Journal rdewald's Journal: Is Obesity a Disease? 21
I started on the journey that led me to weekly individual psychotherapy in early 2001 by going to my medical doctor, my family practicioner, and telling her that I had decided that I wanted to get bariatric surgery (stomach stapling, lap-band, etc). A friend of mine had just undergone bariatric surgery and my friend's weight loss was very impressive. This friend and I shared an office. My friend and I discussed the details of my friend's experience--pre-op work-up to post-op weight loss--in detail. I was envious of my friend's success, we had the same insurance plan, and my friend's out of pocket expenses were minimal--the insurance company, with no argument, was willing to pony up the $40,000 for my friend to get the procedure done in New York City. My obesity and my friend's were of comparable severity, if anything mine was worse because I had more co-morbidities (related diseases) than my friend. I weighed just a little over 500 lbs at the time.
As it ended up, I decided against the surgery, opting instead for treating my obesity with psychotherapy. It took me about 6 months of therapy to come to that decision, but it was definitely the right one for me, I am very grateful that my anatomy is still intact. How is it that one can effectively treat the same condition with these two widely variant (abdominal surgery vs. weekly individual psychotherapy) treatment modalities? What does that say about obesity?
First of all, I want to whine a bit about the disparity in the health care financing system in this country, even though this is only one of many ways it is broken, and hardly the most severe. As I said above, my friend was out relatively little money for the surgery. The insurance company paid the vast majority of my friend's expenses, which ran in excess of $40,000. Not so for the treatment I chose. Of the approximately $30,000 I have spent on therapy, my insurance company has paid about $3000 of that. I have been out of pocket the other $27,000.
I consider my obesity effectively treated at this time, even though I still weigh 400+ lbs at this writing. I am just as sure to lose this weight as a post-op bariatric surgery patient, all that needs to happen now is for time to pass, just as time must pass for a new post-op surgery patient to lose their weight via that method (in case you're thinking that my situation is unique because it is reversible, do some research, a lot of bariatric surgery patients regain the weight they lose post op, as my friend mentioned above is doing now).
Leaving the question of fairness aside for a moment, think about the fact that the private insurance industry is de facto making health care decisions for seriously ill people this way. These accountants and other administrators of health benefits who work for private insurance companies, however well-intentioned they may be, do not have the training, skills or experience to be make these decisions. They're MBA's and CPA's, not MD's. I cannot overstate how serious a problem this is, and obesity is just one condition of dozens for which such a financial bias towards one treatment over another equally effective one exists.
But, is obesity a disease? One cannot simply choose not to have tuberculosis, or cancer, or gall bladder disease. I am losing weight, and if you look at what is different about my life now on a very superficial level, what is different is I choose to eat less. My obesity is being effectively treated because I choose to eat less and exercise more. These choices came about because of therapy, but unlike Tuberculosis, choice is the main determinant of outcome.
Even deeper than that, most therapists will tell you that they have patients in their practice that have been showing up for a similar number and frequency of sessions that I have for a similar period of time who have made very little progress with whatever problem brought them to therapy. Indeed, there exist no external objective measures that would have predicted my success, nothing that you can record on a form and send to an insurance company anyway.
People in this country spend billions and billions of dollars on diets, diet books, diet clubs, health clubs, fitness equipment, and the like and yet obesity is absolutely epidemic, mostly among the very people spending all the money, and the problem seems to be spiraling out of control. This is not because obesity is pleasant, or productive, or enriching in any important way. It is an absolutely hideous way to live, if left untreated it is as painful as any chronic debilatating progressively fatal disease such as Tuberculosis or cancer.
Do diets work? Does therapy work? Is obesity a disease? Is substance abuse a disease? Should those who pay health insurance premiums who choose to live a lifestyle that puts them at a low risk for developing chronic illness be forced to pay for the medical bills of those who don't make such wise and disciplined choices? What is a choice anyway? Did I have a choice about my obesity five years ago? Should we offer therapy as an option to those unwilling to bear the discomfort of introspection and self-analysis? How do you tell them apart before therapy begins?
Is that enough questions?
One might think that I come down decidedly on one side of this debate, i.e., that obesity is a disease and that therapy should be reimbursed at the same rates for which you can collect for chemotherapy or antibiotics. Lord knows a lot of chemotherapy and antibiotics are given to people who stand little hope of ever benefiting from them. But, I am deeply conflicted about these issues, particularly when we live in a country that pretends that it can't afford to grant it's citizens basic health coverage, but we also live in a country that kills itself with food, alcohol, and denial. If someone intends to be self-destructive, there's little that can be done about it with any amount of money. If someone intends to turn their lives around, much can be accomplished with diligent reading at the public library and attendance at free self-help groups.
So, Im not sure where we should be having this debate. If obesity is not a disease, then one might argue that alcoholism isn't either, and an argument could even be made that Type II Diabetes is similarly self-inflicted.
A couple of coincidental events happened earlier in August that got me thinking about this. DHHS announced that obesity is a disease, and the National Association to Advance Fat Acceptance held its annual convention in Newark. They were outraged at the government's declaration of what they regard as normal human variation in percentage adipose tissue composition as a disease. That got me thinking. I have been thinking about it ever since, hoping to come to some insightful conclusion that I could share here, but I am coming up empty. I can't make up my mind. Can you?
Add to the confusion a book like The Obesity Myth by Paul Campos. His assertion is that the real killer in the country isn't obesity, it is inactivity, i.e., that thin sedentary people are less healthy than active obese people. He further asserts that the scientific evidence for the health risks of obesity is exaggerated at best, and that the issue is really moral, not a health issue, and that it is also a class distinction issue, i.e., that rich people are thin and poor people are fat. He asserts that yo-yo dieting is more harmful to health than obesity and because of this the diet industry does far more harm than obesity itself. All that may be true, but it has the ring of a Republican campaign commercial to me, there's something missing.
Anyway, I'd love to hear some discussion from my friends, both those who struggle with the issue and those who don't.
Disease or not, it's irrelevant. (Score:1)
Too often people are telling me to mind my own business & only live out my Christianity in my home. Well, my response to that is that my mind goes where my money goes. If you want me to mind my own business, then you can't expect me to pay for your consequences, legitmate or not.
That being said, I have a lot of respect for you because you are loosing weight. It's not easy.
I remem
I'm on the not side (Score:1)
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Re:I'm on the not side (Score:2)
If obesity is a disease or a disorder, how come it's so much more common in the US than elsewhere? Can a real disease or disorder really be that geographically narrow, especially considering the strong culture of immigration in the US?
I'm more inclined to call it a cultural difference than put a medical term to it. Cause seriously, ya'll eat like a 5 year old would eat if they didn't have restrictions.
There are a few real medical conditions that would cause obesity. But imho most often the search for a m
Re:I'm on the not side (Score:1)
They are a result of a action.
I want this drink. I want this pie. I want this donut. I want this vodka shot....etc, etc.
There is never a point where you honestly truly *need* that drink, or that food.
It's a matter of discipline*, and it appears in America we are sadly lacking that discipline, with regards to food. If you travel to just about any other country in the world, you won't see nearly as many obese people as we have here. Every day I see
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Re:I'm on the not side (Score:2)
Well, actually, there is. But it's after you've been abusing the drink very seriously for a while. But yeah, withdrawal and delirium tremens are real things caused by your body's need for the drink.
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Re:I'm on the not side (Score:2)
Sickle cell anemia, for one.
But I get what you're saying, and agree that obesity is not a disease. A symptom in some cases, but not a disease in and of itself.
Re:I'm on the not side (Score:2)
Part of the problem with this is that some of the cheaper foods available unbalance your diet and make you more prone to gain weight. I have noticed similar things to what you'v
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Re:I'm on the not side (Score:2)
The generic kraft-type macaroni and cheese is dirt cheap. 2 boxes will feed your kids enough. Cost? Less than $1. Or, you could feed them two chicken breasts and some broccoli. That'll run you about $5. Over the course of 1 week, it's $30 extra..x52 and you're dealing with a lot of money for a minimum wage worker.
Eating healthy food (and we won't even get into organic & free range) is as
Re:I'm on the not side (Score:1)
The key here is "influenced". I think it would be foolish to say that diabetes, for example, isn't influenced by diet, but there are forms of the disease that are not strictly controllable by diet either. Which leads me to say that such things are diseases. Type II Diabetes, as it is largely controllable by diet and in the opinion of some triggered by poor diet, is probably arguable. Obesity I think is very similar to diabetes, in that there are forms of
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Re:I'm on the not side (Score:2)
Well, there are a lot of things like that as well. There are a lot of follow-on disorders that go along with obesity as well. Things that aren't necessarily caused by the obesity, but are enabled by it....
Let me say that I don't think that health can be simply described as "lack of disease". So saying that obesity is not a disease doesn't mean that someone who is obese is "just irresponsible", nor that I think they're perfectly healthy (while fat people
the effects of food (Score:2)
I don't know what I think about obesity as a disease, but I have read some books about diet in general (not as in specific diets, but as in diet and nutrition) and one of the authors talked about the body's reaction to the way certain foods are treated by the body.
One of the most interesting points that I found is how he talks about starches. Starches, especially the very simple carbohydr
Re:the effects of food (Score:2)
We've evolved as omnivores and I think we should eat that way. I am careful to get a nice balance of macronutrients (fat, carb, protein) in a day, including an emphasis on complex carbs where it works (I eat whole grain
The US way (Score:2)
If you think it's wrong... sue
Re:The US way (Score:2)
Do diets work? (Score:1)
If you mean fad diets, not long term. If you mean a well-balanced life-style, then yes. Fad diets down't work for many reasons. Most involve cutting stuff essential to health (fat and calories) to levels that induce a starvation response in the body. The response triggers a hoarding and so as soon as you eat something, the body does it best to slow the metabolism and hang onto the fat. Everyone knows this of course.
The real problem I am having is to have to stop and think about what I e
Re:Do diets work? (Score:2)
For some people, and I am one of them, weight management demands active management of your intake. It was a very hard habit for me to get into, it took me about 6 months and $3500 of professional help b