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Tibor V. Varga

PhD student, Lund University

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Is OBESITY a disease?

In 2003 WHO gave the "disease" tag to obesity. Is this right? Is it really a disease or is it a cause/symptom/status? An excuse which gives us the feeling that taking pills or paying for surgery is our only option? Or a useful label which helps people understand that they do have a problem?

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    Dec 18 2011: I think that the problem is really complex in the sense that yes, there IS a level of personal responsibility and food choice that people have, BUT there are environmental and structural factors at play that promote the rising cause of obesity. We are in a situation where there is a double burden of malnutrition. People are starving but obesity is rising. There is much more involved than people "just eat too much" or people lack control. Many obese people are those in the lowest income brackets who don't have access to healthy foods, lack transportation, don't have leisure time to exercise, lack health care, and may live in unsafe neighborhoods where they can't exercise. Case example, single mother of 4 on public food assistance has no ACCESS to fresh produce or healthy foods. She has no car or transportation and lives in a "food desert" outside of walking distance to any large food retailer. This is a huge problem. People are forced to eat energy dense foods because their means can't stretch and they have to have food that LASTS. Many neighborhoofs that are poor only have corner stores that don't even sell produce so families eat preserved, energy dense high caloric junk food as a main means of sustenance. So, poverty is one cause of obesity and stemming from that lack of access. Also, there is scientific evidence that chronic stress, possibly a result of job loss and financial concerns among other things can lead to elevatedstress hormones and a net effect of weight gain ove time. Chronic stress and poverty leads to higher cortisol levels and insulin responses that cause diabetes and weight gain. I just think that in many situations the environment has contributed to this rising epidemic. A change in zoning laws, moving supermarkets to where they are desperately needed, regulating food assistance programs like SNAP and creating either community gardens or urban garden plots could help change the environment to make it support healthier eating.
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      Dec 18 2011: You are absolutely right and thank you for your comment, I also think that these are exactly the things why this question is difficult to answer. And all the things you wrote are understandable for me, but what about the wide public? (wide.. that was a good one)

      How would you make a weigh losing propaganda in the group you mentioned? What kind of governmental or non-governmental actions are needed?
      Is putting a "disease" tag on obesity one of them?

      Thanks for your answer again!
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        Dec 18 2011: I appreciate your response, and I think you ask important questions. As far as weight loss propaganda, I think you mean maybe an educational or awareness campaign to help reach low income communities. I think the problem is that any effort to educate or promote healthier lifestyles are only as effective as the resources that are in place for people to act on that new found education. If we promote weight loss, the communities have to have the resources and structures available to support that. It can be as easy as adding bicycle lanes or safe pedestrain walk ways or it could be as involved as stopping crime in areas to make them more safe. Something that is pretty interesting is the concept of community gardens or gardens in schools. I think that by having gardens available in schools and nutritional education available to kids it could change the culture of food and also provide an outlet where low income families could purchase healthy produce. But, there is not a one stop solution and each community is different. As far as labeling obesity as a disease, it is kinda a sensitive subject because we don't want to stimatize people but at the same time, by calling it a disease it makes it less likely to become a "norm" for society. I think it may help people view obesity as something that isn't acceptable and not normal. A child that grows up around all overweight ot obese family and friends is not going to see that as something inherently wrong or unhealthy and that will make it even harder to change behaviors or address it in an intervention. What do you think?
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          Dec 19 2011: Yes, you are right again.

          I think we should definitely aim for kids, teenagers or young adults if we want to change trends. Countrywide programs, competitions, the right kind of motivation are always the best way. As soon as children discover that health can be fun - playing with a lot of physical activity, nutritional education, good kindergarten and school lunches - we have already destroyed the major obstacle.

          "calling it a disease it makes it less likely to become a "norm" for society" - I liked this. I am against the "disease tag", I disagree with WHO's move, but I simply cannot disagree with this statement. Obesity shouldn't be a norm, people should wake up...
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    Dec 16 2011: I wouldn't say going over board on calories and refusing to do physical exercise should be classified as a disease. In the society we're in, we use things we know to to suppress. We'll advertise a great body on TV just to make money off the people....say it' a way to attract a special someone or viewer. But in all actuality, being beautiful comes with the territory of being healthy. There's no truth in that. That outlook will cause someone to settle for what they look like, instead of focusing on the real picture....great health.
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    Dec 15 2011: Hmm. This is a subject I am sympathetic about and I feel that when dealing with obese people, empathy is required. However when dealing with the issue itself, part of me wonders whether the fact that obesity is or is not a disease is as relevant as whether its status as a disease renders it incurable, or its victims blameless.

    For example (and this is not as perfect as I would like but): throat cancer is a disease. Whilst it is not always caused by smoking, this is the most common cause. The fact that throat cancer is a disease does not make it unavoidable nor does it the victims of it (who smoke) blameless.

    With obesity it is the same -- even if it is a genetic issue and even though we have fast paced lives could we not fit in an hour to go to the gym every other day, scrutinise the food we feed our children more carefully and take them swimming or cycling on the weekends? Wouldn't this have an affect? It is not difficult to lead a healthy lifestyle; if anything the irony of our 'fast-paced lives' is that they have made us more indulgent and less active.
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      Dec 16 2011: Liked your example about throat cancer, good idea. Although it is very hard to illustrate the situation of obesity with any example, that is what makes the status of obesity debatable. :) The mere fact that throat cancer is (in most of the cases) incurable makes the comparison a lot weaker.
      Research has shown that the worst genetic setting can be attenuated, diminished with a proper lifestyle. And with this knowledge I cannot feel empathy (of course in some cases obesity can develop merely because of hormonal problems - that is another thing). And I find the healthcare money spent on self pitying obese people outrageously high...
      Your opinion?
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        Dec 16 2011: Well -- I suppose when I use the word empathy, I mean it purely as a more respectful version of pity. It is so easy to be contemptuous of someone who is obese. If the research you referenced is correct (although I must ask you for a reference for that, as I've never heard it and optimistic though I am about it, I cannot help but be doubtful...) then there is an argument that they have little excuse for their state and thus contempt becomes disgust and we stop seeing them as human beings altogether. Ultimately I have to be empathetic otherwise I become the very things I mentioned, contemptuous and disgusted and it is too easy and inhumane to fall into that trap.

        Also -- I am convinced that there must be some sort of condition involved. I'm not sure how (I'm as far from a biology student as it is possible to get) but I think I find the alternative that they are just gluttons in the extreme too unsatisfying and simplistic. To clarify, I believe they are gluttons in the extreme but something must be causing them to have no sense of proportion or limit even as it infringes on their lifestyle.

        Your point that throat cancer cannot be reversed whereas obesity can is valid (and one I had overlooked but it does support your earlier statement that our inability to find the perfect synonym for obesity is why people are able to debate it: there are too many nuances involved.

        Nevertheless I still stand with my point in my original response that, as much as I am curious about the cause in an attempt to see the victims of obesity as victims as opposed to self-pitying gluttons, the origin holds less sway for me than the practicality of solving it. In terms of health care spend on it, I feel the same way as you do but about smoking victims and as little sympathy as I have for them, the fact that smoking is addictive alleviates some of the blame in a way that does not apply to obesity.

        What do you think is a more potent question: why it starts or how to solve? prevention vs cure?
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    Dec 15 2011: Some people are naturally chubby, due to the way they absorb nutrients. Whatever work-out they do, they remain chubby.

    However, the step from chubbiness to obesity can be controled, whether by psychological help or by eating normal food and having a normal life.
    When I see an obese ten year old, my heart breaks. Obesity is not the disease, lousy parenting is.
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    Dec 15 2011: We eat fat laden meals and we are engaged in office type jobs and activities like web surfing that don't keep us fit. Where I live you have to drive every where because it is too far to walk if you need to get things done.
    We cannot allow children to run a play outdoors for fear of the other dis-ease of child molesting, so they get a bad start in being out of shape. I suppose it [obesity] is just another symptom of the current human condition which no doubt exacerbates the fear and loathing. :(
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      Dec 15 2011: On one hand I agree with you. In our fast-paced world it is really difficult to maintain a healthy living, there are millions of obstacles which can set us back.
      On the other hand... we have to adapt with this. If we have to use cars, because there is no possible way or it is not practical to walk, then we have to deal with it. If our children cannot play at the playground, or there is no playground at all, then we have to find some other way to offer them a healthy living.
      It is our responsibility and we cannot blame the civilization, just ourselves.
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        Dec 15 2011: I agree. I am a firm believer in ultimate responsibility.
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    Dec 15 2011: I like how you put "a useful label which helps people understand that they do have a problem?" I was raised to be conscious of words people use (oddly). Like the word disease, if dissected, dis-ease , so quite likely in that sense it is a dis-ease. I often wonder if obesity is any different, than say alcohol or drug abuse, but is more socially acceptable. Could they all be a demonstration of a need for self love? Or for unidentified feelings of situations we down deep know we must change, but aren't so we push down the guilt and pile food,drugs or alcohol on top to hold it down? OR has obesity become accepted as the norm? I have almost always been thin, I am heavier now than I have ever been 139lbs (5'7") and people are always telling me I am too skinny regardless of my muffin top and back fat! Hummmmm?
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    Dec 15 2011: Apparently eating lots and getting fat has not so long been a problem for us - in evolutionary time. We just never had it so good. Now we must evolve. We didnt plan on eating so much.
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      Dec 15 2011: Dear Philip,
      I am very much familiar with what you wrote. I believe there is strong evidence of the evolutionary causes of obesity. Although we call it "thrifty gene hypothesis", I think it is more than a hypothesis, the idea is reasonable and logical.
      What I asked and what I don't understand is what is the point of "making" obesity a disease. There are various subtypes of it, but in most of the cases aren't we obese because of mere laziness?
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        Dec 20 2011: Our digestion Tibor, has much to do with the composition of the digestive fauna we have.
        Children that have to little contact with bacteria or people that use antibiotics can develop a insufficient or unbalanced composition of species that produce defects in digestion.
        Bacteria in the right composition balance each other out within certain limits. If that’s distorted some species grow out of proportion.
        One species is specialized in harvesting energy from the passing nutrients. Others, do other things.
        If that one species is dominant because some other species are missing the person can become fat and at the same time suffer deficiencies of certain nutrients.

        This you can call a disease