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SPORTS MEDICINE :
MEDICAL: CONDITIONS:
OBESITY:
An Obesity Manifesto: Debunking the Myths
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An Obesity Manifesto: Debunking the Myths
Medscape Diabetes and Endocrinology
Arya M Sharma, MD, PhD
Disclosures
February 23, 2017
Medscape
http://www.medscape.com/viewarticle/875964
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Over the past year, I have been involved in countless discussions and
debates about whether obesity should be declared a chronic disease (as it
has been by numerous medical organizations). Therefore, I thought it might
be helpful to review the common arguments made by those on either side of
the debate.
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Arguments Against Labeling Obesity a Disease
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1. BMI is not a good measure of health.
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This is perhaps the most common argument made against calling obesity a
disease, and I have long railed against the use of BMI (body mass index)
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 associated with obesity (such
as type 2 diabetes or hypertension) are so limited, it would not meet the
criteria commonly applied to most other diagnostic tests.
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So, if not BMI, what should be used as the defining characteristic of
obesity?
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The World Health Organization (WHO) defines obesity as "...abnormal or
excessive fat accumulation that may impair health."
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snip
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2. The relationship between body fat and health is inconsistent.
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It is true that the impact of body fat on a person's health depends on a
range of factors, from a genetic predisposition to the type of body fat.
Some would argue that such variability refutes a causal relationship
between fat and health.
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The direct impact of excess body fat is most evident when the amount of
fat directly impedes physical functioning. It may be harder to understand
the relationship between excess or abnormal body fat and metabolic
problems.
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snip
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3. Obesity is modifiable and preventable.
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This argument is true for many other conditions that are accepted as
diseases, including stroke and heart disease. Most strokes and the vast
majority of heart attacks are both preventable and modifiable (once they
occur), as are diabetes, osteoarthritis, obstructive lung disease, and
many forms of cancer.
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4. Labeling it a disease will detract from obesity prevention.
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In no other instance has calling something a "disease" stopped us from
doing the utmost to prevent it. Consider efforts to prevent heart disease
(dietary recommendations, fitness, smoking cessation), cancers (physical
activity, healthy diets, smoking cessation, sunlight exposure), or
infectious diseases (vaccinations, food safety, hand washing, condom use).
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In fact, if one embraces the concept that established obesity is a
life-long problem for which we have no curethe very definition of "chronic
disease"we should be redoubling our efforts at prevention. Governments,
organizations, and individuals should be more committed to preventing a
"real" disease that has become an epidemic.
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5. The "disease" label would reduce personal responsibility.
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Let's consider type 2 diabetes, another avoidable and modifiable
condition. Calling diabetes a disease does not reduce the individual's
ability to prevent it or to change the course of the disease. And what
about heart disease or lung disease, or even cancer? We still expect
patients to help manage these diseases.
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6. The "disease" label stigmatizes people living with obesity.
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Obesity is already a highly stigmatized condition, as are other diseases
such as depression and HIV/AIDS. Refusing to call obesity a disease will
not address this problem. We must help people understand the complex and
multifactorial nature of this disorder and the rather limited treatment
options that we currently have.
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In fact, it is the fairytale of "choice" and the overly simplistic "eat
less, move more" propaganda that promote discriminatory stereotypes and
the notion that people with obesity are simply not smart or motivated
enough to change their slovenly ways.
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snip
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7. The "disease" label essentially medicalizes a behavior.
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The underlying assumption here is that the root cause of obesity is a
behavior, which may be true on the most superficial level. Yes, behaviors
such as eating too much and being too sedentary can promote weight gain.
But nowhere in the WHO definition of obesity is there any mention of
behavior.
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Many people understand that the relationship between behavior and weight
gain is not straightforward.
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snip
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8. The "disease" label promotes helplessness and hopelessness.
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There are many people living with chronic diseases (eg, diabetes,
hypertension) who are well controlled, who do just fine with treatment,
and who go on to live long and productive lives.
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We do need better treatments for obesity, but even now, people living with
obesity can change the course of their disease (often with professional
help) by identifying and addressing the root causes of their weight gain
(eg, depression, emotional eating) and by adopting behaviors which, even
if not resulting in any noticeable weight loss, can markedly improve their
health and well-being.[3]
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snip
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9. Obesity is just a risk factor for disease, not a disease itself.
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This is only true if one (wrongly) considers elevated BMI as the
definition of obesity, because no doubt, people with higher BMI levels
carry a higher risk for obesity-related complications such as type 2
diabetes, sleep apnea, fatty liver disease, and hypertension.
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However, when you use the WHO definition of obesitynamely, "accumulation
of excess or abnormal fat that impairs health"obesity is far more than
just a risk factor. Using that definition, a person with a BMI of 35 may
be at risk of developing obesity (but may not yet have it); only when
their excess fat starts impairing their health does it become a disease in
its own right.
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Even then, one might argue that obesity itself is not the disease, but
rather the complications of obesity are the real diseases.
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This notion is both right and wrong.
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snip
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10. Obesity affects too many people to be characterized as a disease.
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Some critics have warned that declaring obesity a disease would instantly
turn millions of people into "patients," overwhelming the healthcare
system. I hear from payers and policy makers that providing medical
treatments for obesity is simply not practical because of the number of
people who have it.
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That didn't stop us from calling diabetes a disease, or depression, or the
flu, all of which affect millions of people.
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In fact, even if a disease affected 100% of the population, we would not
shy away from calling it a disease.
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The complete article may be read at the URL above.
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