calories as they┬ácould in preparation for bad times – this is how our ancestors survived to this day.

While finding and eating food during times of plenty does not require much work or motivation, finding food during times of famine requires us to go to almost any length and risks to find food. This risk-taking behaviour is biologically ensured by tightly linking food intake to the hedonic reward system, which provides the strong intrinsic motivator to put in the work required to find foods and consume them beyond our immediate needs.

Indeed, it is this link between food and pleasure that explains why we would go to such lengths to further enhance the reward from food by converting raw ingredients into often complex dishes involving hours of toiling in the kitchen. Human culinary creativity knows no limits – all in the service of enhancing pleasure.

Thus, our bodies are perfectly geared towards these activities. When we don’t eat, a complex and powerful neurohormonal response takes over (aka hunger), till the urge becomes overwhelming and forces us to still┬áour appetites┬áby seeking, preparing and consuming foods – the hungrier we get, the more we seek and prepare foods to deliver even greater hedonic reward (fat, sugar, salt, spices).

The tight biological link between eating and the reward system also explains why we so often eat in response to emotions – anxiety, depression, boredom, happiness, fear, loneliness, stress, can all make us eat.

But eating is also engrained into our social behaviour (again largely driven by biology) – as we bond to our mothers through food, we bond to others through eating. Thus, eating has been┬ápart of virtually every celebration and social gathering for┬áas long as anyone can remember. Food is celebration, bonding, culture, and identity – all features, the capacity for which, is deeply engrained into our biology.

In fact, our own biology perfectly explains why we have gone to such lengths to┬ácreate the very environment that we currently live in. Our biology (paired with our species’ limitless creativity and ingenuity) has driven us to conquer famine (at least in most parts of the world) by┬ácreating an environment awash in highly palatable foods, nutrient content (and health) be damned!

Thus, even without┬ádelving any deeper into the complex genetics, epigenetics, or neuroendocrine biology of eating behaviours, it is not hard to understand why much of today’s obesity epidemic is simply the result of our natural behaviours (biology) acting in an unnatural environment.

So if most of obesity is the result of “normal” biology, how does obesity┬ábecome a disease?

Because, even “normal” biology becomes a disease, when it affects health.

There are many instances of this.

For example, in┬áthe same manner that the biological system responsible for our eating behaviour and energy balance┬áresponds to an “abnormal” food environment ┬áby promoting excessive weight gain to the point that it can negatively affect our health, other biological systems respond to abnormal environmental cues to affect their respective organ systems to produce illnesses.

Our immune systems designed to differentiate between “good” and “bad”, when underexposed to “good” at critical times in our development (thanks to our modern environments), treat it as “bad”, thereby creating debilitating and even fatal allergic responses to otherwise “harmless” substances like peanuts or strawberries.

Our “normal” glucose homeostasis system, when faced with insulin resistance (resulting from increasingly sedentary life circumstances), provoke┬áhyperinsulinemia with ultimate failure of the beta-cell, resulting in diabetes.

Similarly, our “normal” biological responses to lack of sleep or constant stress, result in a wide range of mental and physical illnesses.

Our “normal” biological responses to drugs and alcohol can result in chronic drug and alcohol addiction.

Our “normal” biological response to cancerogenous substances (including sunlight) can result in cancers.

The list goes on.

Obviously, not everyone responds to the same environment in the same manner – thanks to biological variability (another important reason why our ancestors have made it through the ages).

But, you may argue, if obesity is largely the result of “normal” biology responding to an “abnormal” environment, then isn’t it really the environment that is causing the disease?

That may well be the case, but it doesn’t matter for the definition of disease. Many diseases are the result for the environment interacting with biology and yes, changing the environment could indeed be the best treatment (or even cure) for that disease.

Thus, even if pollution causes asthma and the ultimate “cure” for asthma is to┬árid the air of pollutants, asthma, while it exists, is still a disease for the person who has it.

All that counts is whether or not the biological condition at hand is affecting your health or not.

The only reason I bring up biology at all, is to counter the argument that obesity is simply stupid people making poor “choices” – one you consider the biology, nothing about obesity is “simple”.

@DrSharma
Edmonton, AB

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