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Why Recognising Obesity as a Disease is Only Fair to Those Affected By This Condition


American-Medical-Association-logoFor most of yesterday, apart from running a rather full clinic, I was busy answering media queries and giving interviews on the  American Medical Association’s “vote” to “recognize” obesity as a “disease”.

Regular readers, who are well aware of my arguments in favour of “medicalizing” obesity, will no doubt guess that my overall response to this move was rather enthusiastic.

This is not to deny the shortcomings of using a BMI-based definition of obesity – again, regular readers, will be well aware of my reservations and concerns about its limitations for individuals and medical practice.

Yet, I stand by my view that obesity can and needs to be “medicalized” in order to help the millions of Americans (and hopefully Canadians) who live with excess weight and the illnesses and disabilities related to it.

Unfortunately, obesity continues to be often viewed by governments, payers, healthcare professionals, media and individuals as being largely caused by laziness and over-consumption, a stigmatizing oversimplification of a complex health problem.

In contrast, if governments, healthcare professionals, payers, media and individuals viewed obesity as a disease, we can perhaps create a world where health professionals are remunerated for providing treatment services, where people with obesity can seek medical assistance with confidence, and where public and private funders see the provision of obesity prevention and treatment resources  and related research as a priority.

Whether or not this recognition by the AMA will have these results remains to be seen but this is certainly an important step in the right direction.

As far as Canada (and many other countries around the world are concerned) , we still have a long way to go towards translating what we have learnt about obesity into healthcare policies and clinical practice.

Nevertheless, following the the 2009 resolution of the Canadian Medical Association, which

“…encourages provincial/territorial medical associations to work in conjunction with the Canadian Obesity Network to help develop chronic care models for obesity prevention and management.”,

the Canadian Obesity Network has certainly done its share in helping address anti-fat bias and discrimination but also in providing tools (such as the 5As of Obesity Management) to enable health care practitioners to better manage individuals affected by this condition.

@DrSharma
Edmonton, AB

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13 Comments

  1. This means there has to be a big effort to PREVENT people from becoming obese.
    I am looking for public health initiatives like

    – amending the Canada Food Guide to teach people to eat to keep a healthy weight by consuming the right amount of energy in their diets.
    In this day and age calorie awareness is a survival skill.

    – fighting the “fat acceptance” movement, which denies that fat is a disease, and which cries “discrimination” at any effort to prevent or reduce obesity.

    We want to end discrimination towards people who have medical problems – but we still take lots of precautions to avoid the injury or disease which gives people medical problems. It’s not “discrimination” to tell people to wash their hands to avoid getting sick; it’s not “discrimination” to tell people to control their calorie intake to avoid obesity. (Yes, there are non-food related causes of obesity, but most people become obese by eating too many calories, though many of those are in denial that what they eat affects their weight.)

    We need to accept a person who is obese like we should accept a person who is on crutches because of a car crash. We accept the person, we do everything we can to help those people heal, and we try to prevent others from getting the same problem.

    “Don’t smoke”. Don’t drink and drive”. “Don’t eat too many calories.”

    – further scientific study on how to prevent and cure obesity.

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  2. This was wonderful news. The comments on the message boards unfortunately have mostly been along the usual lines. However interviews such as the one you did on CBC Dr. Sharma should help make a difference in public perception.

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  3. Can we expect a better clinical,definition of the disease now that is recognized as one?

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  4. I fear the end result will not be better treatment, but an increased pressure on people with what I would call benign obesity — someone on an Edmonton Scale 0 — to “treat” a condition when the treatment carries risks of disordered eating and rebound weight gain. I see no reason to call someone with stable but higher weight and no related complications “diseased.”

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  5. I worry about the same thing. Also since more than one study has demonstrated that obesity can even be protective, especially for older people, how are Dr.s going to address this “disease” in them? I am also concerned about individual choice. Yes I want to lose weight, I am a serial dieter, it never stops, constant tweaking, adding exercise, changing exercise etc. However I would never consider WLS or any of the drugs currently being offered. So what really will this accomplish? More fat talks from Drs with no “Cure”, being considered “non-compliant”, more public disgust at the diseased among them? I fear this is going to make healthcare even worse for the obese who won’t submit to being sliced and diced or to becoming lab rats for under tested, very possibly dangerous drugs. I just don’t see any good coming from this for folks like me. This will only benefit the drug companies and WLS providers.

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  6. I am interested to hear that Dr. Sharma sees this as good news. I, too, welcome more research and practical health care applications (many of them as there are many differing manifestations of this disease).
    Its also sad to see comment here (from someone who is aware of this website and most informative and excellent blog) insisting that too many calories ingested causes obesity. If that were true my husband would be as big as a house instead of skinny and fit, as he is!! It does make sense to me though, that people would have trouble believing the truth …. one part of the truth is that health-full eating can, quite possibly, have no impact upon obesity (either causing it or preventing it).

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  7. While I am not obese, but am considered overweight (BMI 27.1), I appreciate doctors treating the conditions I do have, including hypercholesteremia and hypertension (not severe, but there) and not lecturing me about my weight. I also have diabetes, but it is closer to T1 than to T2 in that I’ve been insulin dependent since 5 months after diagnosis, and I’m not particularly insulin resistant. I think it behooves doctors to treat the diseases as they happen, and not point the finger of blame. Weight loss, which I did 2 years ago by going genuinely anorexic and lost 30 lb., did NOT help my conditions, so I refuse to accept blame. I do appreciate doctors who work WITH me and not in SPITE of me, if you know what I mean!

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  8. Natalie, if you go between overweight and anorexic, as you put it, you may have a deeper problem with weight management that needs to be addressed. Treating the symptoms, the diabetes etc., won’t be a solution in the long run.

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  9. Evilcyber, thank you for your concern. I do have a problem, but it is not about weight management; it’s an eating disorder, and I am in treatment for it. The point I was trying to make, though, is that pointing the finger of blame at obese people does not help. It’s very hurtful, and while working with these people, doctors need to be supportive, not judgmental. And the co-occurring conditions DO have to be treated without judgment about weight. When I hit my lowest weight, well within the normal range, the diabetes did not go away, nor even improve; the only reason I was taking less insulin was because I wasn’t eating very much. So my diabetes needs to be treated regardless of what I weigh. Thus, it has nothing to do with weight management.

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  10. Obesity can’t possibly be a disease because it is a symptom. That’s like saying coughing is a disease when it is merely the body’s normal reaction to something else. How can you cure people from coughing? Laziness, overeating, medical issues, etc are the really diseases which obesity is a result. If you are over eatting and you become obese then your body functioned as normal. If you have hyperthyroid problems then the disease is in the thyroid not the fat accumulated. Treat the real disease and you eliminate the symptoms, treat the symptom and you are still sick. It is odd that other countries aren’t effected by this so called disease the way Americans are. I think labeling it a disease harms this country more than anything because we are officially trying to catch the wind, and ignoring the fan.

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  11. Kofybean, I think you need to read more of Dr. Sharma’s columns. Laziness and overeating are very easy to blame for obesity (and for the record, in light of the responses above, I am NOT obese). I know too many people who eat a lot of junk food and are not physically active, who remain at a normal weight, and others who eat a very healthy diet and exercise conscientiously and are obese. No, I don’t know all the obese people in the world, and I have not conducted a study, but your overgeneralization is, quite frankly, offensive. You know nothing of the hormonal and enzymatic regulation of weight, and even the scientists are still discovering new things about weight regulation. And it’s not true that people in other countries are not affected by obesity. Ever see a sumo wrestler? They get obese on a Japanese food diet. Of course, they do it on purpose, but I’ve traveled to many foreign countries and seen obese people everywhere. So please put some actual study into the causes of obesity instead of simply pointing the finger. It doesn’t help anyone.

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  12. I completely agree with you Natalie. Obesity is complicated. And there is a big difference between being healthy and being thin. Too often people treat them as the same thing. Speaking as a person who is obese, I think the emphasis should be on exercise and healthy eating and let the weight fall where it may. There are an awful lot of unhealthy ways to loss weight, if weight loss is your goal. If you goal is good health you should emphasis regular exercise and healthy food.

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Trackbacks/Pingbacks

  1. New Medications for Obesity – US Only? | Dr. Sharma's Obesity Notes - [...] yesterday’s announcement of the recognition of obesity as a “disease” by the American Medical Association, I speculated on what …
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