General chatter - Good article...I too think going down the obesity is a disease road is the wrong one




diamondgeog
07-10-2013, 10:22 AM
I saw this article today, I think it is very good and thought provoking.

http://www.huffingtonpost.com/william-anderson-ma-lmhc/ama-obesity-money_b_3512670.html

If we think of obesity as a disease it is just going to make things worse and worse. It will make some people a lot of money but it will make outcomes for people worse. I do think it is an epedemic though.

Why? It focuses on the wrong things entirely. 'Fixing things' (by enriching medical companies more) or rather trying to fix things i entirely the wrong way. We have to fix habits, advertisments, politics of food, environment, and everything else that has been done the past 50 years to make a society that does everything possible to get people fat and profit from that. Yes there is choice, but environment and politics are also very real.

Is surgery absoultely necessary for some people, yes. And I am all for them getting insurance help with that. Also as the article points out at the end I guess there can be some good in taking it even more seriously if that is even possible. But 'fixing' it with costly surgery and drugs and quick fixes and all that and not getting to the root causes and changing those is the wrong road.


kaplods
07-10-2013, 02:35 PM
If we think of obesity as a disease it is just going to make things worse and worse. It will make some people a lot of money but it will make outcomes for people worse. I do think it is an epedemic though.

Only if we choose to look at disease as something to fix with medicine and surgery.

If we chose to focus on preventing disease (whenever possible) rather than simply treating symptoms as they crop up, our nation's health and healthcare would be very different.

Insurance largely ignores most preventive care. Hubby and I are on Medicare, and it will pay for my yearly mammogram, but not a tetanus shot (it will pay for treatment if I get tetanus).

There are many diseases and disease processes that could be prevented, if we valued prevention as much as we do treatment: cancer, heart disease, stroke, obesity, diabetes, diabetic neuropathy...

As a democratic, capitalist society, we vote with our dollars and our political votes, and we need to as a people, start voting for preventative healthcare.

We've proven though, with our dollars, that as a nation we value fast food, clothing, and electronics more than preventive healthcare.

The change is possible, but we have to want and see the value in it. I'm not sure it can happen except from the bottom up.

memememe76
07-11-2013, 02:08 AM
There are very few diseases and illnesses that have no environmental cause. Lung cancer can be preventable for many, many people. Isn't it still a disease, nonetheless?

Obesity is already causing a lot of companies to make money off the misery of people. I don't think this classification will make things worse. Maybe this classification will engender better academic research and better training of future medical practitioners wrt issues of obesity.

Ultimately, I don't have a strong opinion either way. It's not like I ever based my vote on whether a politician viewed obesity as a disease or not. But I am amused by the *anger* that arises when a person doesn't blame themselves 100% for their weight. How dare big people not view themselves as totally lazy and evil and awful?


kaplods
07-11-2013, 04:48 AM
I am amused by the *anger* that arises when a person doesn't blame themselves 100% for their weight. How dare big people not view themselves as totally lazy and evil and awful?

YES! Although I don't find it all that amusing. Dark, gallows humor, maybe. Obesity is often seen as more contemptible and more blame-worthy than smoking, alcoholism, drug abuse, irresponsible sexual behavior and other lifestyle choices that cause and/or contribute to many diseases.

A diet rich in fruits and vegetables may be one of the best cancer-preventing strategies, but we don't as a culture ostracize veggie-phobes.

Even drug and alcohol abuse and sexually transmitted diseases inspires more compassion than obesity.

What I find most disgusting is the idea that classifying obesity as a disease not only absolves the individual of all responsibility, but also will somehow convince people they are helpless to change or prevent it.

I'm really tired of hearing the insane nonsensicle argument that obese people are looking for excuses and reasons to stay fat (because we all know how much fun morbid obesity is).

We assume that intelligence is somehow inversely correlated with intelligence, and that if you weigh more than 250 lbs you must have the IQ of a turnip.

Who in their right mind would argue that calling HIV a disease just gives folks an excuse to have promiscuous, unprotected sex? Or that a diagnosis of lung cancer and calling it a disease gives smokers a reason not to quit?

In my experience, most people diagnosed with an illness (even if it's a common cold), try to do something about it - but somehow obese folks are so stupid, and love being fat soooo much that they're going to do the opposite? Really?

I didn't start truly succeeding at weight loss until I did see obesity as a disease, and decided to treat it like one. Accepting much, but not all of the responsibility was also extremely helpful, especially after reading David Kessler's book, The End of Overeating, in which the author explains the addiction-like properties of many foods.

It did not inspire me to stop trying to lose weight, it only helped explain why the process was so damned difficult - a reason other than laziness or stupidity. It explained why I could and did work my way through graduate school, worked multiple jobs, and generally excelled at everything in my life except weight loss.

When I share my experience with others I often get some strange responses:

I am assumed to be a freak, apparently the only obese person with a brain. That while I had decided to fight a disease, most people are going to use it as an excuse.

Or even stranger to me, the idea that it's wrong to see obesity as a disease even if doing so helps you address the problem.

It's almost as if staying fat and blaming/hating yourself is more socially acceptable than succeeding at weight loss if you aren't willing to do so by self-loathing.

I also find no logic in saying that obesity is an epidemic but not disease, because to be an actual epidemic it has to be a disease. Habits and lifestyle choices can become widespread, but only diseases can become epidemics.

Trying to pretend that severe obesity is not a disease, isn't working. People aren't seeking help, because of the stigma of admitting they can't fix their obesity entirely on their own with a snap of their fingers; and because help is relatively expensive and hard to find (in comparison to help for substance abuse, for example).

2/3 of Americans are overweight. That's 67% of our population. Only 15 to 20% are problem drinkers, so why are AA groups and alcohol treatment programs far more numerous and easy to find than weight management programs?

Largely, because alcoholism is seen as a disease.

When alcoholism and drug addiction were seen only as contemptible and corrupt choices, people tried to hide their substance abuse. Shame prevented them from seeking help or admitting they had a problem.

Call it whatever you like, but compassionate care and support works better than condemnation and ostracism.

Substance abuse and mental illness have lost much of their stigma, and medical care and compassionate treatment has improved outcomes for people affected by these disorders/diseases.

Without a disease diagnosis (and even then, only a handful of diseases qualify), dietitian visits are almost never covered by insurance. To me, this is insane.

Medicare covers 3 hours of diet counseling per year for diabetics. If you're insulin resistant, you get one visit, one time.

Hey, it's better than nothing, but it seems crazy that private and public insurance plans will cover the removal of noncancerous moles, but won't pay for at least a few nutrition classes.

Why don't all health departments have a free or affordable weight loss class?

Treating obesity as a disease won't solve the obesity crises, but I don't see it as a bad place to start.

sacha
07-11-2013, 06:38 AM
I agree with you kaplods.

And while I find alcoholism/obesity mostly comparable, I find one huge difference.

As a recover(ed)(ing) alcoholic, I have found it much easier to not touch a drop of alcohol in 5 years now. An obese person cannot make it to the end of the day without touching their drug. How do you quit your drug when you need it to live? I have never suffered with obesity, rather a side-effect of too much food when boozing it up, so I have great sympathy for those with this challenge.

When I say, "sorry, I can't drink because of xyz" people say "wow! you are so brave and strong!!", they cancel their drink orders, they commend you. I wonder, if you say, "I beat obesity" they probably think "oh yeah you went on a diet good for you... what's your secret? You wanna share breadsticks???"

kaplods
07-11-2013, 10:02 AM
I agree with you kaplods.

And while I find alcoholism/obesity mostly comparable, I find one huge difference.

As a recover(ed)(ing) alcoholic, I have found it much easier to not touch a drop of alcohol in 5 years now. An obese person cannot make it to the end of the day without touching their drug. How do you quit your drug when you need it to live?


Actually, living without our drug is possible, when you realize that not all food is addictive. Most food addiction is carb-addiction and often very specific carbs.

Reading Kessler's book, The End of Overeating convinced me of this. The most addictive foods are high glycemic carbs that combine the flavors of salt, sugar (or starch which becomes sugar), and fat.

It's quite possible to abstain from all trigger foods, it's just not socially acceptable to do so. Low-carb and low-glycemic diets work quite well as a model of sobriety for food addiction. It's just very difficult to convince ourselves or others that it might be possible or beneficial to abstain entirely from our substance of choice (generally carbs and carb-fat combos).

Low-carb and even slow-carb diets are generally seen as being extreme and even unhealthy, but they may be key to combating food addiction.

freelancemomma
07-11-2013, 11:38 AM
Lung cancer can be preventable for many, many people.

That's different. Lung cancer is the outcome of smoking, just as heart disease or arthritis can be outcomes of obesity.

Calling obesity a disease is tantamount to calling nicotine addiction or alcoholism a disease, IMO. I'm not in favour of the designation, because it presumes a lack of agency. ("My genes made me do it.") To me, it's more honest and accurate to say that obesity has a strong genetic component, including the propensity toward hunger and overeating, but that the right behaviours can mitigate the genetic load.

F.

Missy Krissy
07-11-2013, 12:06 PM
Call it whatever you like, but compassionate care and support works better than condemnation and ostracism.




Tell it sister!

memememe76
07-11-2013, 12:13 PM
That's different. Lung cancer is the outcome of smoking, just as heart disease or arthritis can be outcomes of obesity.

Calling obesity a disease is tantamount to calling nicotine addiction or alcoholism a disease, IMO. I'm not in favour of the designation, because it presumes a lack of agency. ("My genes made me do it.") To me, it's more honest and accurate to say that obesity has a strong genetic component, including the propensity toward hunger and overeating, but that the right behaviours can mitigate the genetic load.

F.

I am not sure how that is different. Isn't obesity the outcome of eating too much? Heart disease or arthritis can be the result of certain human behaviour too.

And nicotine addiction and alcoholism are not designated as "disease"? I'm surprised by this. Why not?

freelancemomma
07-11-2013, 01:09 PM
I am not sure how that is different. Isn't obesity the outcome of eating too much?

Yes, but it's the "middleman" in the sequence between behaviour and (possible) disease.

Eating too much... obesity... disease (e.g., heart disease, arthritis).

If "eating too much" is the cause of obesity, then is "eating too much" also a disease?

In any case, I agree that nomenclature shouldn't eclipse compassionate care.

In case anyone's interested, the Council for Science and Public Health issued a 14-page document opposing the classification of obesity as a disease. http://www.ama-assn.org/assets/meeting/2013a/a13-addendum-refcomm-d.pdf#page=19


F.

kaplods
07-11-2013, 01:24 PM
That's different. Lung cancer is the outcome of smoking, just as heart disease or arthritis can be outcomes of obesity.

Calling obesity a disease is tantamount to calling nicotine addiction or alcoholism a disease, IMO. I'm not in favour of the designation, because it presumes a lack of agency. ("My genes made me do it.") To me, it's more honest and accurate to say that obesity has a strong genetic component, including the propensity toward hunger and overeating, but that the right behaviours can mitigate the genetic load.

F.

Obesity is not a behavior, it's a result of behavior. And diseases (such as lung cancer) can be the cause of many diseases, and many disease processes can cause other disease processes.

Lung cancer is the condition caused (often) by behaviors such as habitual smoking, asbestos exposure and coal mining (as well as genetic factors).

Alcoholism is the condition caused by habitual alcohol abuse (as well as genetic factors).

Obesity is the condition caused by overeating (and genetic factors).


Labeling any of these conditions "diseases" does not presuppose a lack of agency.
Many diseases are the result of behavioral and environmental factors over which the person had choice over.

People do not choose to get lung cancer or to become alcoholic, but they do choose to drink and smoke, knowing that cancer and alcoholism could result (especially if the diseases run in the family).

Alcoholism is viewed as a disease in our culture and our healthcare system treats it as such. People are encouraged to seek treatment before the untreated disease of alcoholism causes liver and brain damage, separate diseases.

Diabetic neuropathy, blindness and gangrene are the often result of poorly managed diabetes. Type Ii Diabetes and it's effects are partially caused by behavior.


I learned that my asthma, bordering on copd was being caused by NSAID use. I blame my doctors for not informing me that this is a common risk of NSAIDS. I also blame myself for not researching drugs more thoroughly when my doctor prescribes them. I now know to be more thorough.

I think with obesity, we're more interested in casting blame (whether on the obese person or on someone or something else) than helping people.

With "blame-worthy" diseases like alcoholism, drug addiction sexually transmitted diseases, lung cancer, and obesity, there are many in our society who do not want to pay (through taxes and insurance premiums) for other people's mistakes and carelessness (but they want their own mistake-caused health problems covered).

If we choose to believe that diseases presuppose a lack of agency, we're choosing ignorance because many disease are directly caused by a person's voluntary interaction with their environment.

We need to understand that lifestyle diseases are preventable. Preventing and treating obesity needs to be more important than casting blame. Educating, supporting and helping people prevent and treat their weight problems can prevent the disease or disorder of obesity from becoming a greater illness.

We don't presuppose that calling lung cancer or syphilis diseases presumes a lack of agency. We understand that smoking and promiscuous sex can have life-threatening consequences.

I think it boils down to retribution. We believe that atshma, chronic bronchitis and emphysema, lung cancer, HIV, syphilis, herpes, anorexia... are each punishment enough, and that we shouldn't kick a person when they're down, even if they fell of their own accord.

When it comes to obesity though, as a culture we do feel justified in kicking the **** out of people, even when they are down. No punishment is severe enough.

If obesity is not a disease, then neither is anorexia. If eating to obesity is a choice then refusing to eat to attain skeletal thinness is just as much a choice.

But we don't treat anorexia or even substance abuse that way. Obesity inspires very little compassion. Compassionate help isn't impossible to find, but it's much rarer than help for other self-inflicted diseases. We seem to believe that where obesity is concerned, that blame is more important than dealing with the problem.

Many solutions wouldn't even require any money at all. Just making it more acceptable for a fat woman to be seen at a public pool in a bathing suit without facing condemnation and ridicule would be helpful. Removing the stigma of admitting you have a weight or eating problem and that you need help with it would also be helpful.

If help were not available for smokers and heavy drinkers who want to quit, they would still be responsible for any illness or condition that resulted from their disease-causing habit. Just as calling obesity a disease doesn't absolve a person of responsibility for their actions that caused or contributed to the disease.

In my experience, more people take action against what they perceive as a disease than what they perceive as simply a bad habit or a poor choice.

I'm all for calling it whatever will inspire people to address the problem with compassion rather than condemnation. Condemnation (from myself or others) never helped me lose an ounce.

I'd like to see weight loss treatment and support groups become as common and as easily accessible as AA. What we call it doesn't matter as much as what we do about it, and whether as a cultre we make the process easier or more difficult.

diamondgeog
07-11-2013, 01:26 PM
What I took the article to be most concerned about is what follows from calling obesity a disease. There can be good outcomes and there can be bad outcomes.

Take lung cancer that someone brought up. If the only thing that followed from it becoming a major health concern and classified as a disease was more nicorite (spelling) gum then that would not have been good.

But TV commercials were banned for cigaretts, warning lables, it is heavily taxed. In an outcome of calling obesity a disease is banning commericals for fast food I am ALL for that. Especially on kids programs.

So what is really important is what comes of this. If it is more efforts to change environments than great. But the author and I am as well a very concerned that this can turn into just another money making opportunity for companies and it can lead to things being worse not better.

And if you don't think environment is important it is. On my drive home yesterday on a local radio program they talked about urban areas that are almost islands of nothing but bad food choices. People have limited incomes and limited mobility. And almost all their food choices and especially the ones thay are most likely to be able to afford are all the bad food choices.

So the problem is a lot more than the indvidual. Now I have more choices and I made bad ones. So for me it might be different. But it is mind boggling how much our enviorment is there to make it at least easy to get overweight.

At my gym they have TVs. And it seems that every commerical break on any program, news, sports, drama, movie, there is at least one if not more commericals for fast food. If you have a TV on you are bombarded by it. If you drive around my neighborhood you are passing place after place after place.

In the end I think the author was very concerned so what happens with this classification? And he warned it is a great opportunity. But from his own reading of our track record it will be very easily perverted into just more money making and making things worse.

freelancemomma
07-11-2013, 02:07 PM
Kaplods: As always, you've given me lots of food for thought. I certainly can't argue with your point that if anorexia is a disease, so is obesity. I'm just afraid that the disease designation will lead to a sense of fatalism in obesity-prone individuals, but your own story suggests another path.

I suppose we need to keep the idea of "preventable disease" in the public discourse and emphasize that a propensity toward obesity does not make obesity inevitable.

F.

kaplods
07-11-2013, 06:39 PM
Kaplods: As always, you've given me lots of food for thought. I certainly can't argue with your point that if anorexia is a disease, so is obesity. I'm just afraid that the disease designation will lead to a sense of fatalism in obesity-prone individuals, but your own story suggests another path.

I suppose we need to keep the idea of "preventable disease" in the public discourse and emphasize that a propensity toward obesity does not make obesity inevitable.

F.


I think we're literally taught to erroneously believe that overweight, and especially severely obese people are so lazy and stupid that they will choose fatalism over logic, because we "know" they're all somehow looking for excuses to stay fat.

That's not been my experience at all, and not just with weight. When I began working as a probation officer, I felt the same about many of my habitual offenders. I thought that the people I worked with didn't want to change and given the opportunity to change, most would screw it up.

I couldn't have been more wrong. There were a few who felt so alienated from "normal" culture that they felt hopeless and powerless to change. I had one young man who insisted that his probation sentence was unreasonable, because it wasn't fair to expect "anyone" to stay out of legal trouble for two years).

Most people though, even the child and spouse abusers, were anxious to take any help that was available. They were indeed desperate for it, and those who succeeded were those who found and were accepted into a supportive group.

Those who isolated themselves and cast blame (whether on others or themselves) were the most likely to re-offend.



I think we need to start using a preventive model for all healthcare. Now that we know that dental care can prevent heart disease, it's absolutely sinful that Medicare and private medical coverage does not include dental (and vision as well).

I currently have several teeth that need attention. Two are intensely painful, but I will have to save carefully to afford dental care. My insurance will pay for antibiotics to treat severe infection, but won't pay for a root canal or extraction.

I have a master's degree and feel like human scum when I look at the condition of my teeth. I know the importance of dental care, I simply can't afford all the care that is needed, so I have to address only the most severe issues and only as I can afford to.

As a culture, we could save a tremendous amount of money and human suffering if we valued preventive care, and not just for obesity, but we do have to stop assuming that any group of people will refuse help if offered. The research doesn't bear this out. Most people do want help with their problems, but they often don't know where to look for, or how to access that help. My main role as a probation officer was facilitating that help, and most of my probation clients jumped at the chance and even worked quite hard for that help. Most had at least some success with doing so.


And if a child-molesting, spouse-beating, substance abusing, car theif can seek help and change their behavior through that help, surely there's hope for obese individuals.

There are many groups we as a culture do not want to help, because we assume the effort would be wasted. And sometimes our efforts at help make the situation worse, if we're not careful. I often saw welfare mothers who wanted to work, but couldn't afford to, because child care and transportation costs would leave the family in worse shape than welfare, especially if their children had special needs. I saw couples who divorced in order to get medical care for their children.

There are aspects of our society that are broken, and most of the broken spots are perpetuated by the falsehood that "those people" don't want to change.

EagleRiverDee
07-11-2013, 07:34 PM
I tend to agree with the OP.

In my opinion, obesity in nearly all instances is a behavioral issue, which requires a change in behavior to cure. (Note that I am not including cases of obesity caused as a side-effect of a disease or a side-effect of drug treatments). Even people who have surgery or get medication to treat obesity are really treating the behavioral issue. The surgery effects how much they can eat (or how many calories they can absorb), the pills affect appetite thus affecting how much they can eat. Behavioral modification.

I'm not against pills or surgery, per se. But I don't think they solve the problem long term. And I think the biggest problem with labeling obesity a disease is it can create an excuse for someone who does not want to change and ultimately will probably create a new class of legal protections for people who in reality are choosing their condition through their lifestyle choices. I really think obese people need to own it, and commit to doing something about it that will last long term, and the only thing that will is behavioral change...in other words, not eating more calories than you burn.

Edit: I don't see anorexia and obesity as the same. People with anorexia have a legitimate psychological issue where they see themselves as fat when they aren't. Every fat person I know, however, sees themselves exactly as they are. If there is a disease out there where a fat person sees themselves as too skinny, then I'll add that to my list of legitimate diseases above but I've never heard of it.

kaplods
07-11-2013, 08:31 PM
I just don't buy the argument that two thirds of Americans are choosing to be overweight, because they're "looking for excuses" to stay fat.

There are a wide range of thoughts and behaviors associated with anorexia. Not all anorexics believe themselves to be or see themselves as fat. That is a cultural myth. Many anorexics see themselves accurately, they simply over-generalize our society's belief that thin = good and fat = bad. They take literally the maxim, "You can never be too rich, or too thin."

The assumption that all fat people see themselves as fat and choose to overeat anyway, is as much a misconception as is that all anorexics see themselves as fat and are unable to change without help. Body dismorphia and image delusional body image can be potential symptoms of anorexia and other eating disorders, but are not prerequisites for the diagnosis.

Both anorexics and overweight people (regardless of what they believe or do not believe) are more successful in choosing healthier behaviors when they have help and support.

I'm just suggesting that what we call obesity is less important than making help more accessible and acceptable.

I met a woman recently, who weighs over 500 lbs, and is in her early 20's. She's desperate to gain control over her eating, but has incredible anxiety when she is not eating. Because she can't control her eating on her own, she's been trying to get into residential eating disorder treatment. Several programs would have accepted her based on her binge eating, but refused her when they discovered her weight. They acknowledged that she fit the Criteria for a binge eating disorder, but refused her admittance because the facility wasn't designed for obese patients.

Not everyone who is obese has an eating disorder, but I think it's fair to say most have disordered eating. How much control or success an individual experiences can vary tremendously. Research again and again though supports the conclusion that people do better when they are not blamed or ostracised and when they have help.

What we choose to call it isn't as important as making help and support easier to find.

Those of us who have found this site are ahead of the game in that regard.

EagleRiverDee
07-11-2013, 09:45 PM
I just don't buy the argument that two thirds of Americans are choosing to be overweight, because they're "looking for excuses" to stay fat.

That's not what I said. Not that they're staying overweight because they're looking for excuses to stay fat. What I was saying is that people who are already fat can now say, rather than I have an eating problem, I have a disease. "It's a disease." I've seen it with alcoholics- as soon as alcoholism got labeled a disease (and I'm not saying it isn't since clearly addiction is real- but it certainly starts with a choice and with a behavioral problem) people who were alcoholics all of a sudden had an excuse and stopped taking responsibility. They used it as a defense for things they did while drunk. They became a protected class- many workplaces won't fire someone who is an alcoholic when their drinking becomes a problem because it's a disease and therefore protected. I fear we will see the same fallout by classifying obesity as a disease - that people will use it as an excuse, and that protections will be put into place that shouldn't be there. It's already happening in other countries.

kaplods
07-11-2013, 11:15 PM
The logic still doesn't work. It would be like saying a diagnosis of gum disease provides people with an excuse for not brushing their teeth.

I don't think many people are that stupid.

I also don't believe excuses find people, people find excuses. Anyone who uses an illness or anything as an excuse does't do so because someone handed them an excuse. The sought out the excuse.

People who would use a specific disease as an excuse would find another excuse if that one weren't available.

Most people won't make excuses, and those who do use excuses are not picky about which one they use. They'll pull something out of their behind to use an excuse. Making obesity a disease wouldn't increase excuse-making, it would only give excuse-makers another option to add variety to their excuse-making. There won't be a greater number of excuse-making, there'll just be one more excuse-makers can use, but that Changes nothing, because if you take that excuse from them, they'll just make or find another.

I find the assumption that a large number of fat people are just waiting for an excuse to fall into their lap, ridiculous. Anyone prone to excuse-making has already got an arsenal of excused they're already using. One more or less, isn't going to change anything for excuse-makers.

There will always be idiots, I just don't think they're given excuses, I think idiots will track and hunt down excuses to suit themselves. If obesity as a disease isn't available to them, they'll use it anyway or find something else. It would be nice if we gave fat people a little more credit for intelligence. Most of us aren't idiots or excuse-makers, and those who are will find or create excuses regardless of what the rest of us think.

EagleRiverDee
07-12-2013, 02:00 PM
Kaplods-

By the way you keep using "us" I get the feeling you're taking my comment personally. It wasn't directed at you. For that matter, I would exclude anyone on 3FC or in Weight Watchers or in any program where they are facing their obesity head on and working at making the lifestyle changes necessary to address it.

Other than that, I think we should agree to disagree. Time will tell whether classifying obesity as a disease was a good idea or not.