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Is Obesity a Disease?

The American Medical Association says so. Is this just an insurance scam?

by
Charlie Martin

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June 22, 2013 - 10:00 am
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13 Weeks: Experiment 3, week 4

Well, the AMA now thinks so. On June 18, the AMA voted to classify obesity as a disease, where in the past they’d called obesity an “urgent chronic condition,” a “major health concern,” and a “complex disorder.” But not a “disease.”

The motivation, like a whole lot of things in medicine right now, really came down to insurance. If obesity is a disease, then doctors are obliged to treat it and insurance plans are obliged to cover it.

But is obesity really a disease? Let’s look at that a little bit more. Here’s the definition of disease from the Apple dictionary:

a disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury: bacterial meningitis is a rare disease | a possible cause of heart disease.

Long-time readers of this column may remember that back at the end of my first 13 week experiment, I wrote a little science-fiction piece from the point of view of 100 years in the future, when the underlying causes of obesity had been discovered and it had been redefined as a particular variety of lipodystrophy, that is, a metabolic condition in which fat distribution in the body becomes abnormal.

It does kind of sound like obesity, doesn’t it? And lipodystrophy is certainly considered a disease. But lipodystrophy is normally defined in terms of an abnormal loss of fatty tissue. If we look at the various kinds of lipodystrophy, though, many of them are actually characterised by loss of body fat in some areas and abnormal deposits of body fat in other areas. Now think back to “syndrome X,” “metabolic syndrome,” that is, the collection of characteristics that appears to indicate someone is heading for type-2 diabetes. These include high triglycerides, high blood pressure, high blood sugar, and a particular distribution of excess body fat around the abdomen — the so called “apple body” — but not around the legs or arms.

Looked at that way, honestly, it seems a no-brainer to at least characterize “metabolic syndrome” as a disease, and in particular a variety of lipodystrophy.

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Top Rated Comments   
In 2000 I was a pretty hard & muscular 190 lbs. at 6 feet tall. In June of that year I had a leaking appendix that an incompetent surgeon tried to fix using the scope method. I was in the hospital for 10 days on IV antibiotics, went home for a week, then went back in with an abdominal abscess. They made a 12" incision, laid my guts out on the table, cleaned things up, and put me back on IV antibiotics. I damn near died, and was in the hospital for over 2 weeks the second time, which is an eternity in this day and age.

Three months later I weighed about 175, was starting to feel almost normal again, but noticed my vision was going downhill. I immediately went to see my optometrist, and was diagnosed a few days later w Type II. Thirteen years later I am about 270 and struggle to stay below there.

A few years ago I tried to tell a smart-ass-know-it-all arrogant jerk of a cardiovascular surgeon that severe trauma coupled with genetic tendencies (my father's family all struggled with weight) can bring on Type II, and that I can exercise my backside off, eat less than 1,800 calories a day, and still gain weight. He wouldn't listen - he just said "I've seen a thousand of you guys and it all comes down to will power." I left his office before I did something stupid and knocked him on his butt.

That jackass was wrong and so are some of you. Yes, there are some people who are fat just because they won't stop stuffing their cake hole. There are also people who for a variety of reasons can just sniff a baked potato and gain 5 lbs. That's a different story, and those of you who are more fortunate would do well to remember that.
42 weeks ago
42 weeks ago Link To Comment
All Comments   (66)
All Comments   (66)
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I did find it interesting, reading the book, "Good Calories, Bad Calories", that the question came up, "Are obese people obese because they are sedentary, or sedentary because they are obese?" Evidently, body changes accompanying increasing weight make it more and more difficult and unpleasant to get enough exercise, or something. In my own case, I had severe asthma as a young girl, and exertion made it hard to breathe,and so I was somewhat chubby (NOT obese),which ended when I went to college and walked many blocks a day just getting around the campus, and ate healthier. In Utah back then,40 years ago, the air was dry, too, and my asthma almost vanished,so I became semi-athletic, able to walk faster than most of my lean 6 footer guy friends. I lost18 pounds in 4 months.
42 weeks ago
42 weeks ago Link To Comment
As to homosexuality not being a mental illness, anyone following the news over the behavior of homosexuals before,during and after the voting on and passage of Prop 8 in California , for just one example,would have personally observed a LOT of behavior suggestive of SEVERE mental illness, totally apart from their homosexuality.
42 weeks ago
42 weeks ago Link To Comment
The major nationally recognized medical organizations lost my confidence when, back in the 1970s, the American Psychiatric Association de-classified homosexuality as a mental illness. Part of it was from intense pressure by the radical homosexual community, part of it was because there was no one universally effective cure for it, it being a complex problem. And the AMA has changed its mind over and over about egg eating, what fats are OK, etc., etc., and their renaming obesity as a "disease",to me, is stupid and disgusting. A "disease" is often contagious,and a cure for one patient with that disease generally works for ALL the patients. Obesity is not contagious,obviously, and no one cure seems to work,and calling it a "disease" may cause fat people to just give up on trying to achieve a healthier weight. "I'm SICK, not a lazy,overeating slob, I just have to await a CURE". Human nature suggests so,anyway.
42 weeks ago
42 weeks ago Link To Comment
This is all really very simple. If it is a disease, it gets an Officiamal Code Number in the Big Books of Medical Billing Codes. (ICD-9, et al).

If there is a code in the BBoMBCs, the physician or hospital can charge for "treating" it.


If there is not a code in the book, the physician or hospital can NOT charge for "treating" it.


So, everything under the sun has been gradually redefined as a "disease", so that it can be assigned a code, so that the physician or hospital can bill for "treating"it.

It doesn't matter in the least whether it makes sense or not. The evidence, the standards. the entire language, will be re-arranged as needed to make sure that a code gets assigned.


This has NOTHING to do with science, and EVERYTHING to do with $$$.

42 weeks ago
42 weeks ago Link To Comment
Obesity is not a disease. It is a condition - like medical knowledge is a condition.
42 weeks ago
42 weeks ago Link To Comment
No, obesity is not a disease. Neither is alcoholism.
42 weeks ago
42 weeks ago Link To Comment
Ah. And you received this knowledge from which supernatural figure?
42 weeks ago
42 weeks ago Link To Comment
I think the important thing to understand is that a higher accumulation of fat or a higher BMI is as result, not a cause. In discussing the term disease, we must return to talk of causes, not results. Let's move to a similar type of issue to show the different way we need to approach this.

I am naturally tan. I can sit in the sun all day long without much worry of becoming sunburnt. In this, I'd be comparable to someone who has a naturally high metabolic rate that can eat freely without worry about weight.

Now I have friends who by their different genetic lines are very pale skinned and burn easily. These are similar to those like myself who gain weight very easily and have to work hard to keep from gaining weight.

Then we come to those who have actual conditions, such as xenopigmentosum, that prevent them from having a normal relationship with sunlight.

As for all the talk of Diabetes and other associated conditions, many of them are a result of being overweight for a prolonged period of time. Similarly, prolonged exposure to the sun can result in skin cancer. In this way, the actual disease is a side effect of our behavior.

Like being overweight, being sunburnt is mostly about personal choices. Is it unfair that due to genetic differences, some have it easier than others in avoiding a poor result? Yes it is, but life is not fair.

I've always been overweight, even when my choices were not awful. When I hit 290 pounds last year, I realized that my choices had to be better than others if I wanted a normal result. Today, I'm 210 and still losing because of those choices.

Yes there are those for who normal day to day choices will not prevent obesity, but for them, there will be an underlying cause. Obesity is the result of a disease or condition, not the cause.

So, I'm against classifying obesity as a disease just as I am against classifying a sun burn as a disease. While either can have specific disease causes and too much of either can result in other diseases as a side effect, in most people, personal choices determine their results. As such, obesity doesn't meet the disease definition.

I should note, that I say all this despite the fact that I would financially benefit if insurance companies covered obesity as a disease.
My personal weight loss story can be found at www.theritterchallenge.com.
42 weeks ago
42 weeks ago Link To Comment
Sam, the thing about the notion that diabetes results from obesity isn't well proven -- it assumes a causal connection. At least with T2DM, it may be that "metabolic syndrome" is the disease and obesity a characteristic syndrome of the disease.
42 weeks ago
42 weeks ago Link To Comment
I agree Charlie. I believe diabetes can be the underlying cause of obesity or a result of obesity. Sometimes it is difficult to lay the finger on the proper cause. But for the latter, I do believe a lot of the blame falls on our own shoulders. Just as cancer is a disease, often our choices are the ultimate cause. Classifying poor choices as a disease gives us an "out" to say, "Hey, its not my fault." For me, my obesity was not a disease - it was a preventable condition. Medical focus should be on the causes of obesity.
42 weeks ago
42 weeks ago Link To Comment
But saying that disease as a model is an out gives people an excuse to say "ifg you just had self-discipline you wouldn't have this problem" and neglect research into treatment. Obesity has about the same remission rate as glioblastoma, a bad cancer.
42 weeks ago
42 weeks ago Link To Comment
About "heathy" humans' gut bacteria on high fat with low fiber diet vs low fat with high fiber diet see:
"Linking Long-Term Dietary Patterns with Gut Microbial Enterotypes"
Free full text = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368382/
And for Type 2 diabetes & probiotics technical report try:
"Intestinal mucosal adherence and translocation of commensal bacteria at the early onset of type 2 diabetes: molecular mechanisms and probiotic treatment"
Full free text = http://onlinelibrary.wiley.com/doi/10.1002/emmm.201100159/full
42 weeks ago
42 weeks ago Link To Comment
Meningitis is a disease. Cancer is a disease. Obesity is a condition. I'm sure cancer patients would love to have a problem that they could eliminate by expending more calories than they consume. Is no one responsible for anything anymore? If someone self-medicates with alcohol or drugs or food, she now has a "disease" that absolves her of any responsibility for controlling herself or introspecting or changing her thinking and behavior. She can't help it. Wah.
42 weeks ago
42 weeks ago Link To Comment
Well, no, strictly meningitis is a symptom: inflammation of the meninges. Cancer is a generic name for a whole bunch of diseases with some similar characteristics.
42 weeks ago
42 weeks ago Link To Comment
Fine. Malaria is a disease. Cancers are diseases. Obesity is a condition. Do you think your pedantry invalidates my point? Think again.
42 weeks ago
42 weeks ago Link To Comment
42 weeks ago
42 weeks ago Link To Comment
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