Obesity is not a choiceWednesday, March 25, 2009
My take published in the Globe & Mail on why obesity is not a choice and why people with obesity need better access to care and support:
In over 20 years of medical practice, I have yet to meet a patient who chose to be fat. I have also yet to meet a patient, who chose to have diabetes, wished for a heart attack, or longed for cancer. But while we often look at diabetes, heart disease, or cancer as largely the result of bad genes, bad luck, or both, most people happily attribute obesity to people simply making poor choices. Why can’t people with excess weight just push away the food and get off their butts? Why should the community pick up the tab for obese people’s health problems resulting from gluttony and sloth?
Space does not permit me to present all of the hard and fascinating science that supports the notion that obesity is a disease, which like diabetes, heart disease or cancer has a complex causation (i.e., genetic, physiological, lifestyle, environmental, etc.).
The underlying causes and paths to obesity are manifold – no one is immune. A change in economic status or activity level (due to aging, injury or illness), an introduction of a weight-promoting drug for an illness, becoming pregnant, or moving to a new less-walkable community can result in obesity. Few recognize or acknowledge the close relationship between mental health and eating behaviour – whether causal as in the form of depression or addictions or as a major barrier to treatment as in attention deficit disorder or chronic pain. For many eating is the easiest and most affordable means of coping with stress, anxiety, boredom, loneliness, isolation, abuse, despair, and frustration. Fast food is not the cause of obesity – it is merely a “symptom” of a society that does not take time to eat.
Whatever the cause, once established, obesity becomes a chronic condition for which we have no cure – only treatments. Whether the treatment consists of behavioural interventions such as dieting or exercise, prescription anti-obesity drugs, or even surgery – when the “treatment” stops, the weight comes back. Thus, the dieter has to keep dieting, the runner has to keep running, the bypassed stomach has to stay bypassed – for life! The folks who believe that the solution to obesity is as easy as simply “eating less and moving more” are probably busy counting the fortune they made on the stock market by simply “buying low and selling high”.
Thus far, no society has found a way to stop or reverse the obesity epidemic – it appears fundamentally tied to our Westernized lifestyles – high stress levels, no time for families to sit down to meals, abundant supplies of cheap highly palatable energy-dense foods, automation and elimination of physical activity from our homes and workplaces, dependence on powered transportation rather than on our feet. Are any of these conditions likely to be reversed in the foreseeable future? Probably not.
So where do people, trying to control their weight, go for help? The commercial weight-loss industry, while often promising weight-loss solutions that sometimes defy scientific rationale, does little to help. This is because the only weight loss that matters is the weight you keep off – too little (if any) with most products and programs. Unfortunately, too many health professionals also do not understand obesity – offering advise that is useless, expecting the impossible from their patients, failing to acknowledge the root causes of the problem, or ignoring the barriers to treatment.
It is becoming increasingly evident that addressing obesity requires the same resources and paradigms as treating other chronic diseases such as diabetes, asthma or heart failure. The same principles apply – education, lifestyle change, self-monitoring, and in severe cases, prescription medications or even surgery. As with all chronic conditions, treatments have to be continued for life – patients need regular check-ups, encouragement and guidance to avoid recidivism or progression of the underlying condition.
All of this will require money – money that the healthcare system cannot afford not to spend. Not addressing obesity today means addressing the complications of obesity tomorrow. If we do not prevent, control and treat obesity today, we will never have enough diabetes centres, heart hospitals, cancer wards, or orthopedic clinics to deal with the multitudes of patients disabled and defeated by obesity. The epidemic of obesity is rampant amongst children, the young and the middle aged – an economic disaster in terms of lost productivity, especially in the face of retiring baby-boomers.
Many organizations such as the federally-funded Canadian Obesity Network are working towards finding solutions to prevent obesity and improve care of people suffering the consequences of excess weight. But solutions to obesity will require the same public support, political decisions and healthcare resources as targeted at other conditions such as diabetes, cardiovascular disease or mental health.
We have a lot to lose – but, fortunately, far more to gain!