7 Comments

1. Yitka Graham

   Saturday, January 19, 2013

   I agree that non-medicalisation of obesity is potentially discriminatory. There are documented high rates of stigma associated with obesity, resulting in discrimination, and poor quality of life. Then we have to add the physical co-morbidities associated with obesity such as Type 2 diabetes, into the equation. The WHO definition of health is ‘state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. To me, this definition conceptualises obesity, as it encompasses all the multifactorial elements to this disease and supports the case for medicalising the condition. Well done Arya, for raising this contentious debate again.

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2. Linda Fair

   Saturday, January 19, 2013

   I agree that obesity IS a medical problem and should be treated by the medical profession. I must add however that it is also a spiritual, emotional and mental problem and must be approached holistically on all levels. There are 12 step programs that can also be helpful and need to be recommended in addition to the medical treatment. Why can’t we fire on all cylinders?

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3. Linda

   Saturday, January 19, 2013

   Thank you Dr. Sharma for being an advocate for those of us who struggle with weight issues. I personally have been overweight since the age of 10 years old. I was a very active kid, involved in sports, biking, swimming etc. My two problems are self discipline and anxiety. It is very frustrating to exercise and try to eat healthy then something happens on an emotional level and all of the efforts have been in vain. I am 5″6′ and 257 lbs. I have tried every diet program on the market at least a few times and have not weighed less than 227 lbs in the past 15 years. Not for lack of trying. I have spent thousands of dollars in my quest for a healthy and fit body. For the past three years I worked out 5 – 6 days per week. Three times at the gym for 1 1/2 hrs. and walking 45 minutes the other days. Some life events have happened recently and I have “fallen off the wagon” for a few months. Of course I have gained most of my weight back. Totally frustrating. Perhaps if obesity is promoted as an addiction and partially a mental health issue it might be more accepted by the medical community. Part of the program could focus on teaching us about self discipline and how to control our emotions. Something really has to change. I am a nurse and worked on the Inpatient Mental Health unit of a local hospital. There are plenty of programs for those members of our society who are addicted to drugs, alcohol and eating disorders like anorexia and bulimia. What about those of us who suffer in a different way? We are just considered lazy and have lack of willpower. Thanks again for what you do Dr. Sharma.

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4. Marcela Rodriguez-Flores

   Saturday, January 19, 2013

   Discrimination has to do with ignorance and fear, which of course can be present among health professionals and any one else. I don’t consider lifestyle to be a superficial thing, it is how everybody expresses themselves, so healthy or not there are some behaviors which are health related and others which are mostly motivated by emotional or personality factors and it is necessary to discriminate between the responsability that every person has to improve their own life by seeking and accepting help, and the environment or selection of prioritiess with lack of good options to sustain healthy habits. I think there has to be an agreement of work with health professionals to better understand the modifiable drivers of weight to a better management of health problems, including mental health, which many people are reluctant to treat and many health professionals ignore, in order to achieve what people counciosly choose. This is not a condition treated by operating or drugs and that I think is what it makes obesity so complex to come with recipes of management. As an MD I think that the oath of Hippocratesl includes the respect and individual management that obesity or any disease should have, I don’t know how it is no applyed to obesity all the time.

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5. Thoelen Dominique

   Sunday, January 20, 2013

   Maybe the reason of non-medicalisation is the perception of obesity being a question of “free choice” like smoking behaviour, using drugs, (recreative) sporting, drinking alcohol, … As a health professional using the 2nd A of obesity management illustrates the complexity of the problem. Looking just to the weight or the BMI, ignoring the underlying drivers and barriers to this physical result, simplifies the problem and his management at first sight and leads to frustrations in a longer timeperiod. It’s simply saying to our patient to lose weight so blood pression, hyperglycaemie … will become better …Only, after this advice, nothing will change.

   On the other hand, simply “medicalisation” obesity can also simplify the problem and may suggest the solution to this problem is only medical, waiting for the just farmacon to be found or the succes of surgery to be widespread.

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6. Jan Beck

   Sunday, January 20, 2013

   Of course Obesity is a medical problem! How else does the body get off track and gain so much weight. When we talk about problems with self discipline, we’re really saying “my body is filled with cravings, so much that I cannot resist”. What causes these craving, why do they persist even after a full meal? These are the questions with which we need to be concerned. In our culture, we believe “behavior drives biology”, but actually, its the opposite, “the biology of obesity, drives our behavior”. Ask any type 2 diabetic. How do you feel when your insulin levels are under control, how much energy do you have? Then conversely, how much energy do you have when your levels are up? Ask anyone who’s lost weight on a low carb diet? How did you feel before, when sugar and carbohydrates dominated your life? How do you feel now, since weight has been lost and sugar and carbs play a minimum role in your lifestyle? So, is obesity a medical problem? I think the answers will be clear

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7. DebraSY

   Sunday, January 20, 2013

   I just ache reading Linda’s response. A nurse who maintained an exercise routine of 45 to 90 minutes per day, 5-6 days per week for three years. And she somehow believes she has a problem with self-discipline? She takes a break and, naturally, regains. Well, naturally trim people get to take vacations from exercise all the time. They rarely go three years without some kind of break. They grouse about how they’ll feel it the next day, and they do have some short-term muscle pain consequences, but they don’t gain 30 lbs (because they never lost the weight to begin with) and some time off can be rejuvenating. Time off, however, is just not an option for someone trying to maintain a weight loss. That’s one of the injustices of weight-loss maintenance.

   Linda, don’t be so hard on yourself. Your “self discipline” was likely hijacked by your hormones which in a weight-reduced body are different from someone who is at their highest established weight. Run a search on this blog for “Rudy Leibel.” Dr. S has a great summary of his work revealing Leptin’s contribution to the problem. In addition leptin being suppressed and affecting insulin and satiety, Ghrelin is cronically elevated in weight-reduced people (Google “Cummings Ghrehlin” for an interesting study on that, or search my blog). You probably don’t need to be taught anything about self discipline. And nearly everyone can benefit from learning how to manage our emotions better, regardless of our weight, but it’s actually a separate issue.

   What needs to happen is that programs need to tell the truth about weight-loss maintenance, so people don’t enter into weight loss thinking that loss is the hard part, followed by some less challenging zippy dippy lifestyle.

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