Monday, June 24, 2013

Is Fat Really a Disease?

     I do not feel qualified to answer this question. But the AMA has made the decision. Last week the doctors' association officially announced that obesity is now classified as a disease.

     However, as a lifetime owner of a spare tire (which has expanded and contracted with the seasons of my life) I do feel qualified to make a few comments about the issue.

     I think it's a good thing to name obesity a disease if that will help people get treatment -- especially for morbidly obese people who might want to get stomach bypass surgery and have their medical insurance help defray the cost. And by the way, kudos to weatherman Al Roker, and now New Jersey Governor Chris Christie, for going public with this type of surgery. Maybe they can do for obesity what Betty Ford and others did for addiction.

     I also think it's a good thing if it raises our awareness of the perils of obesity, and somehow gets us all to eat less and do more exercise -- though I doubt this is going to happen. The New York Times had an article yesterday, Don't Count on Calorie Counts by Frank Bruni (a former fat person) saying how just informing people of how fattening certain foods are does not seem to get them to switch to a healthier diet. As he says, "Knowledge may be power, but hunger routinely trumps it."

     Yet, in my opinion, labeling obesity a disease could be a bad move if it encourages people to believe that obesity is just something that happens to them, like catching the flu, and that they have no control over their own weight. It's in their genes; it's in their environment; there's nothing they can do about it.

     Some tendency for obesity is surely in the genes. And the explosion of obesity over the past 20 or 30 years offers substantial evidence that our environment is also a significant factor.

     But obesity -- like most things -- is not an all or nothing issue. Our body weight and BMI are not entirely in our control; but they're not entirely beyond our control either. Many people have gone on many successful diets, and they've proved that we can lose weight if we really put our minds to it. It's hard to lose weight. It's hard to quit smoking, too. But a lot of people have done it.

     What about discrimination against fat people, the shame that many feel, or are made to feel by their family, their colleagues, the media? I don't know what to think about this. On the one hand, it's a terrible thing for people to feel bad about themselves. It can wreck their lives, regardless of how heavy they are. On the other hand, maybe fear of embarrassment and shame helps keep many of us from gaining even more weight, and thus keeps us healthier.

     But back to Frank Bruni. He says that various studies have shown that posting calorie counts at restaurants doesn't influence people to select lower calorie menu choices. He makes an analogy to smoking. Almost 50 years ago, the Surgeon General required tobacco companies to print warnings on packs of cigarettes. But for the most part people read the warnings, then ignored them and went right on smoking. What finally got people to stop were the various smoking bans that went into effect in the 1980s and 1990s -- in offices, in restaurants, and finally even in bars.

     To me, that suggests that maybe Mayor Bloomberg isn't so crazy after all, trying to ban those big gulp drinks in New York City.

     I remember a few of my own efforts to lose weight. One time I gave up drinking alcohol. Get rid of all those empty calories and I'm bound to lose weight, I thought. But what did I do? I told myself that I hadn't had a drink before dinner, hadn't eaten any appetizers that go with it. So, surely it wouldn't hurt if I indulged dessert.

     A few years ago I finally got serious and lost 15 pounds. My motivation was a bad knee. The doctor told me he could give me a cortizone shot, and exercise would help. But he looked me in the eyes and said, "You know, it wouldn't hurt to lose a few pounds, either. The less weight that knee has to bear, the better off it's going to be."

     How did I do it? I gave up drinking soda, and went to bottled water. And here's the thing -- I mostly drank diet soda! But it didn't seem to matter. Without the soda, I lost 15 pounds. I did some other things too -- cut out dessert, joined a gym -- but I think it was giving up soda that did the trick.

     Now, four years later, I've kept off about ten of those pounds. I do drink a soda now and then, even though I know I shouldn't. And right now, I can hear B in the living room exercising to her Leslie Sansone CD. And, er, I realize I should probably get up to the gym more often, too. 


Linda Myers said...

I had a checkup this morning and my doc calculated my risk for heart issues based on cholesterol, blood pressure, age, and family history. I am very low risk.

I said, "What about the 40 pounds I need to lose?" He said that isn't included as a factor in the calculator.

So, for me, the motivation would be to get off the bp meds. I do exercise, but I also eat too much.

Stephen Hayes said...

In spite of the fact that I've managed to lose a hundred pounds four times in my life, I was born fat and will no doubt die fat. It's possible for me to lose weight but only if I commit my entire existence to denying myself the foods I love, and I don't think it's worth that to be thin---which I could never be anyway.

DJan said...

I tend to gain weight now that I'm older. I've found an app for my iPhone that has made all the difference for me: it's called "Lose It!" and I enter all the food and exercise I do each day. It calculates based on my BMI and I can add meals from previous days. It is easy to use, and when I get towards dinner, I see how many calories I have left to spend and don't go over. It's kept my weight constant for a year now. :-)

Janette said...

My mom and I are the same rather huge size. She is 82. Yes, she has diabetes 2 but so does her tennis playing 135 lbs, 84 yr old sister. They have both had hips replaced- but her sister has been in the hospital for sports injuries more times than I can shake a stick at. Both women have clear minds.
Shaming? The only people it is politically correct to harrass is a large person.

Calling it a disease maybe they will come up with some meds that will not kill you to help with the adsorption of fats. I don't eat many fats, don't drink soda, eat smaller meals- but the fat that I gained during a time of tremendous stress, stays.
No clue.

Try New Things said...

I am just past 55 and before 50 my weight was easy to manage. Now it seems to be just a little more difficult and the things that used to work don't always work now.

So need to try new things and change things up. Not a bad thing helps with motivation when you change things up.

Douglas said...

I have had this theory that diet drinks are fattening. Reason 1 is I rarely saw skinny people drink them. Then there were some studies which suggest that diet soda and artificial sweeteners did not help people lose weight but gain weight.
But reason 2, which I considered long ago, was that the human body needs sugar which it gets from, well, sugar and carbohydrates. And that, if you do not give it what it wants, it will find a way. Perhaps (and this is my theory) storing up what sugars and carbohydrates it does get almost immediately. How does the body store up those sugars? As fat... which it then converts to energy later, as needed. I believe I wrote a post about this theory once. Drinking diet soda is fine, as is dieting, but you have to exercise or it won't work. I weigh about 25 lbs more than I did when I got out of the Navy. I credit my genetic makeup with the weight thing inherited from my father (who was thin as a rail most of his life). Something to think about: Bloomberg bans 32 oz super sodas but does not ban buying two (or three or four) 16 oz ones. How does that help?

Olga said...

I never drink diet beverages and rarely drink soda of any kind. My problem is that I still think of myself as a thin person even though I have that over 50-hormonal thing making me not as thin as I think I am. Now I resist weight loss because I don't want any more wrinkles.

Kathleen McCoy said...

I suspect that classifying obesity as a disease by the AMA is to facilitate treatment and insurance coverage. I've always had to watch my weight, but was never heavy until I go into my forties. At that point, I gained more than 100 pounds in two years and have been fighting my way down the scale since. I had a serious addiction to diet sodas for years and just stopped drinking them four months ago after reading that these could cause weight gain. I've lost 18 pounds since then, with everything else -- from diet to exercise -- remaining pretty much the same.

Tamara R said...

I see obesity as the visible result of an underlying addiction, an addiction to food. To me, therefore, the classifications and treatments should be similar to those for other addictions, such as alcohol and drugs.

I am all for stomach bypass surgery in that it severely restricts calories, resulting in weight loss, which then results in improved health. But if overeating is the addiction, and the addiction is not addressed, it will simply morph into another addiction, alcohol being the most likely candidate. See for just one article on this. Every major news website has a similar study up for viewing.

Barb said...

Well, I hate to get on my soapbox here. Obesity has very little to do with overeating, for many many people. I gained a great deal of weight at one time in my life...bed rest on multiple occasions with nothing to do but eat will do that to you. However I have been overweight-what some would call obese-for many years. I eat very little, exercise, and will never, ever be thin, although I may be less obese.

On the other hand, my husband, who never exercised in his life and never weighted more than 130 at six feet even has been known to eat a whole angel food cake, and both his dinner and most of mine in restaurants. the only difference is metabolism and genetics, pure and simple. and the fact that men cannot go thru meopause.

From a medical standpoint, obesity and food dependence are two issues that sometimes overlap but often do not. In fact a visit to overeaters anon will show non overweight people as well as the opposite.

Hopefully treating obesity as a disease will get rid of the "if you just ate a little less" response to people with less than perfect bodies, and allow insurance paid and alternative treatments and research.

We also have huge assumptions about overweight people. Many live long, healthy lives. the assumption that thinness is healthier than weight is often false....and shame never accomplished anything.

Tamara R said...

Every study I've read about this indicates that, preexisting conditions not withstanding, at the end of the day, obesity does have to do with overeating. Overeating does not necessarily imply the consumption of enormous quantities of food, healthy or unhealthy, but it does imply more calories being consumed than burned.

If obesity is not ultimately about an over quantity of calories being consumed, than why is stomach bypass surgery so prevalent as treatment? And successful for so many?

I'm not without sympathy for those struggling with obesity. I get the tenacity of this condition. But I have seen no evidence that it can't be reversed through lifestyle changes. I've only seen evidence that it can.

Janette said...

Can the same be said about over exercising? I know more then a few people who have had many trips to the ER for corrections of tendons, feet, hip breaks, knee replacements, beoken bones, skin cancer and such. Yet, they are held high as bastions of health? Really?
And gastric by pass, really? Never eat normally again plus have the chance that it will disolve leaking stomach juices into your main cavity.. I didn't enhance my boobs with silicon, get rid of wrinkles with Botox, or staighten my nose. I plan to be who I am until I die. I will lose some of my weight- but that will be over the course of time and happily.

Barb said...

I suspect that there are a host of ever think types that think like Tamara does.

I on the other hand, have always been the girl who looked at a donut and gained weight, even when I was twenty, in the army and running with a backpack every single morning of my life-which is why I know better than the common wisdom. I at a normal diet,worked out more more than most of the population and still struggled with weight. I decided at that time not to obsess about Americas obsession with thinness.

I then married a guy who was just the opposite, never exercised whatsoever and literally ate what he wanted (as did and do his family). fortunately, he knew he was lucky and not necessarily healthier and was not a "eat less or eat something else" person.

I refuse to let someone mess with what is a basically healthy organ under any circumstances, and I generally think that the new regulations are simply a way for the diet and diet surgery business to get more money.

Tamara R said...

Janette, be careful not to confuse overuse injuries with disease. Overuse injuries don't generally cause death, they just cause temporary discomfort. The heart and the lungs are still vastly improved irrespective of the overuse injuries.

Yes, exceptions can always be found, but the vast majority benefit from daily, vigorous exercise. Surely we don't need to debate that issue do we?

And yes, I understand gastric bypass is severe. I wouldn't wish it on anyone. My point was simply to illustrate that in situations where someone has been unable to effect change on their own, restricting calories through surgery does create weight loss.

Sometimes I think we set ourselves up to battle each other, when really we are all trying to better understand each other. I do understand the struggle, I just don't accept that it's not correctable with modified behaviors. We may not like what has to be done to get there, but that's beside the point.

June said...

The following appear to me to be facts:
1. If a person ingests fewer calories than he burns, he will lose weight.
2. A loss of weight does not indicate an increase in fitness.
3. Diet soda is bad for us, not least because of the phosphorus in it which does bad things to bones.
4. Overweight people are not de facto less virtuous, less disciplined in general, stupider, or less good-looking than people who are not overweight.
5. Feeling ashamed precedes weight gain as often as it follows it.

Tom Sightings said...

I certainly agree with one thing Tamara said: "Sometimes I think we set ourselves up to battle each other, when really we are all trying to better understand each other."

Anyway, for those who are interested, NPR had a program on the issue just this morning, which you can listen to or read at said...

Well, you got plenty of feedback on this one.

As you may remember, I joined weight watchers a year ago and have lost 20 pounds and kept it off since then. My goal now is to lose another 20 pounds which will be more difficult. I have mastered the business of stablilizing my weight with the new weight loss, but it means I can NEVER go back to my old habits.

Too often we lose weight and then get off the diet and revert back to our old eating disorder.

Losing weight takes patience, persistance and a burning desire. Half measures avail us nothing.

As for the disease part, yes, if metabolism is an issue, that is certainly related to genes and I can attest to this because David eats twice as much as I do and weighs much less. He is trying to gain weight. Can you imagine? Dianne

Retired Syd said...

I've never really had a weight problem, just the usual slow steady increase in weight that often accompanies age. This year, though, I have lost 10% of my body weight (what I had gained over the last 20 years!) Unfortunately, I can't really explain it, I haven't done anything drastic. (In fact, it coincided with being post-menopausal, which is exactly the opposite of what I've heard about that!)

In any case, I do have one friend that lost a ton of weight by getting that surgery. He's kept it off for nearly a decade and is very happy with his results (as are his doctors.) I have another friend that lost a ton of weight the old fashioned way but has gained most of it back. Not sure he would consider the surgery even if obesity's classification as a disease would mean insurance covered the the surgery. I think it's still pretty scary to most folks to go the route of surgery.