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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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Arguments For Calling Obesity A Disease #9: Medical Education

sharma-obesity-medical-students1Next in my miniseries on the pros and cons of calling obesity a ‘disease’, I turn to the issue of medical education.

From the first day in medical school, I learnt about diseases – their signs and symptoms, their definitions and classifications, their biochemistry and physiology, their prognosis and treatments.

Any medical graduate will happily recite the role and function of ADH, ATP, ANP, TSH, ACTH, AST, ALT, MCV and a host of other combinations of alphabet soup related to even the most obscure physiology and function – everything, except the alphabet soup related to ingestive behaviour, energy regulation, and caloric expenditure.

Most medical students and doctors will never have heard of POMC, α-MSH, PYY, AgRP, CART, MC4R, or any of the well studied and long-known key molecules involved in appetite regulation. Many will have at best a vague understanding of RMR, TEE, TEF, or NEAT.

The point is, that even today, we are graduating medical doctors, who have at best a layman’s understanding of the complex biology of appetite and energy regulation, let alone a solid grasp of the clinical management of obesity.

Imagine a medical doctor, who has never heard of β-cells or insulin or glucagon or GLUT4-transporters trying to manage a patient with diabetes.

Or a medical doctor, who has never heard of renin or aldosterone or angiotensinogen or angiotensin 2 trying to manage your blood pressure.

How about a medical doctor, who has never heard of T3 or T4 or TSH managing your thyroid disease?

Elevating obesity to a ‘disease’ means that medical schools will no longer have an excuse to not teach students about the complex sociopsychobiology┬áof obesity, its complications, prognosis, and treatments.

As I mentioned in a previous post, suddenly, managing obesity has become their job.

No longer will it be acceptable for doctors to simply tell their patients to control their weight, with no stake in if and how they actually did it.

Thus, if there is just one thing that calling obesity a ‘disease’ can change, it is expecting all health professionals to have as much understanding of obesity as they are currently expected to have of diabetes, heart disease, lung disease, and any other common disease they are likely to encounter in their medical practice.

Apparently, simply treating obesity as a ‘lifestyle’ problem or ‘risk factor’ was not enough – hopefully, recognising obesity┬áas a ┬á’disease’ in its own right, will change the attention given to this issue in medical training across all disciplines.

@DrSharma
Edmonton, AB

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Arguments For Calling Obesity A Disease #7: Demands Empathy

Empathy-Four-ElementsNext in my miniseries on arguments for calling obesity a disease is the issue of empathy.

Our normal response to people who happen to be affected by a disease – including lung cancer and STDs – is at least some measure┬áof empathy (even if residual stigma continues to exist).

Even if the disease was entirely preventable and you did your lot to hasten its development, once you declare yourself as having diabetes, or heart disease, or stroke, or cancer, the expected social response is empathy – and not just┬áfrom family, friends, and colleagues.

Thus, diseases demand empathy -┬áthat’s the normal, ethical, humane response.

But apparently not towards people affected by obesity.

Here the response is blame, shame, disgust, jokes, name calling, and even physical attacks (spitting, pushing, shoving, beating – you name it).

No empathy, so sympathy, no understanding, no compassion – i.e perhaps until we call obesity┬áa “disease”.

Then, suddenly, everything changes – because diseases demand empathy.

Perhaps this is the real┬áreason that some┬áfolks are so vehemently against calling obesity a disease┬á- to fully┬áaccept that obesity is a disease, they would have to show empathy – not something they feel people living with obesity quite deserve.

After all, how can you still make jokes and poke fun at people living with a disease?

How can you still shame and blame people living with obesity, if we call it a disease?

How can you still wage a “war” on obesity – take no prisoners?

That’s definitely a spoiler!

Think about it!

@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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Arguments Against Obesity As A Disease #5: Reduces Personal Responsibility

diet journalIn 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┬áa 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┬ájust because we call them “diseases”.

There is even a term for this – it is called “self-management” – a┬ákey principle of chronic disease management.

The course of almost every chronic disease┬ácan 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┬áobesity largely as a matter of personal “choice” rather than the complex multifactorial problem that it actually is.

Indeed, the opponents often┬áappear “morally” opposed to the very notion of┬áaccepting 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 have no greater┬áor┬álesser “responsibility” of contributing to the self-management of their disease, than people living with hypertension, diabetes, depression, heart disease, or cancer – people living with any disease should be doing what they can – why would obesity be any different?

@DrSharma
New Orleans, LA

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