Arguments For Calling Obesity A Disease #3: Once Established It Becomes A Lifelong Problem
Continuing in my miniseries on arguments that support calling obesity a disease, is the simple fact that, once established, it behaves like a chronic disease. Thus, once people have accumulated excess or abnormal adipose tissue that affects their health, there is no known way of reversing the process to the point that this condition would be considered “cured”. By “cured”, I mean that there is a treatment for obesity, which can be stopped without the problem reappearing. For e.g. we can cure an ear infection – a short course of antibiotics and the infection will resolve to perhaps never reappear. We can also cure many forms of cancer, where surgery or a bout of chemotherapy removes the tumour forever. Those conditions we can “cure” – obesity we cannot! For all practical purposes, obesity behaves exactly like every other chronic disease – yes, we can modify the course or even ameliorate the condition with the help of behavioural, medical or surgical treatments to the point that it may no longer pose a health threat, but it is at best in “remission” – when the treatment stops, the weight comes back – sometimes with a vengeance. And yes, behavioural treatments are treatments, because the behaviours we are talking about that lead to ‘remission’ are far more intense than the behaviours that non-obese people have to adopt to not gain weight in the first place. This is how I explained this to someone, who recently told me that about five years ago he had lost a substantial amount of weight (over 50 pounds) simply by watching what he eats and maintaining a regular exercise program. He argued that he had “conquered” his obesity and would now consider himself “cured”. I explained to him, that I would at best consider him in “remission”, because his biology is still that of someone living with obesity. And this is how I would prove my point. Imagine he and I tried to put on 50 pounds in the next 6 weeks – I would face a real upward battle and may not be able to put on that weight at all – he, in contrast, would have absolutely no problem putting the weight back on. In fact, if he were to simply live the way I do, eating the amount of food I do, those 50 lbs would be back before he knows it. His body is just waiting to… Read More »
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
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