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Arguments For Calling Obesity A Disease #7: Demands Empathy

Next 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 of 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 from family, friends, and colleagues. Thus, diseases demand empathy – that’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 a “disease”. Then, suddenly, everything changes – because diseases demand empathy. Perhaps this is the real reason that some folks are so vehemently against calling obesity a disease – to fully accept 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

Continuing 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 driven in times of plenty to take up and store as many calories as they could 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 our appetites by 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 part of virtually every celebration and social gathering for as long as anyone can remember. Food is celebration, bonding, culture, and identity – all… Read More »

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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 »

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Arguments Against Obesity As A Disease #2: Inconsistent Relationship Between Body Fat And Health

Yesterday, in my brief series on the pros and cons of calling obesity a chronic disease, I addressed the issue of BMI as a poor definition of obesity (understood here as “abnormal or excess body fat that affects health”). Another common argument I hear from those who do not support the notion of obesity as a chronic disease, is that there is an inconsistent relationship between body fat and health. This is no doubt the case. Indeed, whether or not your body fat affects your health depends on a range of factors – from your genetic predisposition to certain “complications” to the “nature” of your body fat, factors that cannot be captured or assessed by simply stepping on a scale. Often, this variability in the relationship between excess body fat and its impact on health, is used to argue against a “causal relationship” between the two. This argument is often presented along the lines of, “If obesity is a disease, how come I don’t have diabetes?”. Where the direct impact of excess body fat on health should be evident,  is when the amount of excess fat poses a direct “mechanical” problem that impedes physical functioning. This impact, however, is likely to vary from one person to the next. A good example of this, is obstructive sleep apnea, where an increase in pharyngeal fat deposition is directly and causally related to the airway obstruction. The causal relationship of pharyngeal fat and the symptoms is directly evident by improvement in symptoms following surgical removal of the excess fat (an operation that is seldom undertaken due to possible complications and redeposition of fat). There is also substantial evidence that significant weight loss (such as induced by bariatric surgery) results in a dramatic improvement in apnea/hypopnea index and sometimes even in complete resolution of the problem. Yet, not everyone with excess weight develops obstructive sleep apnea. One of the factors that explains this variation, is the anatomical dimension of the pharyngeal space, which varies significantly from one person to the next. So, just how much excess fat in the neck region results in symptoms (if any) will necessarily be highly variable. This is not an argument against the relationship between excess body fat and obstructive sleep apnea, it is just the expected variation between individuals that is evident in many diseases. Likewise, when the amount of excess fat impairs the body’s capacity to perform essential functions (from mobility… Read More »

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Developing A Research Agenda In Weight Bias

Last year, the Canadian Obesity Network and the Werklund School of Education and departments of Psychology and Community Health Sciences at the University of Calgary co-hosted the 2nd Canadian Summit on Weight Bias and Discrimination in Calgary, AB. The proceedings of this two-day summit, which was attended by 40 invitees representing education, healthcare, and public policy sectors in Alberta, British Columbia, and Ontario are now published in OBESITY. The 40 attendees included 14 researchers, 11 practitioners, and 15 policy makers, although some participants represented multiple perspectives. On the first day, speakers from across Canada presented their research on the prevalence and consequences of weight bias, as well as on interventions to reduce weight bias in the education, healthcare, and public policy arenas. These daytime sessions concluded with an evening public outreach event in the form of an expert round table titled “Fear of Fat: Promoting health in a fat phobic culture” at a local community center with 100 attendees. The second day consisted of a round table of facilitated discussions to identify what research question(s), if answered, would make the greatest impact on weight bias reduction efforts in Canada. The key outcome from these deliberations include the identification of six research areas that warrant further investigation in weight bias: costs, causes, measurement, qualitative research and lived experience, interventions, and learning from other models of discrimination. It also became evident that progress in this field requires attention to three key issues: language matters, the voices of people living with obesity should be incorporated, and interdisciplinary stakeholders should be included. A 3rd Summit on Weight Bias and Discrimination that will build on the learning form the previous workshop will be held in Edmonton, May 26-27, 2016. It will be interesting to see what progress has been made in field since the last meeting in 2015. @DrSharma Edmonton, AB

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