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Arguments Against Obesity As A Disease #9: Its Just A Risk Factor
Next, in my miniseries on arguments I commonly hear against the notion of calling obesity a disease, is that it is “just a risk factor” for other diseases. This may be true, if you just (wrongly) considered elevated BMI as your definition of obesity, because no doubt, people with higher BMI levels carry a higher risk for obesity related complications including type 2 diabetes, sleep apnea, fatty liver disease, hypertension – just to name a few. (Note that increased risk is not the same as actually having the condition!). However, when you use the actual WHO definition of obesity, namely, “accumulation of excess or abnormal fat that impairs health”, obesity is no longer just a risk factor – it is now (by definition) impairing your health, which makes it far more than just a risk factor. So while someone with a BMI of 35 may be at risk of developing obesity (not the same as having it), when their excess fat actually starts impairing their health, it de facto becomes a disease in its own right. Even then, one might argue that obesity itself is not the disease, rather the complications of obesity are the real disease. This notion is both right and wrong. There are many conditions that are both diseases in their own right as well as risk factors for other diseases or complications. Take type 2 diabetes for instance – it is both a disease in itself but also a risk factor for coronary heart disease or end-stage kidney disease. Take hypertension – a disease in its own right but also a risk factor for strokes and heart attacks. Take gastro-oesophageal reflux disease, which is also a risk factor for Barrett’s disease and oesophageal cancer. Take fatty liver disease, which is also a risk factor for cirrhosis. Gall bladder stones, which is also a risk factor for pancreatitis. Multiple sclerosis, which is also a risk factor for neurogenic bladder and pyelonephritis. The list goes on and on. So just because obesity is also a risk factor for a wide range of other medical problems, it does not make obesity any less of a disease in its own right. When excess or abnormal body fat affects health – it’s a disease. When it doesn’t, it’s at best a risk factor. That, is perhaps a subtle but important distinction. @DrSharma Toronto, ON
Arguments Against Obesity As A Disease #8: Promotes Helplessness And Hopelessness
Continuing in my miniseries on arguments I hear against calling obesity a disease, I now discuss the objection, that doing so promotes a sense of helplessness or even hopelessness in people who carry extra weight. First of all, as noted previously, carrying extra weight is NOT the definition of obesity. For someone to have obesity they need to be carrying weight that is actually due to excess or abnormal fat tissue AND there has to be some negative impact of that fat tissue on their health – otherwise they do not have obesity!. That said, I am not sure how calling obesity on changes anything in terms of helplessness or hopelessness. Yes, the effective options to better manage obesity are limited and most people will likely struggle simply not to gain even more weight – but that fact doesn’t change whether you call obesity a disease or not. Indeed, there are many diseases for which we lack effective treatments (e.g. Alzheimer’s disease, multiple sclerosis), this does not make any of them any less of a disease. As for hopelessness, just because you are diagnosed with a chronic disease doesn’t mean everything is hopeless. In fact, there are many people living with chronic diseases that are controlled and well managed (e.g. diabetes, hypertension, sleep apnea), who do just fine (with treatment) and go on to live long and productive lives. Obviously, we need better treatments for obesity but even without those, people living with obesity can change the course of their disease by identifying and addressing the root causes of their weight gain (e.g. depression, PTSD, emotional eating, etc.) and adopting behaviours, which even if not resulting in any noticeable weight loss, can markedly improve their health and well-being. Again, whether you call obesity a disease or not is completely irrelevant to whether or not you feel helpless or hopeless – the management approach would be the same, except that hopefully it will shift attention to a chronic disease strategy that requires long-term sustainable management rather than an acute intervention that is unsustainable. If we are serious about providing patients with help and hope, let us get serious about finding and providing better treatments for this disease. @DrSharma Toronto. ON
Arguments Against Obesity As A Disease #7: Medicalizes A Behaviour
Continuing in my miniseries on objections I have heard against calling obesity a disease, I now address the argument that, doing so “medicalizes a behaviour”. This argument is of course based on the underlying assumption that the root cause of obesity is a behaviour. This is perhaps true at the most superficial level of understanding of obesity – yes, there are behaviours that can promote weight gain like eating too much, sedentariness and working shifts. Note however, that nowhere in the WHO definition of obesity as a “disease that results from excess or abnormal body fat that impairs health”, is there any mention of behaviour whatsoever. This is because for many people, the relationship between behaviour and weight gain is not at all as straightforward as many think. Take for example physical activity – although over 95% of Canadians do not meet even the minimum criteria for daily physical activity (a behaviour), only 20% of Canadians have obesity (using the BMI 30 cutoff for the sake of argument). So if behaviour (not moving enough) is touted as one of the root causes of obesity, why does not 95% of the population have obesity? The simple answer is that for any given level of physical activity (or rather lack of it), some people gain weight while others don’t. Similarly, if you believe that eating a lot of junk food (a behaviour) is the root cause of obesity, you will have to explain why not everyone who eats a lot of junk food has obesity and why a lot of people have obesity despite never touching the stuff. No matter what behaviour you pick, it will never explain all (or even most) of obesity and there will always be plenty of people with those exact same behaviours, who manage to maintain a “normal” weight with no additional effort. As I have previously outlined in blog posts and articles. “behaviours” leading to obesity, if anything, are no more than a symptom of underlying root causes of energy imbalance that can be related to a wide range of psychological, social and/or biological factors, with the precise cause varying widely from one person to the next. Thus, equating “behaviour” with “obesity” only happens in the minds of people who fail to see obesity for what it actually is – a complex heterogenous often multifactorial disease characterized by excess or abnormal fat tissue that impairs health. Thus, all that declaring… Read More »
Arguments Against Obesity As A Disease #6: Stigmatizes People Living With Obesity
Continuing in my miniseries on arguments I often hear against calling obesity a disease, I will now deal with the issue of stigma and discrimination, namely that declaring obesity a disease stigmatizes people who may be healthy. I have already dealt with the issue of not using the terms “obesity” to describe people of size, who are perfectly healthy. Thus, using the actual WHO definition of obesity (the accumulation of excess or abnormal body fat that impairs health), this term should not used to describe people who do not experience health problems from their body fat. That said, how exactly does obesity stigmatize people who actually have obesity (using the above definition and not simply BMI)? No doubt, obesity is a highly stigmatised condition, but so are numerous other diseases including depression, addictions, HIV/AIDS and many others. While much has been achieved in destigmatizing these conditions, obesity still lags far behind. This problem cannot be addressed by refusing to call obesity a disease – it can only be addressed by getting people (including friends and family) to understand the complex and multi-factorial nature of this disorder and the rather limited treatment options that we currently have available for people living with this disease. It is not calling obesity a disease that promotes weight bias and stigma, rather, it is the fairy tale of “choice” and the overly simplistic “eat-less move-more” propaganda that stigmatises people living with excess weight by promoting discriminatory stereotypes and the notion that they are simply not smart or motivated enough to change their slovenly ways. In contrast, acknowledging that obesity is a disease with a complex psychosociobiology, if anything, can actually help move us towards destigmatising obesity in the same way that depression has been destigmatised by reframing the issue as a matter of “chemicals in the brain” (which incidentally would also apply to most of obesity). Thus, not only should calling obesity a disease help reduce stigma but also hopefully go a long way in reducing wight-based discrimination in everything from access to care to disability legislation. @DrSharma New Orleans, LA
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 »
