Obesity Is Now A “Disease”

No surprise that diseases are political. What are we marching “against” this week?

Never mind. What you might not have known is that how the word is applied is decided by politics. Stubbed toes are not a disease, but self-inflicted drunkenness is. And don’t let’s get started on mental “diseases.” “Johnny is not acting like a girl. This pill will cure him.”

Never mind! The AMA decided to call obesity a “disease.” Here’s the key quote: “being overweight or obese increases the risk of health conditions and diseases including”, well, everything.

I want you to repeat the logical truth with me “‘Increases the risk of’ does not mean has.” Chant that twice or thrice and then memorize this example. If you have a risk of 0.0000000001 of contracting a malady, and if you engage in a behavior which triples that risk, you now have a risk of 0.0000000003. Call the EPA.

Next comes figures in dollars. Obesity costs X dollars, heart disease Y. Everything human reduced to money. How depressing.

The AMA and the American Association of Clinical Endocrinologists have concluded

that the disease of obesity must be addressed using a robust medical model for treatment and prevention that includes lifestyle modifications, medications, and surgery together with interventions targeted to public education, behavioral change, and the built environment.

Bioedge rightly says this decision will “medicalise a condition which affects one-third of all Americans.” Yes, soon everybody will have a disease, and since diseases require intervention, everybody will have to be looked after. And because diseases cost money, as we are endlessly reminded, the more people classified as having a disease, the greater the costs will be, therefore the louder the call for more “investment” into prevention and “cures.”

That in course means a larger bureaucracy, which will recognize the problem is ever “growing worse.”

At least we can be cheerful with the implication that, since obesity is now a disease, it isn’t the fault of those that catch it. That is, it’s not your doing. But since everything has to have a cause, and the disease wasn’t caused by those who have it, it must be somebody’s fault. Probably somebody with money. Say food companies and restaurants.


27 Comments

  1. … and makes for full time occupation by first ladies and employs fawning “journalists” to cover it.

  2. “being [insert anything] increases the risk of health conditions and diseases including…”

    With this definition of disease and the next medical study claiming

    Related to life expectancy choosing a wife is easy for men – the younger the better http://www.medicalnewstoday.com/articles/188621.php

    There is only one conclusion: Single men are sick people; The Doctor Says So!!!

    So, please, government, will you be so kind to provide young wives to all of us? It is a health issue… thanks.

  3. I thought obesity was already an epedimic so it must be a contaigous disease. Can I call my employer monday morning and tell them I won’t be in today becaus i’ve caught obesity?

  4. The increase in obesity correlates with the increase in governmental intervention/regulation/taxation/meddling. See where I’m headed with this?

  5. “I thought obesity was already an epedimic so it must be a contaigous disease.”

    It is a contagious disease: https://en.wikipedia.org/wiki/Adenovirus_serotype_36

    A certain amount of weight gain with age is natural and healthy (see “obesity paradox” for statistics) but there is also such a thing as morbid obesity, which is most definitely a serious medical condition. Under normal circumstances the body’s energy balance is controlled by a complex system of hormones and signalling molecules, which control the appetite, in much the same way that other aspects of body biochemistry like oxygen, salt, insulin, and so on are controlled. Nobody faints because they forgot to breathe enough. And contrary to popular opinion, when your body thinks you’ve had enough, it’s actually very difficult to force yourself to eat any more. They did experiments where paid volunteers were asked to over-eat, and they found it nearly impossible.

    Morbid obesity is caused by a derangement of this system, and when it’s broken, it’s as hard to control your eating as it would be to control your breathing if your brain incorrectly said you wasn’t breathing enough. It’s not due to “lack of willpower”. It’s not stupidity or greed. When it gets so bad you can’t walk, or get out of bed, it’s an illness.

    However, the mild obesity that goes with age and body type is a different affair. Again, it’s not really under conscious control, but it’s a far more minor risk factor that the medical profession ought to butt out of trying to “fix”.

    The biggest factors affecting it are age and genetics. It’s also been connected to certain varieties of gut bacteria that can make digestion more or less efficient, certain sorts of exercise regime, carbohydrate balance, certain nutrient deficiencies, and as I noted, some infections seem to damage part of the control mechanism like Ad36. As Ad36 is a variety of the common cold virus, you should be no more likely to get a day off work than you would for a few sniffles. Mild obesity is probably less dangerous than influenza.

  6. But wait. Does not sodomy “increase the risk of” contracting AIDS? Is then male homosexual behavior a “disease” to be addressed with “behavior modification” and drugs? What are they thinking?

    Does not skiing (and most other sports) “increase the risk of” orthopedic injuries? Is then skiing a “disease” to be addressed with “behavior modification” and drugs? What will their friends at Gstaad think?

    Does not eating, as such, “increase the risk of” food-borne illness? Is eating a “disease”?

    Forsooth.

  7. Nullius: I’m not sure there is actual science backing the “deranged system”. I have read obese people have less sensitive taste buds, so they eat sweeter and fattier foods. Breathing and eating are not even close to the same–one is the autonomic nervous system, the other voluntary.

    I will agree that being forced to eat when you are not hungary is difficult. However, since I have to eat at least 4 times a day, and more if I miscalculate on insulin, I can attest to the fact that you can keep stuffing food into yourself even when you are full or sick. I do sometimes wonder if forcing people to overeat would reduce appetite, though. The problem is people don’t just sit down and inhale 8 big macs one day. The weight gain is often gradual and the increased calorie intake becomes normal. Volunteers would do the same if you added a few hundred calories a week to their diet–they would adapt.

    As noted above, eating is voluntary How much is a matter of choice. People can and do get up and walk away from the table. Overeating may also be a response to emotional issues. However, none of this places it in the “not-my-fault-its-a-disease” category. It’s just cop-out and an attempt to wrench even more control from people’s lives.

  8. Sheri,

    Even the word “overeating” implies a theory of obesity unsupported by the facts. Mainly the common misconception that overweight people eat more than others. A useful dose of reality is to do the numbers based on the rough conversion of 3500 calories per pound and to realize that extra food is not required in other to maintain extra weight in the form of fat. I will not support a theory of obesity that does not do the numbers. So do the numbers and show me how you can control food intake and exercise output to a few calories per day.

  9. Only a person trying to fail at losing weight would cut calories to a few hundred per day. As noted, people don’t get obese overnight and they don’t lose weight overnight. You don’t drop 3500 calories per day to lose weight. You drop 500 calories per day and lose a pound a week. Yes, it takes much longer to lose weight that way, which is both why people give up and why people succeed. The same is true for exercise–you start by walking a few blocks, then keep working your way up. Most weight loss failure is due to the person using a proven unsuccessful technique and then blaming the technique for failure.

    Basic biology/physics says calories that are used up don’t add weight and calories not burned do not go to fat. Unless you have evidence that physics is wrong and years of study missed some crucial element, calories and exercise still are the determining factors in weight.

    Before you jump in about metabolism and genetics, yes, these do have some effect. It is harder for some people to lose weight and some people will never be rail-thin. However, I guarantee if you give me a person and allow me to 100% control their food intake, they will lose weight.

  10. Sheri,

    If you have the solution to a problem that has evaded everyone else through all of human history you should definitely publish. Yes, you can make anyone lose weight through starvation, but this is not a desirable diet method or one that will gain popularity. What years of study are you referring to? The studies that I am familiar with show exactly the opposite. I am curious as to what principle of physics gives support to your position. I believe that I could follow the argument. I am still waiting for the numbers. Specifically I would like to see how you can measure, yet alone control, a daily energy balance to the accuracy needed to consciously control body weight to within a few pounds. The body metabolism must have its own feedback mechanisms to do this separate from conscious control much the same as is the case for breathing. We fool ourselves because we can exert short term control. This cognitive bias is very difficult to overcome. But as Feynman said science is the belief in the ignorance of experts.

  11. Scotian: You are deliberately twisting what I say. No where did I say I would “starve” someone to lose weight. That’s your term and a great way to avoid even trying to lose weight. Call it starvation and pronounce it evil.

    I don’t need studies to prove that eating more calories than you burn causes weight gain. It’s physics/biology. There are factors that feed into how many calories you burn and hormones,etc, can have an effect. See: http://www.webmd.com/diet/features/5-surprising-reasons-you-are-gaining-weight

    However, I will stand by my statement that you give me virtually any person who wants to lose weight and let me determine their food intake and they will lose weight. This is seen in the diet programs where they send the food to the person. As long as the person only eats the food sent, they lose weight. Of course, once they are on their own, they can return to old eating habits and gain weight. One sees this all the time.

    I’m not worried about Feynman since I am not relying on the ignorance of experts, but rather actual observations. I certainly would not agree with diet experts in many cases. I also won’t disagree with what is easily proven. Eating less will cause weight loss. The problem is not “eating less” but why the person eats what they do and why they will not cut back. Then we get into psychology and that’s a whole lot more complex. Unless you want to call obesity a mental illness, then I could agree that the causes are very complex and not easily solved. It doesn’t change the physics of calories in/calories burned/calories stored, but it does allow a lot of wiggle room for failure and not being able to find the “cause”.

    (Again, obesity is not related to the autonomic nervous system. Metabolism is, meaning you have little control over how your body uses food and even that is a stretch. You are arguing that we cannot control what goes into our mouths, so it’s not our fault. No way. It just makes it more difficult for some people to maintain or lose weight and may provide a convenient excuse not to try.)

  12. Sheri,

    Still no numbers? I know that you are absolutely convinced that what you say is true as a great many people have the same misconception. The human body is no way as simplistic as you have described it. Since you will not give the numbers I will have to. You wish to control weight by restricting intake, so we will focus on that first. There are two basic approaches. The first is to count calories and to do this we need to consider the uncertainty of our knowledge of calorie content. This can easily be 20%. But even at 10% this represents about an extra pound weight gained or loss over ten days. The uncertainty of energy expended through exercise is at a similar level. Thus counting calories is out. The second method is the one that most people attempt and involves the use of a bathroom scale. When you see that you are gaining too much weight you cut back and similarly eat more if your weight drops too low. This leads to the familiar yo-yo effect that plagues most dieters. In the short term this can seem to work but sooner or later your body takes exception to what you are doing and the weapons in its arsenal are formidable. Your body can not distinguish between the weight loss that your mind may desire and starvation. You will be hungry all the time and think of nothing but food. You will also have no energy or interest in anything but food. The despotic approach that you suggest is nothing short of torture. You may not like the word starvation but that is what it is.

    The conservation of energy that you mention is a complete red herring. The question here is control not energy balance. Energy will always balance, but not necessarily where we wish it to.

    If you think about it the body has to operate as I have suggested. It can not rely on us remembering to eat or our ability to estimate food intake as we would accidentally starve to death. Fat people on diets are starving and it is frankly pompous to suggest that they lack will power. Please consider that you may be wrong.

  13. ” I have read obese people have less sensitive taste buds, so they eat sweeter and fattier foods. Breathing and eating are not even close to the same–one is the autonomic nervous system, the other voluntary.”

    You would have thought if people had less sensitive taste buds, they’d be less inclined to overeat. What’s the appeal if they can’t taste it? Although as noted by Scotian, there’s very little relationship between the amount eats and their weight.

    Breathing is voluntary too – you can hold your breath quite easily. If someone persuaded you that oxygen was unhealthy (which is about as sensible an idea as that stored energy is unhealthy) you could hold your breath for a minute or two and then subsequently only breath the absolute minimum you had to, and keep your oxygen level consistently low. It’s just a matter of willpower.

    ” Most weight loss failure is due to the person using a proven unsuccessful technique and then blaming the technique for failure.”

    Almost all techniques are unsuccessful, in the long run.

    ” Unless you have evidence that physics is wrong and years of study missed some crucial element, calories and exercise still are the determining factors in weight.”

    Yes, but what are the determining factors in calories and exercise?

    The biological homeostasis sets upper and lower limits on the weight your body thinks you ought to be. These limits are mostly genetic, but also increase with age. If you exceed the upper bound, your appetite vanishes and food stops tasting good, while your metabolism accelerates to burn the excess.

    If you drop below the lower bound your appetite increases until it becomes an obsession, you crave fatty, sugary foods, you feel cold and lethargic, and your metabolism slows down. Reduce the intake still further, and the reduction in metabolism starts to make you feel ill, the body switches to burning protein and you lose muscle mass, and it becomes very difficult to get enough micronutrients. The metabolism switches modes, various other non-essential systems (like the immune system) shut down to conserve energy, and your body becomes far more efficient at using what energy it can get. The mechanisms no doubt evolved to cope with the periodic famines that were once mankind’s lot. You have to reduce intake even more to maintain the weight loss. Eventually it starts to do permanent damage, and then it kills you.

    Have you ever considered the effect of temperature? You burn food to stay warm, which means you ought to burn a lot more in winter than in summer, and people in hot countries should burn a lot less than people in cold ones. Why are people in hot countries not fat? Why don’t we get fatter in summer and thinner in winter? Because homeostasis controls our intake and expenditure with exquisite precision – you eat getting on for a ton of food over a year and at the end of it your weight is usually within a few pounds of what it was when you started. That’s less than 1% error, which is more accurate than our best measurement of calorific content is for most foods. It can vary quite freely within a certain range, but it doesn’t generally stray far beyond that range.

    Why people would think that the body gets it wrong when it comes to energy balance, despite its obvious skill at managing every other biochemical process, is a mystery to me. There’s something about health scares that appeals to people. As I said, sometimes the mechanism does genuinely go wrong and people become seriously ill from overeating or undereating (anorexia) but when that happens its pretty obvious.

    The main advantage (and I suspect the real reason for it) is cosmetic. Because the natural weight bounds increase with age, being slimmer makes you look younger and more sexually attractive. Hence the appeal.

  14. I stand by my statement that if you eat what I tell you to eat, you will lose weight. You cannot cheat, you cannot lie about your current diet. I can prove I am right–can you prove me wrong? Take the challenge or send me someone who can. I don’t need numbers–just someone who can follow directions. Until then, I’m done. You have ventured into fantasyland and I cannot have a rational discussion when the rules of physics are completely disregarded. I must say you two are the first to seriously claim someone can eat 500 calories a day and weigh 500 lbs. I really would like to meet that person. (If food intake is NOT why a person is fat, then there has to be a 500 lb guy out there eating 500 calories a day due to some mysterious metabolic thing. I’ll even settle for a sedentary woman who eats 5000 calories a day and weighs 90 lbs.) When you send said person my way, I will reconsider.

  15. Sheri,

    You really need to carefully reread what Nullius and I have written. The study that proves you wrong was done in 1944 and is discussed here:

    http://junkfoodscience.blogspot.ca/2008/02/how-weve-came-to-believe-that.html

    I really hope that you carefully read this article. As a physicist I am also very curious why you think that I causually disregard its rules or that anything that I have said is in contradiction. For some reason you are seeing something very different than what I have written in my words.

  16. Scotian: We are not talking about the same thing. You are looking at a starvation study. I am not talking about starvation in any way. As far as I can tell, that is where we run down separate tracks. I am looking at gradual reduction of calories that allows the body to readjust to the new caloric intake. No shock to the system. Just a gradual change in eating habits. I am also not talking about people being all rail-thin. Some people are heavier than others, of course.

    I read what you are saying is eating 5000 calories a day is not why someone is obese. To me, that is unfathomable. How can anyone stay thin by eating 5000 calories a day? As stated before, show someone weighing 500 lbs who eats 500 calories a day or someone eating 5000 calories a day that weighs 90 lbs.

    As for why I think you are disregarding reality and weight gain/loss, I am a diabetic who counts calories all the time. If I increase my caloric intake, I gain weight. If I decrease it, I lose weight. Virtually every time if my activity level remains the same. If there is no correlation between food intake and weight, then I just happen to coincidentally gain and lose with caloric intake adjustments. That seems far less likely than it’s the caloric intake.

  17. Sheri,

    You’re missing the point. Of course calories have an effect, and of course the rate of change of weight is proportional to the difference between calories consumed and calories burned. But that isn’t all there is to it.

    The point we’re making is that both the calories consumed and the calories burned are subject to additional complicated control systems, that keep the two in fine balance within fixed bounds. No you can’t stay thin on 5000 calories a day, but you can maintain a constant (over-)weight on it. No, you can’t stay fat on 500 calories a day, but you can maintain a constant (under-)weight. All you have to do is burn less than 500 calories a day. You’d be pretty ill, but you can last a while like that.

    What you eat is not simply random choice; the accidental total of hundreds of arbitrary meal choices. Nor can you consciously calculate the exact right amount to eat to match the calories you burn, since the numbers in the diet books are not accurate enough and your precise metabolism is an unknown. Within the bounds you can control it easy enough, but once you trigger the body’s self-preservation mechanisms by stepping over them it becomes more and more difficult to maintain.

    There’s a control mechanism that controls the calories used and consumed. While it’s true that the calories are the means by which it happens, the ultimate *cause* of the weight being what it is is *the control mechanism* – unless you consciously and temporarily override it like you can holding your breath. But you can’t keep it up forever, and barring a serious medical condition where the control mechanism obviously isn’t working (and diabetes is one such example – you have my sympathies), that’s not really a good idea.

    There’s *nothing wrong* with the weight of most modern people. Why would you even want to change it?

  18. Okay, I understand you to be saying that more than just calories in affect weight. And once you trigger the self-preservation level with a diet, you make things much worse. Which is why I keep saying you don’t cut back to 1000 calories if you normally eat 4000. It has to be gradual or it fails. That’s the really bad down side to the “diet” industry–it concentrates on fast results rather than lasting ones. Calories in are the one thing that is easily measured and can be compared to weight loss or gain.

    While there exists no quick, straightforward way to calculate in one pass the number of calories needed for weight loss, over time one can figure out what works. I guess I feel you are saying that obese people (people who are over 250 or 300 lbs) are doomed to be obese no matter what. I don’t believe that to be true. People can lose weight if they are determined. My saying that I can show people how to this is not in anyway based on starvation. People can learn food choices and new ways of eating. It has to be individual and realistic. Again, though, the only thing that can be controlled is calories.

    I agree that many people are being labelled obese when they are not. We do need a more realistic view of weight in this country.

  19. Sheri,

    Here is someone who has eaten 10,000 calories a day and remained thin.

    http://en.wikipedia.org/wiki/Michael_Phelps. Food is fuel!

    You have some control over body weight – about plus or minus 5%. This is part of the illusion of greater control. However you can not trick the body by losing weight slowly as you suggest. It will eventually come back as has been repeatedly shown. Also, I’m sorry, but determined weight loss in a person who is naturally fat is indistinguishable from starvation. Although it is, in principle, possible for a fat person to diet and remain thin through a draconian reduction in calories, this requires an almost superhuman resistance to constant hunger and can not be either healthy or a pleasant way to live. Reread the linked article as there is more to it than can be adsorbed in a first reading. You also have my sympathy as to your diabetes.

  20. I give up. You found an exception so the whole theory must be true (I thought since I was exchanging information with a scientist, there would be the understanding that one example does not prove anything–oh, however, since you do go with one example there’e Subway Jarrod who dropped from over 400 lbs to under 200 and remains at about that weight today. So decreasing calories and increasing exercise does work, right?).

    Draconian reduction in calories???? “Naturally fat”??? We are all victims of our genes and helpless in life to change? This whole thing is so fatalistic. Once fat, always fat. Once depressed, always depressed. Once sedentary, always sedentary. We cannot ever change from what our genes make us. That is so very sad.

    Thanks for thought on the diabetes, but it really has not presented any problems other than making me believe that diet and calories determined weight. I actually believed that to be an advantage until I dropped in on this discussion.

  21. “We are all victims of our genes and helpless in life to change?”

    Why say “victims” about fatness? Why should anyone want or need to change?

    “Once fat, always fat.”

    Didn’t say that. The upper and lower limits at which the body starts trying to push your weight back to where it is supposed to be are genetic. Where you are with respect to those limits is strongly influenced by them, but also affected by recent history.

    ” Once depressed, always depressed. Once sedentary, always sedentary.”

    Once tall, always tall. Once brown-eyed, always brown-eyed. Once blood group AB+, always blood group AB+. Some things are genetic, and when they are, it’s not a matter of what you want to be true or what you think ought to be true, but of what *is*.

    Some people are fatter than others like some people are taller than others. It’s just a natural part of who they are, and there’s nothing wrong with it, and no need to do anything about it. If your body is supposed to be fat and you deliberately starve yourself trying to be thin, you’ll likely succeed (for a while) but you may be doing yourself damage.

  22. Sheri,

    The point that I am making about Phelps is quite different than the one that you have assumed. It is that food is fuel for the body. In order to train to Olympic levels of performance he needed every one of those calories. When not training he eats less. It is meant to be a corrective to the misconception that fat people gorge themselves even when they are not hungry and that this greed causes them to be overweight. Therefore the claim continues, if you eat as us virtuous ones you will lose weight and not be hungry, which you aren’t onyway. This is not a parody. It is what most people think about obesity. Also remember that it was you who asked for one example.

    The really sad part is that the misconception has spread to family services and has led to abuses of authority as seen in this link.

    http://www.dailymail.co.uk/news/article-2069986/Child-taken-care-obese-Parents-didnt-control-weight.html

    A quick Internet search will show many such sad stories. Of course when the authorities or foster parents also fail to control the child’s weight there will not be an admissive of error. Nothing to see here folks, move along.

  23. As someone who has worked with a number of people on their weight loss journey (and having gone through it myself), I can say that weight loss depends primarily on three things: (i) what happens in your head, (ii) what happens in the kitchen, (iii) what happens in the gym. And in that order.

    There are *very* few people who cannot make significant improvements in their weight by following a consistent, well-planned approach to nutrition and exercise. Yes, there are numerous internal body mechanisms and controls at work — and many of these can be brought back into reasonable alignment through proper nutrition and exercise. Yes, some people have a stronger natural tendency toward weight gain for whatever reason. But the number of people who are truly medically unable to make significant progress is miniscule.

    The current lifestyle of most people isn’t particularly helpful either. Like me, many people now spend the better part of their day sitting in front of a computer screen. When they aren’t doing that, they are in front of the big screen TV, or pulling into the drive-thru, or walking out of the 7-Eleven with a 64oz Super Size hit of refined sugar.

    A rational discussion can be had about whether we should care about obesity. After all, we’re all going to die anyway. Further, maybe some people just don’t care if they are overweight and one might argue it is their own business and none of our business. Then the discussion can turn to what impact obesity has on others, whether directly on family members or employers, indirectly through medical costs, and so on. We can debate what, if anything, should be done about it all. But to pretend that obesity hasn’t increased significantly in the last 30-40 years, or to argue that obesity is beyond most individual’s ability to control or that changes in lifestyle and activity level wouldn’t help is to place our heads in the sand and miss seeing an issue that is already having a significant negative impact.

  24. Eric,

    What significant negative impact are you referring to? Is it the fact that general health has greatly improved in the last few decades or is it the fact that life expectancy continues to increase? Maybe it is the observation that overweight people live longer than those of normal weight – the so called obesity paradox. Or could it be the observation that even obese women live longer than men of normal weight? Maybe we need a cure for maleness. Of course, it must be that a longer life uses more medical resources. It would be better to die young and thin. Please help me take my head out of the sand.

Leave a Comment

Your email address will not be published. Required fields are marked *