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Mike Tuchscherer
06-21-2013, 12:30 AM
I've seen some upset at the recent decision to classify obesity as a disease. I don't really work with obese people for goals of weight loss, but it is a pet interest of mine, so I figured I'd share my thoughts.

Some people are upset because they think this will contribute to the self perception of obese people that they are victimized. Maybe. Hardly anything is ever all good or bad.
A person can choose not to drink too much, yet alcoholism is a disease. As a fitness industry we have tried to solve obesity with legit dietary strategies, bullshit supplements, workout plans, personal trainers, etc. And all the while pay lip service to "lifestyle change" (whatever that is), and we berate those who fail because they lack willpower as if it was some personal and moral failing. And for all the money and energy spent, obesity rates continue to rise.

The fitness industry as a whole has failed to find a strategy that works. Maybe "eat less move more" works when people implement it, but what good is a strategy that people continually fail to implement? I am a powerlifting coach. If I write a program that "works", but is something that the vast majority powerlifters will fail to complete, then i would be a shitty coach because I would be unable to help the vast majority. Fortunately that's not the case.

I'm hoping reclassifying obesity as a disease will help us come up with interventions that actually work for most people over the long term. You wouldn't tell an alcoholic to "just stop drinking" so why did we expects similar approach to be successful with obesity?

Mark Jamsek
06-21-2013, 03:38 AM
The only things that work must be implemented by the sufferer. It's not like other diseases that can directly be treated by physicians. In most, if not all, cases the sufferer needs to eat less and move more. I can't see any other way around not being obese. And it will be awfully hard to address in the current climate of supersized fast-food and convenience-based consumerism. Didn't some state introduce legislation prohibiting sale of supersized soda?

I hope the reclassification helps. It's a massively costly epidemic, and such a shame to see so many young people increasing their likelihood of suffering debilitating conditions and reduced life-expectancy.

Mike Tuchscherer
06-21-2013, 01:44 PM
Its true that the solution might end up being something that looks a lot like "eat less move more" but just saying that and expecting it to work is like telling an alcoholic "just stop drinking". People have tried that. They can't follow through.

It's not about diets, workouts, or "lifestyle change". That stuff doesn't work long term as evidenced by the fact that most people fail to implement it. Most people know what to do,they just can't do it. So I'd suggest starting there. Look at things like community, engagement, etc. Address the things that cause people to fail. Berating them doesn't work. There are several good ideas in Roy Baumeister's book "Willpower". But its not just about willpower either. Its a complicated problem.

Sorry for the typos. Typing from my phone.

brudman
06-21-2013, 03:46 PM
Could it be that the obesity epidemic has something to do with the fact that our nature as humans is indulgence (not necessarily in food), and in America we have the wealth to satisfy that indulgence? I just got back from China and they have less obesity, portion sizes are smaller, and in general eat less. They also have crappy food supply in that area I was and don't have access to much.

At the end of the day, I have a Christian worldview. Mankind is sinful. We all sin, we all have our demons. I could argue that the only reason people aren't obese in Africa is that they don't have access to excess for lack of a better way of putting it.

Therefore with that conclusion, what is the solution to sin? Jesus Christ. I'm not saying, "Know Jesus and you won't be fat", but I am saying that our very nature requires a solution that is bigger than a self help book. Some people do have diseases that make them fat. Some people are fat because they are gluttonous and lazy. Others are fat so they can fit in their gear (just kidding gearwhores).

At the end of the day we all meet our Maker. In the meantime, some people are delivered from their demons in this life, and some after this life. Others reject Him and don't get delivered at all. It comes down to the personal level, and you aren't going to fix this problem with a legislative initiative, otherwise we would have done it generations ago.

sparkskk
06-22-2013, 02:33 PM
This is an interesting topic. I would probably have jumped straight into the "OBESITY IS NOT A DISEASE!!" camp if you hadn't posted your thoughts. Sometimes it's no harm to take a step back and think about things a little more.

I think it's probably okay to classify it as a disease. That doesn't mean that it is not easily preventable or curable though. I can accept that obesity is a disease and still be of the opinion that the vast majority who have it are lazy and glutenous. Maybe that opinion isn't helpful but if I'm honest, that's where I stand.

It's easy for me wonder why there are so many around me (2/3 of Irish people are overweight or obese at the lastest estimate) who are giving pop n fresh a run for his money, but I was involved in competitive sport from about the age of 8/9. I sprinted numerous times per day basically every day of the week until I was 18. After I left school, there was less 'fun' running around and mainly competitive team sport, but the point is that that kind of activity level as a habit has meant I've never really had to consider too much what I ate. I'm so glad my father was such a great role model fitness wise!

I suppose some of the questions about the obesity disease are why so many people are "catching" it and why those people live predominantly in the developed world? Is it simply a survival of fittest mechanism? Those who aren't strongest (of body or mind) are doomed to be culled first like in any area of nature. We try to ensure their safety as part of the herd but there will come a time when the weakest utimately gets maimed/kiled/eaten despite the best efforts of the rest of the herd.


PS. I don't buy into this "mankind is sinful" thing at all. Mankind just is as mankind is. Cats are as cats are, etc....I'll it there because I don't think this is the forum for this kind of debate.

BobW
06-22-2013, 04:14 PM
I'm not sure it's that cut-and-dry.

Mike: you realize that you're medically classified as obese, and that you now have a disease? The only medically accepted way to classify an individual as obese is through BMI.

(Pretty sure this applies to a lot of other lifters on this forum, but I haven't seen you all enough to know.)

I have the disease as well.

There's a couple problematic things in my mind about this classification. First off: many of the bad effects of carrying too much bodyfat can be mitigated through intense exercise - for example, even though I'm probably in the 20% bf region, my insulin response is fine. Exercise has been shown to mitigate that problem. So I'm not sure that a man carrying 20% bodyfat is automatically unhealthy.

There's a lot of problems with this approach. So, we now have a lot of powerlifters and other athletes (let's ignore the SHW gearwhore class for now), who are now obese, because of muscle mass. My bet is these athletes are going to refuse treatment.

What are the ramifications for refusing treatment for a disease? Is there any impact with health insurance or treatment down the road? What about obtaining life insurance?

Take that a step further: you know that car insurance rates - at least in the US - are determined in part by your credit score. You have a crappy credit score, that shows you're irresponsible, can't manage your life, which means (somehow) that you're going to be more accident prone.

Hey - you're obese. You refuse treatment, or you try, but you still have this disease. You're irresponsible. You can't manage your life. Sound familiar?

I fear that there could be real material impact for a lot of people because of this ruling.

Now, here's another thought: let's say that doctors decide the standard course of treatment for this disease is to prescribe a diet, and give the patient 12 months to make progress. If there is no weight loss, the patient will then be prescribed a new drug. That's just the course of treatment for the disease.

The problem I have with that is that we really don't know how many of the new drugs work, and they often damage health terribly. Look, for example, at the Phen-Fen cocktail for weight loss, and the heart issues this caused, and the tragedy for some people.

And don't think that pharma won't find a way to cash in on this. They're the big, salivating dog at the end of the chain trying to reach the food bowl.

Mike Tuchscherer
06-22-2013, 07:55 PM
Bob, you raise a lot of good points about potential negative consequences. And all of that might come to pass. And it would suck.

My thoughts are more in the realm of mental health on this issue. What's the difference between a person who worries a lot versus a person with an anxiety disorder? Largely it's if worry is disruptive to your life. I think alcoholism falls in a similar category. So if it gets treated that way, I think it makes sense.

A person wants to lose weight, but always falls off the wagon diet wise... If that person wants help, then I think it makes sense to help them primarily from a psychological standpoint. Saying they are lazy isn't helpful. And for that person, maybe it will take more than psychological intervention. I really don't think we fully grasp the problem. Calories in versus calories out might be true, but it's too low resolution to be helpful to the vast majority. It's like saying an engine is about turning gasoline into movement. It's true, but that knowledge isn't sufficient to fix one.

BobW
06-22-2013, 09:58 PM
My thoughts are more in the realm of mental health on this issue. What's the difference between a person who worries a lot versus a person with an anxiety disorder? Largely it's if worry is disruptive to your life. I think alcoholism falls in a similar category. So if it gets treated that way, I think it makes sense.


Sorry, another hot button - lol.

Mental health / anxiety disorders / etc: the current treatment for most mental health issues is to prescribe a pill. There's mounting evidence that this is not necessarily the best treatment option. It also presupposes that we can define a "norm" in mental health, and then essentially drug all people who deviate from that norm. I'm not a big fan of that.

Throw in the mix that we really don't understand how the new drugs work: it's hit or miss. Sometimes they cause more mental health issues than they solve.

So now we're going to the same thing with the fat guy?

Speaking of alcoholism: what treatment plans do you have in mind? Because to the best of my knowledge, the treatment plans for alcoholism are largely failures - the majority of people who recover from alcoholism do so on their own. See, for example: http://pubs.niaaa.nih.gov/publications/AA70/AA70.htm - if I'm reading this correctly, the results are that 75% of the recovery population recovered without any assistance. Now, this is a bit outdated (2006), so you might have some more recent data.

I 100% agree with you that obesity is a complex problem. I absolutely agree that it would be wonderful to help people who really struggle with losing weight. I absolutely hope that we can do something to remove the stigma associated with obesity. I find it unconscionable that it's socially acceptable to use essentially "hate speech" towards the obese - the obese seem to the best last target of every petty, hurtful emotion we have. Whatever we can do to stop that is a step in the right direction.

webby
06-23-2013, 12:13 AM
I'm not fussed about what they call it but here in Aus having it named as a disease will most likely make it easier for local governments and hospitals to get funding for it. If they do something productive with that funding then it could be a great thing. It might even mean that eventually things like gym and PT may be discounted and made more readily available for obese people.

Mike Tuchscherer
06-23-2013, 07:25 AM
Webby, I expect the intent is similar here in the US. But Bob does bring up some good points about unintended consequences -- at least here for our system in the US.

Bob, it seems like you're more educated than I am on the issues of mental health, etc. So I could certainly be wrong about this. But it's my understanding that there are pretty broad definitions of "normal" in mental health. If you're hearing voices... pretty far outside of normal. If you worry alot... well that doesn't necessarily mean you have an anxiety disorder. I'm sure lots of people are prescribed drugs too soon in the treatment process. But I don't think drugs are the only treatment available. What about cognitive behavior therapy? It's my understanding that this tool has been used to treat a wide variety of mental health issues. And back to alcoholism for a sec... again, maybe I'm relying on outdated information, but I thought AA has been shown to be somewhat effective as a treatment. I don't think it was a huge effect, but significantly better than chance. Again, maybe my info is outdated.

Donald Lee
06-23-2013, 05:58 PM
Here's an article written by a physician against the classification of obesity as a disease:

http://www.huffingtonpost.com/david-katz-md/obesity-disease_b_3478322.html

It touches on some of the stuff already discussed here.

Mike Tuchscherer
06-23-2013, 06:53 PM
Good post, Donald!


That's where our attention and corrective actions should be directed. If calling obesity a disease makes us treat the condition with more respect, and those who have it with more compassion, and if it directs more resources to the provision of skill-power to adults (http://www.rediclinic.com/weighforward/) and kids (http://www.mindstreamacademy.org/)alike, it's all for the good. But if, as I predict, it causes us to think more about pharmacotherapy and less about opportunities to make better use of our feet and our forks, it will do net harm. If we look more to clinics and less to culture for definitive remedies, it will do net harm. If we fail to consider the power we each have over our own medical destiny (http://www.huffingtonpost.com/david-katz-md/nature-nurture-fate_b_681732.html), and wait for salvation at the cutting edge of biomedical advance, it will do net harm.

I think that sums it up pretty nicely. Of course this opens the conversation up to the over-medication of society. Funny... it seems to be pretty popular opinion that there is too much medication in society today, yet nobody (including me) does anything about it. Certainly some drugs are good and beneficial to people. But as Bob was saying, we often prescribe stuff with side effects that aren't well understood for diseases that are vaguely even real.

webby
06-23-2013, 10:02 PM
One of the best things to come out of it so far is how much it is being debated about. There must be forums all over the world having the same discussions we are. The more people that are aware of the implications of obesity the better. Maybe it'll mean it creeps into the curriculum for primary schools. I'm sure that'll open a whole new debate but.

BobW
06-23-2013, 10:14 PM
Webby, I expect the intent is similar here in the US. But Bob does bring up some good points about unintended consequences -- at least here for our system in the US.

Bob, it seems like you're more educated than I am on the issues of mental health, etc. So I could certainly be wrong about this. But it's my understanding that there are pretty broad definitions of "normal" in mental health. If you're hearing voices... pretty far outside of normal. If you worry alot... well that doesn't necessarily mean you have an anxiety disorder. I'm sure lots of people are prescribed drugs too soon in the treatment process. But I don't think drugs are the only treatment available. What about cognitive behavior therapy? It's my understanding that this tool has been used to treat a wide variety of mental health issues. And back to alcoholism for a sec... again, maybe I'm relying on outdated information, but I thought AA has been shown to be somewhat effective as a treatment. I don't think it was a huge effect, but significantly better than chance. Again, maybe my info is outdated.

In no particular order: AA and other 12 step programs have been shown, study after study, to be no better than "chance" - that is, there's a success rate of about 3%, IIRC, which could easily be accounted for by chance. I didn't realize this until a friend of mine had a spouse who was struggling terribly with alcohol. The things they went through were just horrid trying to find help.

Cognitive behavior therapy: absolutely, 100% agree with you. The problem is that CBT is a long process, it's difficult, and it's not practiced that much in comparison. The pill-mill approach to mental health issues seems to be largely in vogue today. The studies and interviews I've read indicate that it comes down to reimbursement and patient load. A CBT specialist can see one patient in 60-90 minutes. A pill-mill MD can see one patient every 5-10 minutes.

Again, I absolutely agree that it would be great for us, as a society, to somehow help the obese.

I tempted to really launch on a rant here. Let me think before I post, however.

Fraser
06-25-2013, 09:16 AM
Hi guys, first post here.

As someone who has observed the way that people with chronic mental illnesses are treated (in the UK) at a pretty personal level, I can think of nothing worse than the validation of the prescription of drugs to obese people. My first problem with this is that obesity is a phenomenon which seems to be a product of our internet-driven, get rich quick society. By that I mean that people no longer have to struggle to survive, at least in the sense of physical subsistence, and thus are becoming more and more unused to struggling to achieve anything at all. Just as an internet search is a completely false "quick fix" to ignorance on a topic, at least when compared to reading a book on the subject or, god forbid, going out into the world and learning about it first hand, the prescription of a pill for obesity is reinforcement of the ideals which are probably some of the root causes of the phenomenon in the first place. Obesity is not a problem which is easy for anyone to overcome, and obese people need to recognise that, harsh that sounds. After all, they'll find out sooner or later once they start to actually lose weight that it isn't as simple or easy as noxious media (and now potentially official medical) sources would have you believe. Rather than encouraging a long-term view, pill-pushing very much prioritises treating the symptoms of the problem, not the cause. Just as Mike said, approaching obesity from the perspective of long-term psychological change is probably a good avenue to explore. However, in my experience this is not the current go-to course of treatment for mental disorders, so I am personally doubtful that long-term therapy will be the direction any new initiative will take coming off the back of this re-classification.

Aside from this anthropological and psychological argument, I find the practicalities of the implementation of obesity "treatment" potentially as worrying as other people in this thread. I think there's a fine line between helping people help themselves and impinging on their personal freedom, and I'm not sure that it's one most governments and large profit-driven organisations (I'm thinking mostly of pharmaceuticals, insurance and media here) have many qualms about blurring. If ultimatums start to be delivered (lose weight or no insurance/job/suffer the legal ramifications) a whole new level of weightloss-driven fitness media brainwashing would find fertile ground in people even more desperate to shed pounds than they are now. Placing a larger stigma (if not social then legal) on overweight people is probably not the solution to the obesity problem. After all, we already live in a time when people want to lose weight more than ever before, as evidenced by the multi-billion dollar fitness industry and the countless magazines dedicated to celebrity figures and weight loss, and yet we also live in a time when obesity has reached an all-time high. I'm just not sure that shifting the balance of power further towards the media and the government and away from personal desire, accountability and responsibility is a positive thing.

Not sure how constructive this was, just some thoughts that came into my head reading through here!

Ozymandias
05-07-2014, 09:07 AM
As a former addict who spent 7 months in a an AA based treatment facility, I found it to be an outdated model that is rendered useless by psychotherapy technologies such as CBT and others . As a current student of psychology (undergrad), my opinion and experience is that severe obesity, like addiction, is most often a symptom of other factors and should be addressed as such.

Will the disease classification help accomplish that? I don't know, I have seen numerous addicts fall into recidivism because they viewed their addiction as a disease that was an integral part of themselves. I guess classifying obesity as a disease might cause people to view it differently, but it may have the opposite effect as well. Most addicts are taught that addiciton is a disease and most addicts stay addicted in the long run. Correlation vs causation?

Johno
05-07-2014, 01:21 PM
Just to add complication to the debate - there's also a 'structural' element to this issue too, with studies finding obesity most prevalent in certain demographics of the population. eg in America poverty and women (http://depts.washington.edu/uwcphn/news/summits/poverty_obesity/sturm_pov.pdf See slide titled 'And Women'). Education levels also consistently shows differences. Is that shaped by the individual? The family life? The economic/social/cultural situation in which they live? All of it? So there's also a need to take a 'big picture' view of this issue. Will classifying it as a disease ensure it gets the attention it needs? I'm not so sure. I agree with many of Bob's points.

It certainly isn't 'sin' that is the problem - if anything the issue lies with irrational and illogical thinking (for whatever reason) by the individual towards their future health. And if we are to solve this problem as a human species we require us to use these two virtues extensively.

Really nice discussion from an economist on this if anyone is interested in this presentation. Some good points. - http://depts.washington.edu/uwcphn/news/summits/poverty_obesity/sturm_pov.pdf

colin
05-08-2014, 09:48 AM
Are you guys sure that 'eat less, move more' actually works? Before I found the barbell my ONLY concept of exercise was low intensity steady state stuff. Before I found dietary advice for strength and weightclass athletes my ONLY concept of 'dieting' was to eat like a rabbit. This combination sure gets you to lose weight in the short term, but it is not a successful long term plan for both physiological and psychological reasons.

YOU may know better and now I do too, but I think you would be surprised at what the vast majority of people think about how to go about losing weight. A lot of other factors go into it, but if most people have a poor solution to a problem, how can you expect good outcomes? Losing weight is pretty simple and easy if you count macros, strength train, and maybe include some non-liss conditioning. However, if you just try to eat less and less and do more and more cardio, you are in for a rough ride.

REAL Physical Education would go a long way here.

Lastly, anyone who has been through or has had a loved one go through the mental illness health care system knows how incredibly overwhelmed it is. People with real mental illness struggle to get into facilities, get appointments,... get anything except pills. Sending a giant demographic like obese people into the mental illness system is just ludicrous. They would only get fed some pills anyway because that is most definitely what mental illness treatment is all about.

Alexandru
05-08-2014, 11:02 AM
I think for many people obesity is caused by other problems (addictive personality etc), but from what I could tell many people also don't know, and were never taught, what makes them fat. As in, they might read the latest dubious study on eating meat and stop eating steak, but keep drinking 50 sugary drinks a day. A friend who worked for a while in a clinic for children was mentioning childhood diabetes is reaching epidemic levels. And something tells me that kids taught by their parents to eat badly, will grow up eating the same way and will need more effort to switch if they learn how to eat later on in life. I also taught a bit for some science outreach at a public school in a pretty bad area, and most of the stuff the kids seemed to be getting at the cafeteria were Skittles, Coke etc. That food is really not going to help them in the long term, neither with their health or school results.

Alexandru
05-08-2014, 03:15 PM
And btw of what Bob mentioned about BMI, this is throughout the research process. A friend was doing some study relating BMI and breast cancer. So I asked her why not bodyfat? Her response was that "BMI is accurate enough". No, no it isn't. I'm borderline obese by BMI standards, and I'm at 14-15% bf, and not really that muscular either. Something tells me the structure of fat on women, and particularly on breasts is even more likely to vary at the same BMI. And if it barely costs you anything to improve the quality of your study, why not do it? Of course, a bodyfat measurement with skinfold calipers is less accurate than measuring pounds, but it's more accurate than extrapolating bodyfat from those pounds.

Johno
05-08-2014, 08:08 PM
Actually the studies show BMI, when used across the population, is accurate within acceptable boundaries of confidence. Sure for certain groups (ie us - power/strength athletes) it doesn't hold up, but as a population wide tool the science is robust.

Karl Schudt
05-09-2014, 11:21 AM
BMI in the obese range actually has less morbidity than the so called optimum range. http://www.ncbi.nlm.nih.gov/pubmed/17636102

ChadHydro
05-09-2014, 01:21 PM
BMI in the obese range actually has less morbidity than the so called optimum range. http://www.ncbi.nlm.nih.gov/pubmed/17636102

I haven't read the full study but have heard of this. Did the researchers control for lean mass? That could be a confounding variable

Johno
05-09-2014, 01:41 PM
^^ I think this is part of the problem at the moment, we simply don't know enough of the facts yet.