Thursday, June 20, 2013

"Oh no! I caught obesity" Should obesity be labeled a disease?

This post is most likely going to open the proverbial can of worms and cause an onslaught of angry emails to flood my inbox, but I am going to post it anyway because I am that type of guy. This post is not intended to convince you whether obesity is a disease or not because I myself am not sure. The intention of this post is to get you think, look at both sides and not to sway you either way except to better health and understanding. 

Yesterday, the American Medical Association (AMA) officially recognized obesity as a disease ( By labeling obesity in such a way, the AMA recognizes that obesity deserves "medical attention and insurance coverage as do other diseases." Considering, that almost 2/3 of American children are obese and that if the obesity rate continues to rise just under half of America will be obese by 2030, obesity is obviously a big, fat problem. However, is it really a disease?

This is a very sensitive and touchy subject among Americans and especially for me. I come from this subject not as someone who is obese but from the opposite end of the eating disorder spectrum. The American Psychological Association recognizes anorexia as diagnosable disease, and as a result patients of eating disorders can usually file claims for psychological help, nutrition counseling, and in patient care through their insurance companies (unfortunately this is rare, and insurance companies will find any excuse to drop coverage and deny coverage for those who have been diagnosed, leaving the patient with huge bills for inpatient treatments which can sometimes cost upwards of $1000 a day...but thats another subject for another day and another post). HOWEVER, most of the time with diseases like anorexia and even alcoholism, insurance companies are not paying for the treatment of the disease itself rather they are paying for the ancillary diseases that arrise from such disease such as cirrhosis of the liver and depression. Currently obesity is being treated in the same way. We are not treating obesity (if anything we are encouraging but once again another post), we are treating the resulting problems like diabetes, gout, heart issues, low testosterone etc. Defining obesity as a disease, though, increases coverage of disease itself making "treatments" like plastic surgery, gastric bypass surgery, and weight loss pills open for insurance coverage.

My first reaction is this is ridiculous. Why should I have to shoulder the cost of people being fat? Why should I be paying for someone else's surgery to make them be thin again? They ate their way to where they are and therefore they have to deal with consequences. Plenty of people have lost weight successfully on their own without me having to pay for them to help them do it. However, before I get all verklempt lets take a deep breath and look at the pros and cons of labeling obesity a disease:

Pro disease:

  • If we look in the dictionary, Merriam-Webster disease is defines disease as:

"a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms" 
"A particular quality, habit, or disposition regarded as adversely affecting a person or group of people. 
Does Obesity impair normal functioning? Yes. Does it have signs and symptoms? Yes. Does it adversely affect a person or group? Yes. So obesity passes the dictionary test.

  • Obesity apparently also has other similarities to diseases: its contagious(, it can lead to other health problems, and it can kill you. Ostensibly it seems that obesity is a disease.

  • Then there is the moral side of it being that these people need help and therefore as my neighbor I would like to help them. 

  • Saying obesity is a disease also increase awareness and sends the message that being obese is a problem that needs to be treated. 

Now lets look at the cons of labeling it as a disease:

  • By labeling it a disease we are taking the blame from them; we are telling them that its not their fault that they are sick. The same thing happened with alcoholism in the 1950s and 1960s and anorexia in the 1990s and early 2000s. As a recovering anorexic I recognize that my anorexia was my fault. I decided to lose the weight in the very beginning; I decided to keep on losing weight even though it was bad for me; I decided to fight my doctors tooth and nail; but I also decided to get better and to stay better, a decision that I make daily if not hourly. At the deepest darkest part of my disease, I was powerless over it; it controlled me and my actions. Yes, I would call it a disease but a non traditional one and more of a mental issue and problem that I needed help to deal with. 

My conversations with recovering alcoholics show that many in the program think along the same lines. They recognize it as a disease that they are powerless over but that they have to take the necessary steps (showing up to meetings, not putting themselves into situations where they may relapse, etc) to get better. Its not like they can pop a pill and continue on with their normal lives.

  • If we label it as a disease chances are we are going to treat it like other disease through medications and quick fixes like surgery. These do not work! They may temporarily solve the problem or treat the conditions but they do not deal with the underlying issues. 

  • Chances are that insurance premiums will rise especially since its such a wide spread issue. 

  • Labeling it as a disease also adds to the growing number of diseases out there. It seems that everything is a disease now. 

So I am still on the fence here about the whole label. Here is what I do know though:

  • Obesity is a problem
  • I would love to help in any way I can to help them get better. 
  • Everyone has a personal obligation her and himself to respect their bodies
  • Those who are obese have my compassion. I can understand the problem and relate in some way
  • It needs to dealt with through multiple interventions
  • It can and should be treated though other means than medication and surgery except for EXTREME conditions
....but thats just my two watts

I would love to hear your thoughts on this issue so leave them bellow

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