[SportMed] SPORTS MEDICINE : MEDICAL: CONDITIONS: OBESITY: An Obesity Manifesto: Debunking the Myths

 

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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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Net-Gold content and posts regarding obesity

http://tinyurl.com/grszdwh

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WEBBIB1617

http://tinyurl.com/gtdzaq3

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Sincerely,
David Dillard
Temple University
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jwne@temple.edu
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Bushell, R. & Sheldon, P. (eds),
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[SportMed] SPORTS MEDICINE : MEDICAL: CONDITIONS: OBESITY: An Obesity Manifesto: Debunking the Myths

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