Plan B Forum

Last week, the American Medical Association voted to classify obesity as a disease. But is being fat the same thing as being sick?

The decision came at the annual meeting of the American Medical Association (AMA).

Though a committee of experts recommended against classifying obesity as a disease, the association's delegates voted to approve the change.

And at a stroke, a third of the US population became diseased.

The immediate repercussions of the vote are not clear - while insurance companies may now be more inclined to cover obesity prevention and treatments, they are under no obligation to do so.

AMA president Ardis Hoven says the new designation will increase the focus on obesity treatment and prevention, and in doing so help medical professionals deal with the increasingly complex health problems associated with being overweight or obese.

Though obesity has been a health issue in the public eye for decades, doctors are not always equipped or prepared to help patients treat and prevent obesity-related illnesses.

Hoven says the vote will encourage doctors to change that, and will provide more training and education for both doctors and patients.

"When we are sitting in the examining room and talking about things to prevent weight gain and promote weight loss, what this is going to enable us to do is put together tools and teaching and education around better ways to impact patient responsiveness around our concerns about their obesity," she says.

For Americans who went to bed feeling fine and woke up with a disease, the new designation is alarming.

"Pretty uniformly people are not real happy about it," says Lesely Kinzel, associate editor at the website XOJane.com and author of Two Whole Cakes: How to Stop Dieting and Learn to Love Your Body.

Soon after the announcement of the decision, the hashtag #IAmNotADisease became popular on Twitter for those wishing to express their dismay with the decision.

Kinzel says that many fat people already have trouble accessing proper healthcare, because their ailments are not taken seriously except as an extension of their weight.

"You might go to the doctor with a twisted ankle or a head cold and be told you need to lose weight, which doesn't help with the twisted ankle or the head cold," she says.

She worries this classification will only make the problem worse.

New Jersey governor Chris Christie recently underwent weight-loss surgery
"It says that a fat person is inherently sick, and in need of special treatment for this visible sickness," she says, noting that at least a third of people who are classed as obese don't have any increased risk for diabetes or cardiac problems.

"It makes me worried that doctors are going to be less able to listen to patients."

On the other side of the debate, some worry that classifying obesity as a disability removes an element of personal responsibility.

"Are people going to start taking off work and claiming disability because they are obese? If restaurants are offering [high-caloric] items on the menu, does that open the door for people to sue?" asks Judy Gaman, a health and wellness consultant at Executive Medicine of Texas.

"When you take personal responsibility out of the equation, it opens the door for a lot of other things."

Marlene Schwartz, the acting director of the Rudd Center for Obesity and Food Policy at Yale University, says that calling obesity a disease could allow for obese people who require medical interventions to get the help they need.

But she cautions that such a classification can lead to stereotypes and oversimplification.

"To the extent that this helps people get the resources they need and convinces insurance companies that funding prevention is better, I'm all for it," she says.

"To the extent that it makes people feel badly about themselves and increases stigma, I'm more cautious."

Obesity, she says, is incredibly complicated. The idea that those with a Body Mass Index over 30 - the official mark for obese - just need to put down the hamburger and pick up a jump rope is reductive.

"The definition of obesity needs to take into account how complicated the issue of weight eating and physical activity is," she says.

She says a subset of those with a BMI over 30 are perfectly healthy, and that those who are not see a dramatic benefit from losing just 10% of their weight.

In those cases, a patient's health may change substantially, but their appearance and their BMI may not.

The designation of obesity as a disease, she says, has tremendous potential to help harness resources and direct attention to the potential health issues of those with a BMI over 30.

Used correctly, she says, the new classification should fight stigma.

"We need to be able to use this disease label to the extent that it makes people take obesity seriously, and not keep blaming people for being irresponsible," she says.

In the end, she says, everyone involved in this debate wants the same thing - for all Americans to enjoy nutritious food, physical activity, good health, and to feel comfortable with their bodies.

Whether this new classification will help with that mission that remains to be seen.

rubato wrote:Being fat is being sick. High blood pressure. Diabetes. Degenerative joint diseases. &c.

yrs,
rubato

a person who is genetically predisposed to gaining weight?

Sean wrote:I remember reading a story some time ago about a woman who deliberately set out to become the Worlds' heaviest woman. I haven't heard anything about her recently but I'm sure that if she stuck with it she'd be fairly rotund by now. Should she be classed as having the same disease as a person who is genetically predisposed to gaining weight?

oldr_n_wsr wrote:

a person who is genetically predisposed to gaining weight?

Fine line there. In the rooms we have more people who have (or had) alcoholics in their family history than people who have no family history of alcoholism.
But then the "nurture vs nature" debate comes in. Does one have a genetic disposition to drink more? or was alcohol readily available and accepted and worshiped (for lack of a better word) while growing up thus learning drinking (even in excess) was acceptable, perhaps even promoted?

dales wrote:The longer ETOH has been part of a culture, the more tolerance a given population has for its effects.

ie: American Indians resultant disaterous dealings with "firewater".

Genetics Has Key Role In Obesity

Oct. 17, 2007 — New evidence that genetics plays a key role in obesity is published in the International Journal of Bioinformatics Research and Applications. The findings relate to the genetics of modern Pima Indians who have an unusually high rate of obesity but the finding could be extrapolated to all people. Their obesity is thought to be linked to a thrifty metabolism that allowed them to metabolize food more efficiently in times when little was available but causes problems when food is in abundance.
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Mark Rowe, David McClellan, and colleagues at Brigham Young University in Provo, Utah, USA, have studied the effect of evolutionary selection on Pima Indians, a people indigenous to the present-day Sonora desert of Arizona and New Mexico. The researchers anticipated an effect consistent with higher metabolic efficiency among these people and focused specifically on recently discovered variations in their mitochondrial DNA, so-called SNPs, or single nucleotide polymorphisms.

The metabolic rates of 200 obese Pima individuals were measured and revealed that two of the three known SNPs influence metabolic efficiency. The researchers then used the genetics software TreeSAAP, to analyze the biochemical changes caused by these SNPs and then tracked the evolutionary selection of these genetic variations in 107 different types of mammals. This allowed them to propose a mechanism by which these SNPs affect the mitochondrial respiratory chain and consequently increase metabolic efficiency in the Pima people.

The team suggests that an increased metabolic efficiency could have been an evolutionary advantage. The SNPs may have persisted because they helped the Pima survive the harsh dietary environment of the Sonora desert throughout the history of the people. In the current environment of caloric over-consumption an increased efficiency is unfavorable and may contribute to the high rates of obesity among the Pimas.

While the Pima Indians are an extreme case, the entire human population may also have evolved in a restricted caloric environment, say the researchers. Many populations may exhibit similar SNPs that were advantageous to our ancestors but may now be detrimental. The presence of these SNPs may thus provide one explanation as to why obesity is so rife in the 21st century.