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Prevention Vs Treatment Is Not An “Either-Or” Question



sharma-obesity-rod-of-aesclepiosYesterday, at Obesity Week, I attended a debate on whether or not obesity is a disease (really, is anyone still debating this?).

While both sides made the usual arguments and both debaters (one perhaps more so than the other) landed heavily in favour of calling obesity a disease, the audience comments against calling obesity a disease were what you may expect.

While I get the caution against possible stigmatization and the issue that not all people living with obesity are necessarily “diseased” (we desperately need a non-weight based definition of obesity), the counterargument that to me is most irritating and holds the least merit, is the notion that calling obesity a “disease” will somehow distract from or even hinder the efforts at prevention.

This is something I simply do not get.

Indeed, I am not aware of any preventable condition (CVD, Cancer, Diabetes just to name a few) where efforts at prevention are abandoned, diminished or hindered by calling the condition a “disease”.

If anything, you would think that ‘legitimizing” a condition by calling it a (serious) disease, would lead to even more efforts at prevention – especially when we have such poor treatments.

In fact I simply do not get why one would even discuss which is more important: prevention or treatment – both are!

No amount of prevention will treat the people who already have the condition and treatments should never replace prevention.

Funnily enough, I do not believe that I have ever heard anyone who calls for better treatments (of any disease) pooh-pooh the need for prevention – at least not for conditions where prevention actually works.

The opposite, sadly, is not true.

@DrSharma
Boston, MA

 

2 Comments

  1. It is the bias against considering treatment of obesity over prevention that is personally discouraging to me. I often get the feeling that society feels it is too late for me as a person who suffers with obesity and the efforts must be made to keep others from this fate. I am left feeling discouraged about my chances of getting to a healthier weight and shamed by the overwhelmingly loud voice that talks about prevention imply that it is all about a eat less, move more approach and my inability to do this is a lack of willpower (character).

    It honestly feels more complicated to me, and I am not trying to make excuses for myself. I have not fought harder for anything in all of my life and it is hard not to then feel a societies disapproval and disgust for me and others suffering with the same disease.

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  2. I actually disagree that “no amount of prevention will treat the people who already have the condition.” In the case of obesity, prevention efforts are necessary and perhaps even sufficient to treat some cases of obesity. Maybe not all people with obesity need behavioral counseling, medication, or surgery. Perhaps population-based efforts that we frame as prevention such as workplace and school policies, increasing healthful food access in communities, menu labeling, taxing soda, etc. are enough to help some people decrease a few BMI units such that they’re not obese anymore. If that’s too much of a stretch though, perhaps the existence of these efforts, in combination with targeted treatment, help individuals sustain weight loss. I personally think prevention vs treatment is a line in the sand and community-based vs clinical might better distinguish the types of work we do. For example, school-based interventions are framed as prevention but a substantial proportion of students are already obese in many of these studies. Are the studies then not prevention because of their sample?

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