Monday, June 24, 2013

Will Calling Obesity a Disease Cause Harm?

Some folks sure think so.

While there's no doubt there's always a risk of unintended consequences (and no doubt too that we should always be on the lookout for them to deal with them as they arise), exploring the arguments that arose last week with the AMA's description of obesity as a disease it would seem people are up in arms about some odd stuff. Here's a summary of the most common arguments against that I was able to find followed by some thoughts of my own:

1. Calling obesity a disease will cause insurance rates to rise

All of today's insurance policies require heights and weights and people are already regularly and routinely being rejected or penalized consequent to their weights.

2. Healthy people with obesity will now have a label of having a disease.

Given weight's visibility, they already do, except now society labels them as lazy and gluttonous. While labels are always misguided, which label do you think leads to more stigma?

3. People with obesity will now be able to call in sick simply consequent to their weight

This one's too stupid to bother with.

4. If we label people with obesity as "sick", they'll no longer want to try to lose weight.

Since when do we label people as "sick"? Are people with asthma "sick"? And moreover, are people newly diagnosed with asthma deciding not to take puffers due to their new "labels"?

5. Calling obesity a disease will increase eating disorders.

There is zero evidence that would suggest that this is a real risk. Established eating disorder risk factors include youth, being female, family history, mood disturbances, restrictive dieting, life upheaval, and certain career paths (ballet dancers, actors, models, gymnasts, etc). And while some are bound to comment that restrictive dieting will increase consequent to a disease definition (with no evidence to suggest this to be true), I'm hopeful that even were it true that over time a new way of thinking about obesity will help to illuminate the nonsense and medically unsound nature of highly restrictive dieting.

6. Calling obesity a disease will increase the severity of weight loss approaches.

Actually treating obesity as a disease would mean evaluating it as we do any other disease - as part of a whole picture and with varied penetrance (sticking with asthma, there's mild that requires an occasional puff or two all the way through a spectrum to major that requires regular and multiple medications). And we do have a means to do this with obesity - the Edmonton Obesity Staging System where for instance those with an Edmonton Obesity Stage of zero or one likely wouldn't be recommended treatment of any sort, but rather watchful waiting.

7. Calling obesity a disease will increase the notion that scales measure health.

While this in indeed a faulty notion I'm confused as to how we'll increase a notion that however faulty is already accepted by nearly everyone on the planet? The only direction left to go on this one is down.

8. Calling obesity a disease will lead people to think that it's contagious.

Do you think that asthma is contagious? How about glaucoma? Hardening of the arteries? Arthritis?

And then lastly,

9. Because lifestyle changes might treat obesity, labelling obesity a disease will dissuade folks from making healthful changes.

Here's some news for you. Lots of diseases are preventable or treatable through healthy lifestyles including hypertension, high cholesterol, coronary artery disease, diabetes, ischemic stroke, osteoporosis, cataracts, erectile dysfunction, and oh yeah, 40% of all cancers to name just a few. Yet no one has a problem with those diseases leading folks to consider pharmacologic or surgical interventions to help manage them. But then the world doesn't implicitly loathe people with cancer I suppose.