The following is a post I made on the LinkedIn Medical Devices forum in response to an issue raised regarding the recent decision of the AMA to classify Obesity as a disease.
An active discussion continued and is still drawing comments, many off topic for the medical device forum.
An excellent discussion and represents a broad slice of current attitudes towards weight. Simply stated we as a society have bias against overweight and obese individuals for the most part and see this as personal failure on their part. Into this mix we throw condemnation of the food industry, government programs and a host of other issues.
This discussion and many like it are going on around the world as we face a real crisis in health care from both the perspective of people’s lives and the cost to the healthcare budgets of many countries around the globe.
As someone who has been working on a device to treat obesity I have certainly changed my attitudes towards the issue over the years. I post the following for the discussion group and welcome comments.
A video of our efforts can be found at https://vimeo.com/68641599.
The problem of the rise in obesity can be traced to the mid 70’s as shown in the ‘Rising Rates of Obesity’ as shown on another blog page. It is interesting that a timeline for the increase in sales for fast food companies essentially parallels this graph; cause and effect? A similar correlation can be found in the rise in computer gaming, remember Pong? The game was originally manufactured by Atari Incorporated (Atari), who released it in 1972. (http://en.wikipedia.org/wiki/Pong). In addition to this is the change in behavior patterns for children. How many parents allow their children to walk to elementary school? I know that in the mid 50’s I walked roughly two miles each way to school from first grade to sixth grade. AND YES it was uphill both ways in the driving sleet and snow (even in Los Angeles – ). Seriously every elementary school these days has a line of parent’s cars waiting to pick up their children. Kids are not allowed to wander over to the local park, as we did, to run, roughhouse and generally be kids. Why, again multifactorial but largely a fear of child abductions in my honest opinion.
Where does that get us in this discussion, the causes of obesity and the increase in over the last 40 years has many causes and it is not simply that we as a nation or a species has become lazy. Add this to the fact that once you have gained weight the body fights you every time you try to lose weight as has recently been shown by researchers. An excellent analogy to this was posted today (7/3/13) by Dr. Aryl Sharma, a Canadian expert on Obesity and treatment. (http://www.drsharma.ca/running-down-the-up-escalator.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+AryaSharma+%28Arya+M.+Sharma%2C+MD%29)
An additional issue is the relationship between obesity and comorbities. The BMI index is clearly only a rough indicator of the effects of weight on health. However, statistics support a weight base first pass at understanding these issues. Dr. Sharma has developed a staging system, the Edmonton Obesity Staging System (http://www.drsharma.ca/edmonton-obesity-staging-system.html) that is being used more frequently to determine treatment.
What we do know is that obesity itself, i.e. >30 BMI does not predict metabolic disease. The breakdown for metabolic disease and road to type II diabetes is related to weight in the following manner, two-thirds of obese, BMI > 30 have metabolic disease, one-half of overweight, BMI > 25 and < 30 have metabolic disease, and one-third of BMI < 25, normal to underweight have metabolic disease. These numbers are for men and the data is slightly different for women. This is related to a combination of genetic, diet (high carbohydrate consumption) and other factors. I posted a link to a graph showing this information on my LinkedIn page.
The classification of obesity as a disease reflects an honest attempt to encourage better understanding of the issue and promote better discussions between patients and physicians. Of course we can always point to alternative rationale, many of them at least partly true. The real issue is how do we deal with an incredible problem and see that patients are afforded appropriate care and the costs in terms of patients’ lives and healthcare dollars are better managed.