Kipper, what I was trying to argue is the idea that everyone who's obese suffers from a disease. As previously stated, VulgarDisplay didn't suffer from alcoholism just because he drank 20 beers per day. Whereas someone else who drinks 20 beers (or much less) per day can suffer from alcoholism. The evidence that he wasn't suffering from alcoholism was that he just up and decided to quit one day.
Let's apply that to obesity. You have Jim Bob who lives a sedentary lifestyle and eats 6,000 calories per day. He's obese according to his BMI. He knows he needs to change and has tried several fad diets, exercising, etc. but none of it has put him into a healthy weight category. He must be suffering from obesity disease.
Then, you have Joe Schmoe who lives a sedentary lifestyle and eats 7,000 calories per day. He's morbidly obese according to his BMI. One day he decides he's had enough and starts to exercise for 2 hours per week and eat 3,000 calories. He drops down to a healthy weight. Obviously since he can up and decide to quit, he doesn't suffer from obesity disease.
That's what I'm arguing. You can look at Jim Bob and Joe Schmoe, and they are both obese; however, if you can't tell whether someone's an alcoholic by how many drinks they have, then I think that you can't tell if someone suffers from obesity disease by how fat they are.
I told you, the NUMBERS drive the diagnosis of obesity, NOT the propensity or ability for anybody to lose the weight. If you fall within those diagnostic criteria, you have the condition. You aren't "borderline," or "sort of obese." What you are looking at is the MOTIVATIONAL capability for someone to exact change, which has nothing to do with their weight status or diagnosis of obesity - it is a psychological sign of their readiness to change. Now you can certainly disagree with the diagnostic criteria for obesity and say that medical professionals should assess someone's readiness to change in addition, but the current criteria is weight status, and that means the definition of obesity is someone who falls above a certain cut off point. Period, end of story.
But, how do we distinguish between that, and is it important that we do? I'm asking this honestly in an attempt to try to learn more about this. If we can't make a blanket statement that everyone who drinks 20 beers or more per day is an alcoholic, then I don't think we can make a blanket statement that everyone who's obese according to BMI suffers from a disease.
As far as I am aware the alcohol dependency rests on socio-psychological diagnoses (according to DSM-IV) and not quantity. FOR THE DIAGNOSIS, it is reallly irrelevant how much they drink. From a different perspective, how much is certainly important (if you were, for example, a dietitian or an internist). You cannot apply the same standard to obesity t hat you do to alcoholism because they are two separate conditions (although there is possibly some overlap) requiring two completely different interventions. Weight status is important because epidemiologically, above certain points, the risk for developing chronic disease due to obesity increases drastically. Someone's willingness to change doesn't cut their risk for cardiovascular disease, diabetes, or cancer. Keep in mind that the diagnosis is made in context of tevery person: a BMI of 30+ is not an automatic obesity diagnosis. Someone who is VERY lean and has a BMI of 30+ (highly, highly, highly unlikely) may not fall into the category, for example, if they are an athlete. But in the majority of cases (99.99%) you are going to be dealing with people who are clearly too heavy.
As SC already said, someone can be overweight and exercise and not have the severe health problems of someone who's overweight and sedentary. However, we could look at both of those individuals and say, "You must be suffering from obesity disease. The only way to solve this is to send you off to fat camp for the summer. Oh, you can't afford fat camp? I guess there's no hope for you, because you can't fight this disease without proper treatment
".
Correction: it is better to be "fit and fat" than "fat and sedentary," but "fit and fat" does not beat "fit and lean." Epidemiologically your disease risk is still higher compared to those with lower weight status and the same fitness. The evidence for this is fairly strong. I am not quite sure where you get your rationale for that quote from, but the "cure" for obesity is not fat camp, nor is the diagnosis indicative of "no hope." It does, however, mean that some sort of intervention (a lifestyle change) is indicated. This is obesity we're talking about, not stage 4 metastatic cancer.
The problem I see with this is that it (a) labels those who re healthy but overweight as having a problem, (b) tells those without a disease that they can't fight their obesity without proper treatment, and (c) places the emphasis on the government or medical professionals to solve the problem, thus removing the hard-work component from those who truly are suffering from the disease.
As I have mentioned, those with higher weight status but are fit still have elevated disease risk. Being active DOES NOT cancel out the risk for chronic disease posed by high body fat percentage, particularly abdominal fat.
I have no idea where you get this idea that a disease diagnosis automatically makes people helpless and frankly, I find it confusing. If I have undiagnosed cancer and all of the sudden receive a diagnosis, does this diagnosis make me automatically helpless? If anything, it may empower me because the diagnosis gives me access to treatments which can correct the disorder. Without the diagnosis, I a.) have no idea that I have cancer, and b.) can't access treatment.
All the diagnosis does is say: this is the problem, here is a solution. If you somehow feel that makes people helpless, I don't quite have any idea what to tell you. Lifestyle modification is generally the treatment for obesity, but it would be independent of the diagnosis. The diagnosis of obesity doesn't change anything materially about the treatment, or a person's ability to address it besides make services available to them that they might not otherwise be able to access.
I'm sure many of you will disagree with me, but that's how I see this. I don't know the right way to treat this, but I do know that even if it is a disease, it's still going to take a lot of hard work for people to change from being obese to healthy and fit, and I just feel like labeling it as a disease places the work component on somebody else rather than on themselves.
And it's not like alcohol or smoking in that they can just avoid the catalysts to their addictions (not that it's that simple, just saying that they absolutely can't avoid food). Unless someone puts a padlock on the fridge and regulates what goes in and out, it's going to take probably a lot more hard work and willpower than fighting other diseases, which are largely treated by doctor's rather than by constant 24/7 effort from the patients. Unless we can label it as a disease and show people that it takes both treatments and a helluva lot of hard work, then I think the disease label is counterproductive.
I don't think ANY healthcare professional who works with obese populations (myself included) would say that losing weight and then keeping it off is "easy." I have no idea where you got this idea that disease labels somehow make people helpless -perhaps because in your mindyou think that lumping it in with other diseases makes people think that external forces are going to take care of the problem for them? I don't see exactly where you get this idea from. It's patently obvious that nobody is going to lose the weight for Mr. X BUT Mr. X. But that's the case for any condition. "Noncompliance," as it is termed in the healthcare field, is where patients don't follow recommendations. Healthcare professionals can only do as much as they can do - each individual has to do the rest of the leg work, whether that means taking medications properly or showing up to appointments; it doesn't matter what condition you have, unless you are unable to care for yourself. Obesity may be different in that it requires a lot more work, all around.
I totally realize that it does nothing to point the finger at the obese and say, "It's all your fault, fatty! Put down the donut, get off your ass, and do something about it!" But I think it also does nothing to say, "You're obese because you have a disease. It's not your fault. It's not any different than having cancer." The last statement might work if there's some sort of education and motivation for doing a whole lot of hard work on their own, but simply labeling as a disease and marketing it as such has the potential for making people even less motivated to do anything about it. "Hey, Fred. I just saw on TV that I'm obese because I have a disease. Isn't that great!? All this time I was blaming myself for eating bon-bons and watching 15 hours of TV per day, and I now I know that it's the fault of a disease and not the fault of my own. I can finally rest easy tonight...with my CPAP machine, of course."
And this is where you are completely mistaken. A disease diagnosis does not take anybody "off the hook." It doesn't alleviate the condition in any way, or it take it off of their hands. That is absurd. Each of my patients has to live with the day to day effects of their condition. It does, however, acknowledge that a person suffers from a certain pathologic state and provide solutions. But it's entirely up to the individual to adopt t hose solutions and move forward. That said, obesity is fiendishly more difficult than, say, controlling a condition solved by taking apill because it has far many more inputs and as you've mentioned, is not simply a matter of "not drinking alcohol" or "not smoking." Education has a small component but it's really a matter of finding ways to motivate people enough so they can change; I see precious few cases of people actually not knowing what they are doing wrong.
And motivating people enough so they stay on the wagon, as any mental health professional will tell you, is 99% of the battle. It's not easy, by any means. And culturally castigating obese people for their weight only makes my job a hundred times harder because I have to overcome the powerful social messages AND whatever personal issues stand in the way of peoples' success.
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