Seven Reasons Obesity is a Disease

The American Medical Association (AMA) –  has officially recognized obesity as a disease, joining the scientists of the NIH,  a move that could encourage physicians to pay more attention to the importance of addressing obesity, and spur more insurers to pay for treatments. Contrary to popular stigma obesity is not the result of eating too much or exercising too little.

Research has shown that obesity is far more complex than many people, and most physicians, understand.

 
Arguments Why Obesity Shouldn’t Be a Disease – and The Rebuttals 

(1) Obesity is preventable


Rebuttal: so is most heart disease, lung cancer, type 2 diabetes, trauma, food poisoning, osteoarthritis, and suicide. To state that something should not be a disease because it can be prevented is naive. First, we don’t know if it can be prevented – that is, while some would love to say all people have to do is eat less, the reality is we don’t know. Ever meet someone who eats junk food and never gains a pound – and yet you watch your overweight friend struggle with diet after diet?

Does this mean we should stop funding heart disease from those people who smoke, or those who have eaten the “wrong” diet? Never mind that we don’t know what the “right” diet is to prevent heart disease, or even obesity.

(2) Now that it is a disease it will cost us more to treat it

Rebuttal: Treating obesity is not popular among physicians. We do not have drugs that are effective, and less than 1% of those who meet the criteria for surgery get it. But not treating obesity does cost us – it leads to increased costs for heart disease, hypertension, sleep apnea, joint disease, and cancer. Today the US spends over 190 billion a year on health care related to obesity.

If we develop and have an effective treatment, then we can prevent a lot of other diseases, or manage them much better than we do now. The average price of weight loss surgery is far less than the average price of treatment of heart disease, or diabetes, or disability from obesity.

(3) Calling obesity a disease will increase the stigma

Rebuttal: Could the stigma for obesity could be any worse than it is? Teenage children who are obese, when tested with quality of life measures have the same outlook as teenagers with terminal cancer.

(4)  Calling obesity a disease will lead to a lack of personal responsibility for the disease

Rebuttal: Obesity is not a disease of personal responsibility. Does the person who eats “anything they want” and stay skinny have a lack of personal responsibility? Obesity may be a symptom of other underlying disorders, how they process food, or the choices. In 23 years of treating obesity most patients have tried multiple diets, gym memberships, or pills to try to loose weight and keep it off.

(5) It is going to increase health care costs by increasing physician bills,  prescriptions, surgery, and devices

Rebuttal: Most primary care physicians have no clue or desire to treat obesity. Few physicians want to treat obesity. Most general surgeons have no interest in doing weight loss surgery. If an effective pill, coaching, or workout routine cracks obesity – it will be quite popular, and no doubt every obese person will flock to it.

(6) The AMA overruled its own committee

Rebuttal: They did because the committee could not come up with a definition of disease. Imagine the other “diseases” out there we would have to ignore because of a lack of definition

(7) Obesity can be cured with (……) – fill in your favorite diet or workout routine

Rebuttal: If you go to primal diet sites, vegan diet sites, raw food diet sites all of them are saying if only they follow our routine they would not be fat and live a healthier lifestyle. For every confirmation bias of those who adopt those diets, there are people in my practice who have been unable to loose weight and keep it off following those diets. We just don’t know what people can do, follow, or if it really makes a difference.

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We surgeons continue to develop operations to fight obesity, but all are combined with some lifestyle changes. And no matter how safe any operation is, surgery has morbidity and mortality associated with it .

 

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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Latest Comments

  1. lynn says:

    My mother died of obesity (diabetes, heart disease, high blood pressure, kidney failure, etc). She did eat a high calorie diet. We kids were underweight non-eaters. Dinner time was an interruption of kick ball or other games. She tried diets but could not stick to them for very long. I lost the weight gained through repeated childbirth by following Weight Watchers and getting lots of exercise, There must be something to that.
    OTOH, my husband can only lose weight if he eats about 500 calories a day. He has a very slow metabolism.

  2. Noadi says:

    I have a different concern: That labeling obesity as a disease might reduce the incentive for doctors to look for underlying conditions causing weight gain which is already a major problem.

  3. Dr Simpson says:

    The only underlying disease for obesity now are thyroid (not really an underlying disease, and not a cause of obesity, but of another condition) and cortisol (again, totally different) – all are screened for, and in 23 years of doing this, never once have I seen that as a condition that can be treated and change the course. Think about heart disease 30 years ago, before hyperlipidemia- still a disease. Think of cancer today – we don’t know many of the causes – still a disease.
    It is a frustration business- we don’t have answers- we have a lot of questions

  4. Steve Courmanopoulos says:

    It’s all about turf. The medical profession also absorbed “mental illness” under its umbrella and opened the door for the medicalization of all problems of living, and ultimately their “treatment” with drugs. Look at the upcoming edition of the DSM (V): Too much laughter? You suffer from Excessive Hilarity Syndrome….here, take an SSRI. It goes back to the fundamental medico/scientific paradigm that everything is a function of biological processes that can be teased apart and “treated” with the appropriate (generally pharmaceutical or surgical) interventions. Were life so simple……

  5. Kyrani Eade says:

    You made a very pertinent point in asking “Does the person
    who eats “anything they want” and stay skinny………..?” When I trained in Aikido I
    learnt to key into the opponent’s breathing in order to know when to strike. At
    the in-breath the person has less power. Being a scientist and interested in
    health I decided to extend this exercise as an experiment. I watched the
    breathing of most people I came in contact with and I found that there were two
    basic types of breathing patterns, especially in people that are over or under
    weight. One type the person breathes very shallow, which makes it harder to
    judge their breathing. The other type breathes fully, which makes their
    breathing pattern easier to judge.

    I found that people who breathed shallowly tended to be
    heavier than those who breathed more fully. From my findings it appears that
    the ones that take deeper breathes may trigger their metabolism to work harder
    so they burn more fuel. This also tallies up with the fact that these people say
    that they tend to “feel the heat” especially when stressed in hot weather. The
    ones that breathe more shallowly store more fuel and hence gain weight. And
    these people also “feel the cold” especially if stressed in the winter time.

    This means that the overweight people can do something to
    help lose some of the weight and that is to change their breathing pattern. One
    suggestion I would give is to sleep under a canopy or tent so that the air has
    less and less oxygen during the night. This will make them breathe deeper and
    deeper during the night while they sleep. It is an easy way of changing their
    breathing pattern and with that their fuel consumption to storage ratio. So
    they can lose some weight even without changing their diet.

  6. Kyrani Eade says:

    I should add here that people with deeper breathing & thus elevated metabolisms can also put on weight if they are being stressed AND they use eating as self medication for that stress. The reason is that they do not benefit much from eating because of the fact that they breath too deeply. The degree of rest is insufficient as their metabolism is easily raised to a higher level. Hence they keep eat to try and regain some measure of rest. This of course will cause them to eat a lot of extra food and that food is stored. So a person with deep breathing and an elevated metabolism cannot effectively self medicate by eating something and using the process of digestion to try and force the body to rest conditions.

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