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Sue 19 June 2013 11:56 PM

Obesity now recognized as a disease
 
In order to fight what it described as an "obesity epidemic," the American Medical Association has voted to recognize obesity as a disease and recommended a number of measures to fight it.

The association voted on the measure Tuesday at its annual meeting in Chicago. The AMA noted that obesity rates in the United States have "doubled among adults in the last 20 years and tripled among children in a single generation" and that the World Health Organization, the U.S. Food and Drug Administration and Internal Revenue Service already recognize the condition as a disease.

According to "F as in Fat: How Obesity Threatens America's Future 2012," a study released by the Robert Wood Johnson Foundation in September last year, adult obesity rates in 2011 exceeded 30 per cent in 12 U.S. states. The study projected that "if rates continue to increase at the current pace, adult obesity rates could exceed 60 per cent in 13 states, and all states could have rates above 44 per cent by 2030."

http://www.cbc.ca/news/health/story/...sease-ama.html

thorny locust 25 June 2013 06:56 PM

Is Obesity Really a Disease?
 
Realized this thread was here just in time to not start a new thread:

http://www.theatlantic.com/health/ar...isease/277148/

Ryda Wong, EBfCo. 25 June 2013 07:05 PM

Thanks for sharing that article. Spot on.

Frankly, I'm pretty offended that I've suddenly got a disease, despite the fact that I make strong efforts to exercise and eat well and that I try to live a balanced, happy life.

Lainie 25 June 2013 07:28 PM

To be fair, plenty of people who have diseases make strong efforts to exercise and eat well and try to live a balanced, happy life. :)

Ryda Wong, EBfCo. 25 June 2013 07:56 PM

True. I didn't phrase that well at all.

I guess what I was getting at is that my body is, in general, healthy. It's healthier than that of many thin people I know. But, now, it's a disease. My body is a disease. It doesn't sit well.

Blatherskite 25 June 2013 08:06 PM

Are there any other diseases defined by one symptom which is, in fact, also the disease? I realise there are other symptoms associated with obesity, but presumably to received a diagnosis of obesity you would only have to be obese.

Lainie 25 June 2013 08:09 PM

To be diagnosed as hypothyroid one need only have a thyroid-stimulating hormone level above the range considered normal.

Dr. Dave 25 June 2013 08:35 PM

Quote:

Originally Posted by Lainie (Post 1747603)
To be diagnosed as hypothyroid one need only have a thyroid-stimulating hormone level above the range considered normal.

True, but that would be called "subclinical hypothiroidism" and it is not clear that it is a disease.

Hypothyroidism the disease would also require a low free T4, basically the form of the hormone produced by the thyroid gland.


As for the question of other diseases, there are some other things called disease that are defined by a lab value, like Von Willebrand's disease, even if the person has not had bleeding problems. In truth, that is probably not really a disease without the bleeding either, but it is called a disease.

I have not really thought about it much, but heart valve issues, say aortic stenosis, can cause severe symptoms but can also be completely asymptomatic. I have it due to a valve abnormality and I run a lot with no problems.


A diagnosis does not necessarily mean a disease.

Lainie 25 June 2013 08:42 PM

My doctor's been diagnosing me incorrectly, then. :) She's never tested my T4; my diagnosis is based on TSH levels and symptoms.

Onyx_TKD 25 June 2013 08:52 PM

Quote:

Originally Posted by Lainie (Post 1747586)
To be fair, plenty of people who have diseases make strong efforts to exercise and eat well and try to live a balanced, happy life. :)

Yeah, likewise, I'm not sure how the bolded parts of this quote from the article are relevant to their point:
Quote:

Consider Winston Churchill. Though average in height, Churchill weighed upwards of 250 pounds. He smoked cigars. He drank relatively heavily. He did not jog or work out. Yet he became perhaps the most important statesmen of the 20th century and one of the greatest political orators in history. He served twice as Britain's prime minister, guiding his nation through a particularly perilous chapter in its history, and won the Nobel Prize for literature. He lived to age 90.
I agree with the premise that being overweight by some specific amount doesn't seem to qualify as a disease (surely it's at most a symptom?). However, having made great political accomplishments and won a Nobel Prize doesn't mean that a person was healthy and had no diseases. It simply means that any health issues he had were not insurmountable obstacles to his success. Good health is helpful, but certainly not necessary, for accomplishing great things.

I hate seeing articles throw in poor logic like that and cloud the good point they're trying to make.

Dr. Dave 25 June 2013 08:54 PM

Quote:

Originally Posted by Lainie (Post 1747613)
my diagnosis is based on TSH levels and symptoms.

That is different than just elevated TSH and no symptoms. I thought you meant that elevated TSH alone was a disease.

And if you have symptoms and are getting thyroid replacement, then titrating the medication to symptoms and TSH level is the way to go. Trust your doctor, not some guy on the internet :)

Dr. Dave 25 June 2013 08:58 PM

Quote:

Originally Posted by Onyx_TKD (Post 1747615)
I hate seeing articles throw in poor logic like that and cloud the good point they're trying to make.

Right. Steven Hawking is one of the most intelligent and accomplished scientists of our time, and he has a disease. FDR had a disease and a lasting disability and he was the longest serving, and generally considered a very successful, U.S president. Et cetera.

Lainie 25 June 2013 09:02 PM

And at a less elevated level, we are all surrounded by (assuming we ourselves are not) people with diseases who live more ordinary but productive, happy lives -- people working demanding jobs, raising children,caring for other family members, etc. etc. Managing the disease is just one more thing on their plate.

quink 25 June 2013 09:57 PM

It does make me think a bit. I have type II diabetes, but my a1c levels are normal without medication or even making any special accommodations in my diet (I eat fairly healthy - and about a billion times healthier than when my blood sugar was so high I had to be on insulin - but I don't deliberately limit carbs or follow a special diet). My doctor has said before that my body behaves now as if I don't have the disease at all, but diabetes isn't something you can just cure. Do I still consider myself diabetic if I have no symptoms of it at all and I don't do anything out of the ordinary to keep it in check? I still personally consider myself diabetic because it's a good reminder of what's lurking again in my future if I don't eat right, but I feel a little bit odd about that label after two years of essentially not being able to check any of the boxes on the symptom list.

I wonder the same thing about obesity. If you're naturally prone to it and you lose weight but have to put extra effort into keeping it off, do you still suffer from the obesity disease? If you swap out 'diabetic' for 'obese' in my first paragraph there (and I was both at the same time, so you could), is it the same thing? I 'cured' my diabetes by working out five days a week and keeping my calorie intake to a certain level - Would that also be considered a 'cure' for obesity, or is it just holding it at bay through extreme measures? I know that there are plenty of people who don't exercise and eat a reasonable 2000 calorie per day diet, and that's enough to keep them at a normal weight. If I do the same thing, I will gain weight, and I'll start to see the other related problems crop up again. Does that mean I'm naturally fat? I guess I am, if I look at 2000 calories and a sedentary lifestyle as a baseline that I should be able to follow, as it is for a lot of people. But what if I say an average of 1600 calories and 30 minutes of activity per day is normal for me? I can maintain my current weight at that level, just like there are people out there who naturally need to eat 2500 calories or more to maintain their healthy weight. So by watching what I eat and exercising, am I treating an illness (either diabetes or obesity), or am I just holding myself to the numbers that are right for my body?

Honestly, I go back and forth with how I look at it. What I do doesn't feel like a diet or anything unnatural, but it did take me a couple years to get to that point. I initially did make those changes to lose weight. In some ways, I'm fighting back against some conditions (both the diabetes and obesity) that run in my family, and I probably have to work harder at it than I would if I didn't have those factors. In that way, obesity can feel like a disease. But it also feels a lot more negative for me to look at it that way. While there were genetic factors that helped me get fat, most of my weight came from simple bad habits. The medical stuff might have been a modifier, but it wasn't the cause.

I remember reading a really pessimistic article about maintaining weight after weight loss, and it talked about the small percentage of maintainers having to exercise constantly and having to always watch their diets for the rest of their lives, as if that was a unreasonable hardship. A couple days later, I read a different article about the lifestyle habits of healthy doctors, and the routines were almost the same - but one article made it seem like the 'treatment' was punishment, while the other made it seem like it was just part of everyday life.

There are some very bad habits that we have as a culture, and many of those have led to obesity. Not for everyone - there are plenty of thin people who eat nothing but fast food and drive everywhere, just like there are overweight marathoners who have fantastic diets - but in many cases, the body weight will be an indicator of lifestyle habits. What people lose is that it's the habits that are the goal, not the body weight itself. People place so much focus on one number without realizing that it's not the target. The fat marathoner is in a much better position than the thin McDonald's junkie, but I'd be willing to bet that a high percentage of people would still call the thinner one the healthier of the two, even if they had both of their fitness and diet plans laid out in front of them. That's a big part of the reason so many people do give up on healthy habits if they don't lose weight, because they don't acknowledge that the habits themselves should be the end goal.

eta: I realized that I'm making it sound like there's one healthy BMI. I don't think that's necessarily true. In my case, I'm comparing treating diabetes (where there is a healthy number I'm aiming for and the effects of being above or at that number are very, very real) directly with 'treating' obesity. For me, the number on the BMI chart happens to work, but for others it won't. That's another scale that needs to be taken into consideration.

Silkenray 03 July 2013 07:41 AM

Quote:

Originally Posted by Blatherskite (Post 1747602)
Are there any other diseases defined by one symptom which is, in fact, also the disease?

Hypertension. In most cases it has no noticeable symptoms, and the only way to tell is to have your blood pressure taken.

Jaime Vargas 03 July 2013 08:14 AM

Quote:

Originally Posted by Ryda Wong, EBfCo. (Post 1747574)
Thanks for sharing that article. Spot on.

Frankly, I'm pretty offended that I've suddenly got a disease, despite the fact that I make strong efforts to exercise and eat well and that I try to live a balanced, happy life.

I have myopia and tooth cavities. I've also had obesity but now I don't.

And it's not different from psychiatric illnesses getting named and categorized - before say, Asperger's was named there were people who had it. I don't know if saying you have a disease is worse than saying you are defective / crazy / whatever.

A Turtle Named Mack 03 July 2013 01:33 PM

I think a major impetus for the decision was this:
Quote:

The AMA's recommendations accompanying the vote included urging physicians and insurance companies to "recognize obesity as a complex disorder," encouraging national efforts to educate the public "about the health risks of being overweight and obese."
You are far more likely to get insurers to pay for treatments for a condition the medical establishment recognizes as a 'disease'. If big noses were labelled a disease it would be much more likely that insurers would pay for nose jobs. Obesity is already covered in many plans, if severe enough, because it (and the habits which support it in many obese people) contributes to so many other bad health conditions.

thorny locust 03 July 2013 08:27 PM

Quote:

Originally Posted by Ryda Wong, EBfCo. (Post 1747597)
I guess what I was getting at is that my body is, in general, healthy. It's healthier than that of many thin people I know. But, now, it's a disease. My body is a disease. It doesn't sit well.

Exactly.

Quote:

Originally Posted by Onyx_TKD (Post 1747615)
I hate seeing articles throw in poor logic like that and cloud the good point they're trying to make.

Yes, the particular article does suffer from that, and also from using specific individual cases improperly to attempt to prove an overall point -- as they say, Churchill also smoked cigars.

However, they'd be a bit hampered in trying to cite studies that separate out fitness from fatness, because to the best of my knowledge there aren't a whole lot of those. Defining the fatness itself as the disease, rather than the lack of fitness, will I suspect make it even less likely that those studies will be done.

Quote:

Originally Posted by quink (Post 1747636)
There are some very bad habits that we have as a culture, and many of those have led to obesity. Not for everyone - there are plenty of thin people who eat nothing but fast food and drive everywhere, just like there are overweight marathoners who have fantastic diets - but in many cases, the body weight will be an indicator of lifestyle habits. What people lose is that it's the habits that are the goal, not the body weight itself.

Yup. And again, most of the statistics don't separate out these factors. Is what's currently defined as obesity a cause, or a correlative factor?

Quote:

Originally Posted by Jaime Vargas (Post 1749511)
And it's not different from psychiatric illnesses getting named and categorized - before say, Asperger's was named there were people who had it. I don't know if saying you have a disease is worse than saying you are defective / crazy / whatever.

Homosexuality was classed as a disease in that fashion for many years. It was important to quite a few people to get it out of that category.


Quote:

Originally Posted by A Turtle Named Mack (Post 1749535)
I think a major impetus for the decision was this:

You are far more likely to get insurers to pay for treatments for a condition the medical establishment recognizes as a 'disease'. If big noses were labelled a disease it would be much more likely that insurers would pay for nose jobs.

There is a whole lot of money in the current weight-loss industry. I expect surgeons specializing in nose jobs would be quite happy to have large noses categorized as a disease.

Avril 03 July 2013 09:36 PM

Large noses aren't a disease, but a deviated septum is. I could have an insured nose job because I have one, and a propensity toward sinus infections as result. But I've refrained, as I think having my nose "fixed" would be traumatic in more than one way, and I can avoid the infections pretty well with a neti pot.

Lainie 03 July 2013 10:00 PM

Everyone I've talked to who's had nasal surgery has stressed that it's painful. I'm pretty sure my septum is screwy, but I think I'll just keep it the way it is.


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