The American Medical Association recognizing obesity as a disease has been making big headlines and for good reason. Will defining obesity as a disease cause us to take it more seriously? Will it cause more physicians to pay closer attention to this condition? Will more insurers pay for treatment? Or will it encourage pharmaceutical companies to just push more drugs? And does it remove personal responsibility? I’ve had a chance to take in many different opinions and would like to share with you my own opinion on why I don’t think this definition is beneficial. First, I will share an opinion that was posted in a comment when I asked what you all thought of this issue on my Facebook page (emphasis added by me); “I am almost 60 years old and have struggled with weight almost my entire adult life and I did think it was a disease. After shedding a lot of weight and getting my health under control, I no longer think that obesity is a disease. I blame the doctors (certainly there are others to blame too) and the conventional wisdom they spew.”
So where does this leave us?
The cause and personal responsibility. When determining if obesity is a disease, it’s important to look at what causes the problem. Labeling obesity as a disease removes personal responsibility. It gives the implication that obesity is something you are born with or predestined to live with instead of managing with lifestyle modifications. “Fat shaming” certainly breaks my heart, as people assume that those who are overweight are that way because they don’t take care of themselves. The problem is that if these very obese people make an appointment with a dietitian or doctor, there’s a great chance they’ll be fed conventional wisdom that CLEARLY ISN’T WORKING. Low fat diets are STILL making us sicker and fatter — when will this craziness STOP!? Or maybe they’ll just be told to vainly count calories. The reason this doesn’t work is because it’s not just about quantity. Portion control definitely matters, but so does the quality of the food we’re eating. (Quantity AND quality! Not one over the other, but both.) Other factors matter too, because obesity is a complex condition. We need to consider the effect of hormones such as glucagon and insulin that determine if we are burning or storing fat, ghrelin and leptin that tell us if we are hungry or full, stress, gut health, quality and amount of sleep, timing of when we’re eating, and the list goes on. All of these various factors play into how our metabolisms are functioning and that number we see on the scale. How many healthcare professionals take all of this into consideration when evaluating a person’s weight status? In my opinion, herein lies the problem. I can’t tell you how many clients I’ve had who have irritable bowel disease, Crohn’s disease, or some other digestive concern and they’ve never been on a probiotic to heal their gut. Or, more commonly, how many people have been put on a low-fat or calorie counting diet where they continued to gain weight, and were told they just weren’t working hard enough? Or, how many people are surprised when I tell them that just because something is advertised does NOT mean it is healthy. (No, this is not common sense. But the truth is that 5%of advertisements are for whole foods.) I’m saying that obesity is not something we are born with, but a result of our environment and lifestyle choices. False marketing plus poor nutrition advice is a recipe for obesity. We need to look at what’s causing this problem in the first place before simply defining it as a disease and looking at treatment options. Which leads me to my next point…
The Drug Dilemma. If labeling obesity a disease means more insurance companies will cover my services, then great! I’m all for it. Unfortunately, I think it’s going more in the direction of drug therapy than nutrition education. This is because diseases are treated with drugs, and already drugs have been mentioned as something that will help people who are obese.
It’s Not About Willpower. Obesity as a disease means health care professionals can’t blame a person’s discipline or willpower. I already am not a big fan of willpower, as our actions are simply a result of the biochemical reactions that take place in our body, and when we can understand this and learn how to modify our physiology, we are empowered. For instance, it’s not just coincidence that the average time of day most people give into food temptation is 3:23 pm. It’s also no coincidence the majority of my clients tell me they don’t have “willpower” by mid-afternoon. If we’re following the SAD (Standard American Diet), then we eat a big lunch around noon. Basic physics tells us that what goes up must come down. In this case, it’s your blood sugar levels. Eating a big meal causes a surge in blood sugar levels, which makes them crash just as hard a few hours later. So, having sugar or carbohydrate cravings mid-afternoon actually has nothing to do with willpower and everything to do with biochemistry.
Maybe I'd have a different opinion if I didn't have a 100%success rate with my clients who come to me for weight loss. Maybe I’d have a different opinion if I were obese. But… that’s a double negative. Obesity is a problem we have a solution for. The problem is the right information isn’t being taught and instead obese people are being taught to work harder using strategies that are unsuccessful. Going the wrong direction with the right dedication will STILL make you miss your destination! Let’s spread the truth on nutrition and tackle this obesity epidemic once and for all. This being said, do note that obesity does not have a one-size-fits-all solution. As I mentioned above, there are several factors that need to be taken into consideration when developing a weight loss program for someone. If you want to start with a real food solution, please don’t hesitate to contact me. I take a big picture approach that many healthcare practitioners don’t take the time to do and I would love to help you.