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 #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 #2: Inconsistent Relationship Between Body Fat And Health
Yesterday, in my brief series on the pros and cons of calling obesity a chronic disease, I addressed the issue of BMI as a poor definition of obesity (understood here as “abnormal or excess body fat that affects health”). Another common argument I hear from those who do not support the notion of obesity as a chronic disease, is that there is an inconsistent relationship between body fat and health. This is no doubt the case. Indeed, whether or not your body fat affects your health depends on a range of factors – from your genetic predisposition to certain “complications” to the “nature” of your body fat, factors that cannot be captured or assessed by simply stepping on a scale. Often, this variability in the relationship between excess body fat and its impact on health, is used to argue against a “causal relationship” between the two. This argument is often presented along the lines of, “If obesity is a disease, how come I don’t have diabetes?”. Where the direct impact of excess body fat on health should be evident, is when the amount of excess fat poses a direct “mechanical” problem that impedes physical functioning. This impact, however, is likely to vary from one person to the next. A good example of this, is obstructive sleep apnea, where an increase in pharyngeal fat deposition is directly and causally related to the airway obstruction. The causal relationship of pharyngeal fat and the symptoms is directly evident by improvement in symptoms following surgical removal of the excess fat (an operation that is seldom undertaken due to possible complications and redeposition of fat). There is also substantial evidence that significant weight loss (such as induced by bariatric surgery) results in a dramatic improvement in apnea/hypopnea index and sometimes even in complete resolution of the problem. Yet, not everyone with excess weight develops obstructive sleep apnea. One of the factors that explains this variation, is the anatomical dimension of the pharyngeal space, which varies significantly from one person to the next. So, just how much excess fat in the neck region results in symptoms (if any) will necessarily be highly variable. This is not an argument against the relationship between excess body fat and obstructive sleep apnea, it is just the expected variation between individuals that is evident in many diseases. Likewise, when the amount of excess fat impairs the body’s capacity to perform essential functions (from mobility… Read More »
Arguments Against Obesity As A Disease #1: BMI Is Not A Good Measure Of Health
Over the past months, I have been involved in countless discussions and debates about whether or not obesity should be considered a chronic disease (as it has by the American and Canadian Medical Associations and a number of other organisations). I therefore thought it perhaps helpful if I discussed each of the common pros and cons on this issue in a series of blog posts. To begin this short series, I’d like to discuss perhaps the most common argument against calling obesity a disease, namely, the well-known shortcomings of BMI. As regular readers will know, I have long railed against the use of BMI as a clinical definition of obesity as it is neither a direct measure of body fatness nor does it directly measure health. In fact, its specificity and sensitivity to pick up health problems commonly associated with obesity (such as type 2 diabetes or hypertension) is so limited, that it would not even remotely meet the criteria commonly applied to other diseases for diagnostic testing. Thus, especially around the BMI cut off of 30 (widely used to “define” obesity in Caucasians), anywhere from 5-25% of individuals would be considered pretty healthy by almost any clinical measure. Even at higher BMI cut offs, it is not all that difficult to find individuals with very mild to non-existent health problems related to their size (as in EOSS 0-1). While some of these individuals may well go on to develop health problems over time, “risk for” a disease is generally not considered a “diagnosis” of that disease. Thus, even if an elevated BMI may indicate increased risk of obesity, it cannot be used to “define” an individual as having the “disease of obesity”. This shortcoming of BMI has been widely (albeit perhaps not widely enough) recognised, which is exactly why, for e.g. the Canadian Medical Association, in their declaration of obesity specifically states that, “BMI is a useful operational definition for obesity but should not be used as the defining characteristic of the disease….in the case of individuals who are very obese, issues of definition and measurement are not relevant.” (emphasis mine) Similarly the WHO in its definition of obesity states that, “BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness… Read More »
European Obesity Summit 2016
This week I am attending the European Obesity Summit 2016 (EOS 2016) , in Gothenburg Sweden. The Summit, which brings together obesity researchers, clinicians and decision makers from across Europe (and beyond) is co-hosted by the European Association for the Study of Obesity (EASO) and the European Chapter of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). The 4 day program not only presents the latest in obesity research but also presents a number of workshops and symposia dealing with a wide range of topics related to obesity prevention and management. A key feature of the program are the awards and distinctions that are bestowed upon older and newer investigators for their contributions to the advancement of obesity science. Obviously, EOS 2016 also provides ample opportunity for networking and renewing the ties to my European friends and colleagues, many of whom I have known for many years. I look forward to an exciting and stimulating conference. @DrSharma Gothenburg, Sweden
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