Physicians group labels obesity a disease(cnn.com)
cnn.com
Physicians group labels obesity a disease
http://www.cnn.com/2013/06/19/health/ama-obesity-disease-change/index.html
9 comments
It seems like calorie counting would be a good first-line treatment for difficulty controlling one's appetite. This requires a fair amount of discipline, but it's also free of side effects and tools already exist to help you. Do you think at least knowing A) what your basal metabolic rate is, and B) knowing how many calories you're eating (and consuming via exercise) is effective in combating this misfire in a body's signals?
I think a lot of the resistance to this is people are worried that the first-line treatment will be things like drugs, which can be expensive (to society, since costs are largely socialized even in the U.S. through the mechanism of health insurance) and have side effects. Look at, say, jrs235's comment ( https://news.ycombinator.com/item?id=5912203 ) elsewhere on this page. That's a valid concern. But obesity also comes with a lot of costs itself. If calorie counting is an effective approach, I think that it could address the problem in a cost-effective way. (And in a software way, too.)
I think a lot of the resistance to this is people are worried that the first-line treatment will be things like drugs, which can be expensive (to society, since costs are largely socialized even in the U.S. through the mechanism of health insurance) and have side effects. Look at, say, jrs235's comment ( https://news.ycombinator.com/item?id=5912203 ) elsewhere on this page. That's a valid concern. But obesity also comes with a lot of costs itself. If calorie counting is an effective approach, I think that it could address the problem in a cost-effective way. (And in a software way, too.)
I calorie count, that's how I get through the day. However, it's worth noting that calorie counting is a depressing thing to do. I've experienced very much the feelings that I read about for diabetics (type 1) and people who are severely impoverished. Every cost has to be counted, every extravagance planned for, every unexpected event has to be compensated for. I overate at the start of the week, so I need to cut back at the end. It's difficult to count calories when I don't have the figures, which means I can no longer be the spontaneous social eater I want to be. I miss that badly.
I like to say it's like going from never having to think about how much money you spent to having to count every.single.penny. It's not 'I should skip that holiday in the maldives this year', it's 'Can I afford that trivial expenditure (a single piece of fruit) today? will I be too hungry to sleep if I cut that out of tonight's dinner?'
I like to say it's like going from never having to think about how much money you spent to having to count every.single.penny. It's not 'I should skip that holiday in the maldives this year', it's 'Can I afford that trivial expenditure (a single piece of fruit) today? will I be too hungry to sleep if I cut that out of tonight's dinner?'
Another thing is how hard it actually is to know your BMR, and expenditure. Most foods have vast variation in nutritional content, and post-obese people have a great ability to put on weight (up to 30% lower calorie requirement, which is a hell of a lot when you are already cut down).
I'm not entirely sure that it's a disease, but I do agree that losing weight is a non-trivial exercise. I'm a good amount overweight myself, and it's only been due to the extremely lean times brought on bootstrapping a company that I've been able to effect meaningful weight loss.
For people that aren't overweight, here's an attempt to convey what living this way feels like:
You can't eat "normal" amounts of food. You eat, a lot, and you feel completely distracted if you can't get what you normally eat. You may eat a snack or full meal before going out with friends just so you don't look like a complete pig. Down to your last dollar, you buy a burrito and cry as you eat it, because you know that you can't afford it but it at least makes your brain stop yammering uncontrollably about needing food.
You can't wear clothing that feels good and looks attractive without doing shopping for boutique stuff. You are lucky, damned lucky, if you can find a shirt that fits and doesn't look dumb on you.
You try to go out and exercise--and you're not weak. You've probably got better-defined legs than most of your skinny friends. However, three weeks into your couch-to-5k, your knee starts freaking out and you have to stop. Pants and jeans chafe on your thigh fat if you walk long distances.
You have a constant, inexplicable negative modifier to members of the preferred gender. You can be the richest, wittiest, sweetest person they've ever met, but it feels like you must work twice as hard to be charming because they do not view you as something physically attractive, and never will. You literally are playing a shit hand in the game of life.
If you attend university, you are surrounded by happy and affluent youths who are in all likelihood much more attractive than you are and put off by your appearance (if you're a smoker, you know this feeling well). You stick out like a sore (swollen) thumb at any gathering.
You are increasingly viewed as lower class and weak-willed for your troubles. There is a very strong socioeconomic correlation with body fat percentage, and you are again a sore thumb sticking out when in the presence of happy yuppies.
You are always a silent witness to folks complaining about their own weight or making fun of your friends. The best folks will exclude you from these remarks, but that's even worse--you're simply too fat to make jokes about in good spirits, and so are excluded.
You are marketed to and pandered to in the most cynical of ways, targeted by ads that are insulting in their attempt to grab you. "Learn one funny trick to lost 5 lbs. in a week". "Eat this shake for a month to lose 20 lbs.". "Blast your abs in fourteen days." Worse, you know that you could fall for this, if things were a bit more desperate.
~
The worst part of this, of all of this, is this.
Let's say you're a hundred pounds overweight. For a male, that's about 270-280. So, if you bust your ass, you can probably get back to healthy weight (180) in nine or ten months (at ten pounds per month, which is nontrivial). Really, really bust your ass to do this.
You decide this, and the sad sorry fact is that you will not see progress of any sort for a few months. You'll be suffering for a long while, seemingly for naught, and you must bull through to make it happen. And all of the above still applies while you are trying this, and the prevailing knowledge is that you won't be able to stick to it to pull it off. And at the end of it, you'll probably be disfigured and scarred with extra skin and stretch marks.
It's fucking miserable to be a prisoner in your own body, every encounter with others a reminder of your own shortcomings and seemingly every ad or show or picture in media a confirmation that you are a failure as a human being.
Being fat sucks.
For people that aren't overweight, here's an attempt to convey what living this way feels like:
You can't eat "normal" amounts of food. You eat, a lot, and you feel completely distracted if you can't get what you normally eat. You may eat a snack or full meal before going out with friends just so you don't look like a complete pig. Down to your last dollar, you buy a burrito and cry as you eat it, because you know that you can't afford it but it at least makes your brain stop yammering uncontrollably about needing food.
You can't wear clothing that feels good and looks attractive without doing shopping for boutique stuff. You are lucky, damned lucky, if you can find a shirt that fits and doesn't look dumb on you.
You try to go out and exercise--and you're not weak. You've probably got better-defined legs than most of your skinny friends. However, three weeks into your couch-to-5k, your knee starts freaking out and you have to stop. Pants and jeans chafe on your thigh fat if you walk long distances.
You have a constant, inexplicable negative modifier to members of the preferred gender. You can be the richest, wittiest, sweetest person they've ever met, but it feels like you must work twice as hard to be charming because they do not view you as something physically attractive, and never will. You literally are playing a shit hand in the game of life.
If you attend university, you are surrounded by happy and affluent youths who are in all likelihood much more attractive than you are and put off by your appearance (if you're a smoker, you know this feeling well). You stick out like a sore (swollen) thumb at any gathering.
You are increasingly viewed as lower class and weak-willed for your troubles. There is a very strong socioeconomic correlation with body fat percentage, and you are again a sore thumb sticking out when in the presence of happy yuppies.
You are always a silent witness to folks complaining about their own weight or making fun of your friends. The best folks will exclude you from these remarks, but that's even worse--you're simply too fat to make jokes about in good spirits, and so are excluded.
You are marketed to and pandered to in the most cynical of ways, targeted by ads that are insulting in their attempt to grab you. "Learn one funny trick to lost 5 lbs. in a week". "Eat this shake for a month to lose 20 lbs.". "Blast your abs in fourteen days." Worse, you know that you could fall for this, if things were a bit more desperate.
~
The worst part of this, of all of this, is this.
Let's say you're a hundred pounds overweight. For a male, that's about 270-280. So, if you bust your ass, you can probably get back to healthy weight (180) in nine or ten months (at ten pounds per month, which is nontrivial). Really, really bust your ass to do this.
You decide this, and the sad sorry fact is that you will not see progress of any sort for a few months. You'll be suffering for a long while, seemingly for naught, and you must bull through to make it happen. And all of the above still applies while you are trying this, and the prevailing knowledge is that you won't be able to stick to it to pull it off. And at the end of it, you'll probably be disfigured and scarred with extra skin and stretch marks.
It's fucking miserable to be a prisoner in your own body, every encounter with others a reminder of your own shortcomings and seemingly every ad or show or picture in media a confirmation that you are a failure as a human being.
Being fat sucks.
This is all quite true, and very much how I feel. I am finding maintaining my weight much harder than losing. I have not lost my appetite, or my habit of bingeing when triggered. It's a life-long struggle.
Great.
1. So now they can prescribe more drugs to more people. 2. Insurance providers will have to pay for more drugs continuing to drive health insurance prices up. (I'm sure the government will mandate that providers can't have plans that omit coverage for weight related services and drugs).
P.S. I'm trying not to be mean, just pointing out the harsh reality and truth. We as a populace have become lazy and complacent. Rome II is about to crumble unless we stop addressing the symptoms and focus on the disease.
1. So now they can prescribe more drugs to more people. 2. Insurance providers will have to pay for more drugs continuing to drive health insurance prices up. (I'm sure the government will mandate that providers can't have plans that omit coverage for weight related services and drugs).
P.S. I'm trying not to be mean, just pointing out the harsh reality and truth. We as a populace have become lazy and complacent. Rome II is about to crumble unless we stop addressing the symptoms and focus on the disease.
That's quite a bit of hyperbole.
My view is quite different. The Human body evolved to survive in certain ecological niches. And, very quickly, those environments changed. So, it's not surprising that the body hasn't kept up.
Your moral angle has a good ring to it, but I think it's misguided. From a moral standpoint, I think it's much better to use our evolutionary strengths (big brains, etc.) to let us invent technology to overcome the slowness of evolution. What benefit is there in forcing people to tough it out when their biology simply wasn't made to cope?
Plus, it's actually probably cheaper to invent new drugs to treat obesity (curbing appetite) than the more intensive, invasive treatments for diabetes, heart disease, etc.
My view is quite different. The Human body evolved to survive in certain ecological niches. And, very quickly, those environments changed. So, it's not surprising that the body hasn't kept up.
Your moral angle has a good ring to it, but I think it's misguided. From a moral standpoint, I think it's much better to use our evolutionary strengths (big brains, etc.) to let us invent technology to overcome the slowness of evolution. What benefit is there in forcing people to tough it out when their biology simply wasn't made to cope?
Plus, it's actually probably cheaper to invent new drugs to treat obesity (curbing appetite) than the more intensive, invasive treatments for diabetes, heart disease, etc.
My guess is that eventually we'll confirm something like the "fat virus" hypothesis and be able to immunize kids (to some degree) against becoming obese.
There exist human cold viruses such that if you give that particular cold to an animal, the animal gets fatter. We don't directly test these viruses on people due to ethical concerns - we're pretty sure they'd make people fat too, and there's no cure. But you can look at biomarkers for exposure and verify that people who've been exposed are more likely to be fat than those who haven't.
Here's a study: http://www.ncbi.nlm.nih.gov/pubmed/17908526
Quote: "This review discusses the 5 animal viruses and 3 human viruses that have been shown to cause obesity and examines the evidence to date for virus-induced obesity. [...] Ad-36 causes obesity in chickens, mice, rats, and monkeys and was present in 30% of obese humans and 11% of nonobese humans. In twins discordant for infection with Ad-36, the infected twins were heavier and fatter than their cotwins."
There exist human cold viruses such that if you give that particular cold to an animal, the animal gets fatter. We don't directly test these viruses on people due to ethical concerns - we're pretty sure they'd make people fat too, and there's no cure. But you can look at biomarkers for exposure and verify that people who've been exposed are more likely to be fat than those who haven't.
Here's a study: http://www.ncbi.nlm.nih.gov/pubmed/17908526
Quote: "This review discusses the 5 animal viruses and 3 human viruses that have been shown to cause obesity and examines the evidence to date for virus-induced obesity. [...] Ad-36 causes obesity in chickens, mice, rats, and monkeys and was present in 30% of obese humans and 11% of nonobese humans. In twins discordant for infection with Ad-36, the infected twins were heavier and fatter than their cotwins."
On the other hand, AMA's declaration could help increase funding for future obesity research. It could also lead to payment for doctors who want to simply talk to patients about nutrition or exercise -- time that's not currently reimbursed by insurance plans.
I don't know enough about medicine to discriminate well between a disease, condition, syndrome etc., but some of the points made in the article make it sound like this new designation of obesity as a disease is mainly to do with appearances.
I don't know enough about medicine to discriminate well between a disease, condition, syndrome etc., but some of the points made in the article make it sound like this new designation of obesity as a disease is mainly to do with appearances.
Probably we're overthinking the whole thing. When I was a kid, obese people just ate too much.
There's a difference between being overweight and being obese you know.
Some obese people do eat a lot, but the causality direction is unclear. It's likely they eat a lot in large part because they're obese.
The human body in general is amazingly good at calibrating how much you eat versus how active you are to stay within a pretty consistent weight range - if it weren't, we'd all starve or become morbidly obese in response to tiny inadvertent changes in diet or exercise. But in some people, that calibration mechanism is off - they feel hungrier than they should or their metabolism works slower than it should given their size, and the mismatch leads them to become obese. We don't yet know why and we don't yet know what can be done to reliably change or fix it.
We've almost certainly been underthinking the whole thing.
The human body in general is amazingly good at calibrating how much you eat versus how active you are to stay within a pretty consistent weight range - if it weren't, we'd all starve or become morbidly obese in response to tiny inadvertent changes in diet or exercise. But in some people, that calibration mechanism is off - they feel hungrier than they should or their metabolism works slower than it should given their size, and the mismatch leads them to become obese. We don't yet know why and we don't yet know what can be done to reliably change or fix it.
We've almost certainly been underthinking the whole thing.
How long ago was that, if I may ask?
This is huge and, regardless of what you think of its labeling, will forever change the way we treat obesity. It's become a real problem in the US and as much as we would like to blame obesity on an individual, the country as a whole is suffering bc of it. It impacts our health, our relationships, and even our economy, and it's time to step up to make some real changes here.
My take - shouldn't be a disease.
Reasoning: most diseases have a direct "cause and effect" - if you can't eat healthy because you weren't forced to eat anything other than chicken nuggets as a child, that may well be a disease. (My GF suffers from this; she says we will serve mini hamburgers and chicken fingers at our wedding...) But obesity in general, to me, is not a disease.
However, if labeling it as a disease can help people in any way to get on the path to a healthier lifestyle, then it doesn't bother me. Calling it a disease should not be a crutch, but hopefully a way to address the problem. I believe insurance companies will have to cover operations that can help people lower their weight.
I believe in Canada our health plan covers that, kind of bugs me though because it comes from my taxes rather than paid insurance.
Reasoning: most diseases have a direct "cause and effect" - if you can't eat healthy because you weren't forced to eat anything other than chicken nuggets as a child, that may well be a disease. (My GF suffers from this; she says we will serve mini hamburgers and chicken fingers at our wedding...) But obesity in general, to me, is not a disease.
However, if labeling it as a disease can help people in any way to get on the path to a healthier lifestyle, then it doesn't bother me. Calling it a disease should not be a crutch, but hopefully a way to address the problem. I believe insurance companies will have to cover operations that can help people lower their weight.
I believe in Canada our health plan covers that, kind of bugs me though because it comes from my taxes rather than paid insurance.
There is something to suggest that obesity is more than simply having a bad diet. Obese people react differently to food, and it appears to have a genetic correlation.
One paper suggests that there is a dopamine response difference in the obese: http://www.ncbi.nlm.nih.gov/pubmed/11210998
The causal direction is open to interpretation, but I still think that there is a difference between 'overweight' and 'obese'
One paper suggests that there is a dopamine response difference in the obese: http://www.ncbi.nlm.nih.gov/pubmed/11210998
The causal direction is open to interpretation, but I still think that there is a difference between 'overweight' and 'obese'
"genetic correlation"
this probably plays a part in it for some, but only a small part if I would have to guess, there's way more to it.
First sign there's much more going on than just 'a disease' is the fact there are way more obese people in the US for instance than in most other countries. And also for instance that children where both parents are obese are more likely to develop obesity as well. First comes down to culture, second to lifestyle. Not two things I'd directly associate with words like 'genetic or 'disease'.
this probably plays a part in it for some, but only a small part if I would have to guess, there's way more to it.
First sign there's much more going on than just 'a disease' is the fact there are way more obese people in the US for instance than in most other countries. And also for instance that children where both parents are obese are more likely to develop obesity as well. First comes down to culture, second to lifestyle. Not two things I'd directly associate with words like 'genetic or 'disease'.
I can't say I agree with this analysis. In the first instance, the fact that both parents' obesity is a factor could be argued to point towards a stronger correlation. In a broad sense, it's also important to note that chronic diseases always have some behavioural and lifestyle component. For example, physical malformations can be caught early and given therapeutic redress -- Scoliosis correction might be a good example.
You're not condemned to be obese if your genetics give you the propensity for it, but it's also fair to say that the genetics mean that disease-like interventions are necessary. http://www.hsph.harvard.edu/obesity-prevention-source/obesit...
You're not condemned to be obese if your genetics give you the propensity for it, but it's also fair to say that the genetics mean that disease-like interventions are necessary. http://www.hsph.harvard.edu/obesity-prevention-source/obesit...
I wholeheartedly look forward to the lavish dinners at doctor conferences where they discuss this malady.
Joining alcoholism in the area of diseases you can get yelled at for having. Damn it Otto, you're obese!
I do think that there is a clear difference between 'I should cut back on the cakes'-type overweight, and 'I have inadequate control over my eating'-type obesity.
It's not as simple as 'eat less', 'put the fork down chubby' or 'get out and run/lift/whatever'. I have trouble with controlling my appetite, and I have issues with knowing when I should stop eating (it's quite hard to hold back when every body signal indicates you are still very hungry).
In my view obesity is a disease, but it's false to think of it as being like the 'flu. It's a chronic issue, like high cholestorol, blood pressure or a peanut allergy. There are environmental factors and behavioural reasons why it is a health risk, but the underlying cause has a physiological source.