Culture

Is Obesity a Disease?

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.

Of course, this definition isn’t standard, at least partly because the social definition of obesity is that it’s because of bad behavior, even a moral fault. Which, frankly, is a pretty common social response to a disease with no obvious cause and a disfiguring result. Think of the way leprosy has been handled historically. Of course, we now know that leprosy, Hansen’s Disease, is just a nasty bacterial infection, hard to catch but also hard to treat.

Now, honestly, I think that we will eventually learn that obesity is not in itself a disease, but rather a syndrome, “a group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms.” I also suspect that some of what we’re calling obesity, in mild forms anyway, will be reclassified as “normal variation.” We talked some about that last week — mildly overweight doesn’t appear to actually hurt you, and may even be more healthy that being mildly underweight. Consider that recent modeling sensation Kate Upton has been criticised as being “fat.”

And yes, I am going to use that as an excuse to include a picture of Upton.

kate-upton

Is this “obese”?

The more obesity is considered a disease, the less it will be considered a moral failing to be addressed by nanny-state restrictions and the endless self-righteous prattle about how “you just have to eat less and exercise more.” All in all, I think that the AMA defining obesity as a disease is a good thing.


 

The hypothesis: a slow carb diet with intermittent fasting, along with continuing to work for greater integration of exercise into my daily life, will help me lose weight and improve my still too-high blood sugar. This is the third experiment of a 13 weeks duration, in an ongoing series. Follow my daily updates at Facebook and join me on Fitocracy to follow my progress there, of which there will be some. Honest.

So where am I this week? It’s hard to tell. I’ve lost some weight — right now, I’m losing weight at a rate of about a pound every five days, but I’m also bouncing on 269 lbs pretty hard — it’s hard to say if this different diet is changing this really stubborn plateau. My blood sugar continues good after the weird first week of the experiment where my blood sugar bounced up to as high as 140 — if we exclude that week, my average fasting blood sugar is down to around 108. And I have managed to get more exercise, in part because of nagging by a good friend who has been getting me out to walk in the evenings.

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