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Arguments For Calling Obesity A Disease #1: It Impairs Health

Following┬ámy miniseries of arguments I often hear against calling obesity a disease, I now turn to reasons why I (and a number of organisations and experts) do consider obesity to be a disease. Let us start with the most obvious reason, namely that obesity, by definition, affects health and well-being. Remember, I am not talking about the BMI definition of obesity – I am talking about the actual WHO definition of obesity as a condition where excess or abnormal body fat affects health. I have already discussed that there are indeed folks across a wide range of body shapes and sizes, who are perfectly healthy – by this definition they do not have obesity (no doubt, BMI and measuring tapes get this wrong). On the other hand, even the most vehement fat acceptance enthusiasts will find it hard to argue that there are indeed many folks in whom there is indeed a direct link between excess body fat and health – be it functional limitiations or medical complications. Thus, excess weight with sleep apnea is obesity, excess weight with type 2 diabetes is obesity, excess weight with hypertension is obesity, excess weight with reflux disease is obesity, and so on. What some people find confusing is that fact that many of the complications of obesity can also be found in people with “normal” weight, which leads them to question the relationship between excess body fat and health. Indeed, almost all complications of obesity can also be found in people of “normal” weight but that is because the “complications”, in turn, can have multiple causes. Take for example fatty liver disease, the most common cause of which is alcohol, which is why in the context of obesity, we use the term – non-alcoholic fatty liver disease. But even if you exclude alcohol, there are a number of other factors that can cause fatty liver disease and these should be ruled out before jumping to conclusions that the fatty liver indeed related to the excess body fat. The same can be said for almost any medical condition associated with excess weight – before concluding that these conditions are related to the excess weight, other possible explanations should be ruled out. Ultimately, the test lies in observing the response to a change in body weight┬á- does the condition get better with weight loss or┬áworse with weight gain┬á- if yes, it is likely related… Read More »

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Arguments Against Obesity As A Disease #10: Affects Too Many People

And finally, to end this miniseries on the arguments I often hear against calling obesity, is the objection based on the idea that there are simply too many people living with obesity to apply the label “disease” to. Doing so, would mean that over 7 million Canadians would wake up to find themselves living with a disease. Related to this argument, I also often encounter the argument, that calling obesity a disease would turn these 7,000,000 Canadians into “patients” thereby completely overwhelming our healthcare system that would now be called about to provide treatments to all these people. I hear from payers and policy makers that providing treatments for obesity as a disease is simply not practical because of the number of people who have it. As I think about it, both arguments are rubbish. Firstly, the definition of disease has nothing to do with how many people are affected. Thus, I have never heard anyone say that we need to stop calling diabetes a disease because it affects 6 million Canadians or we need to stop calling depression a disease because 2.5 million Canadians will be affected during the course of their lives. No one would ever suggest we stop calling the flu a disease just because it affects millions of Canadians leading to┬á12,200 hospitalizations and 3,500 deaths in Canada each year. So arguing that we must not call obesity a disease because that would be declaring┬áfar┬átoo many people┬áas “diseased”, is simply irrelevant. Even if a disease affects 100% of the population causing important health problems and complications, we’d still be calling it a disease. As for overwhelming the healthcare system – I would say obesity is costing the health care system whether you call it a disease or not. We will still have to pay for all the health issues directly related to people having obesity – from diabetes to heart disease to joint replacements to cancers. It’s already costing billions of healthcare dollars. Except that we are now spending those dollars on the complications rather than on preventing and treating obesity itself. Again, if there was any other “disease” threatening to overwhelm the healthcare system, our response would certainly not be to simply stop calling it a “disease” – that would make no sense at all. This concludes my miniseries on arguments I often hear against calling obesity a disease (there are some I hear less often).… Read More »

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Arguments Against Obesity As A Disease #9: Its Just A Risk Factor

Next, in my miniseries on arguments I commonly hear against the notion of calling obesity a disease, is that it is “just a risk factor” for other diseases. This may be true, if you just (wrongly) considered elevated BMI as your definition of obesity, because no doubt, people with higher BMI levels carry a higher risk for obesity related complications including type 2 diabetes, sleep apnea, fatty liver disease, hypertension – just to name a few. (Note that increased risk is not the same as actually having the condition!). However, when┬áyou use the actual WHO definition of obesity, namely, “accumulation of excess or abnormal fat that impairs health”, obesity is no longer just a risk factor – it is now┬á(by definition) impairing your health, which makes it far more than just a risk factor. So while someone with a BMI of 35 may be at risk of developing obesity (not the same as having it), when their excess fat actually starts impairing their health, it de facto becomes a disease in its own right. Even then, one might argue that obesity itself is not the disease, rather the complications of obesity are the real disease. This notion is both right and wrong. There are many conditions that are both diseases in their own right as well as risk factors for other diseases or complications. Take type 2 diabetes for instance – it is both a disease in itself but also a risk factor for coronary heart disease or end-stage kidney disease. Take hypertension – a disease in its own right but also a risk factor for strokes and heart attacks. Take gastro-oesophageal reflux disease, which is also a risk factor for Barrett’s disease and oesophageal cancer. Take fatty liver disease, which is also a risk factor for cirrhosis. Gall bladder stones, which is also a risk factor for pancreatitis. Multiple sclerosis, which is also a risk factor for neurogenic bladder and pyelonephritis. The list goes on and on. So just because obesity is also a risk factor for a wide range of other medical problems, it does not make obesity any less of a disease in its own right. When excess or abnormal body fat affects health – it’s a disease. When it doesn’t, it’s at best a risk factor. That, is perhaps a subtle but important distinction. @DrSharma Toronto, ON

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Arguments Against Obesity As A Disease #8: Promotes Helplessness And Hopelessness

Continuing in my miniseries on arguments I hear against calling obesity a disease, I now discuss the objection, that doing so┬ápromotes a sense of helplessness or even hopelessness in people who carry extra weight. First of all, as noted previously, carrying extra weight is NOT the definition of obesity. For someone to have obesity they need to be carrying┬áweight that is actually┬ádue to excess or abnormal fat tissue AND┬áthere has to be some negative impact of that fat tissue on their┬áhealth – otherwise they┬ádo┬ánot have obesity!. That said, I am not sure how calling obesity on changes anything in terms of helplessness or hopelessness. Yes, the effective options to better manage obesity are limited and most people will likely struggle simply not to gain even more weight – but that fact doesn’t change whether you call obesity a disease or not. Indeed, there are many diseases for which we lack┬áeffective treatments (e.g. Alzheimer’s disease, multiple sclerosis), this does not make any of them any less of a disease. As for hopelessness, just because you are diagnosed with a chronic disease doesn’t mean everything is hopeless. In fact, there are many people living with chronic diseases that are controlled and well managed (e.g. diabetes, hypertension, sleep apnea), who┬ádo just fine (with treatment) and go on to live long and productive lives. Obviously, we need better treatments for obesity┬ábut even without those,┬á┬ápeople living with obesity can change the course of their disease by identifying and ┬áaddressing the root causes of their weight gain (e.g. depression, PTSD, emotional eating, etc.) and adopting behaviours, which even if not resulting in any noticeable weight loss, can markedly improve their health and well-being. Again, whether you call obesity a disease or not is completely irrelevant to whether or not you feel helpless or hopeless – the management approach would be the same, except that hopefully it will shift attention to a chronic disease strategy that requires long-term sustainable management rather than an acute intervention that is unsustainable. If we are serious about providing patients with help and hope, let us get serious about finding and providing better treatments for this disease. @DrSharma Toronto.┬áON

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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┬áare simply not smart or motivated enough to change their slovenly┬áways. In contrast, acknowledging that obesity is a disease with a complex psychosociobiology, if anything, can actually┬áhelp 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 ┬áto 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

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