THE BLOG

In the USA Obesity is Now a Disease

09/08/2013 11:23 BST | Updated 08/10/2013 10:12 BST

The American Medical Association (AMA) has passed a motion to declare obesity a disease "disease state with multiple pathophysiological aspects requiring a range of interventions." This follows in the footsteps of the American Association of Clinical Endocrinologists and the American Heart Association. The question is why would they medicalise obesity? Well of course they would, it's their business to and big business it is. However, if we randomly asked one hundred people with a body mass index (BMI) greater than 30kg/m2 if they considered themselves diseased, how many would agree? Perhaps now when people cross the BMI threshold of 30 we should send them a get well card!

Obesity is set to be the biggest medical cash cow of all time. One out of every eight dollars the U.S. government spends on healthcare goes to provide care for people with type 2 diabetes [T2D] (over one hundred billion dollars) and it is evident that the global T2D epidemic is being driven by obesity. By giving obesity clinical legitimacy, spending on healthcare is destined to soar. There will be many beneficiaries of this outcome, not least many of the physicians and medical affiliates that moved to pass the motion. The irony is that currently the medical model is a failure when it comes to obesity. The drugs don't work and in time the surgery normally fails with clients putting weight back on after 5 years. As U.S. medical spend on obesity increases exponentially, so too does the obesity epidemic over there - and over here.

There are no specific conditions associated with obesity but it is a risk factor for disease markers such as hypertension, impaired glucose tolerance (IGT) and elevated cholesterol. Obesity is directly linked with established diseases such as certain cancers, liver disease, atherosclerosis and diabetes. However, there is much discussion about how obesity contributes to disease and this picture is far from clear. It is well documented that being sedentary is a dangerous pastime, with fit fat people having less disease and outliving unfit lean people. Therefore 'fitness' appears very protective. One emerging theory is that it is the upstream determinants of obesity not the obesity itself that is causing disease. The toxic combination of a sedentary life and the daily calorie overload required to support obesity act synergistically to overwhelm the organs and metabolic process that maintain homeostasis and health. If this is the case, then obesity cannot be a disease, it is merely a sign and symptom of our obesogenic environments, or as some would say, of our lifestyle choices.

I happen to work in child obesity and I can tell anyone that cares to listen that it is a frequent occurrence for me to see six year olds in excess of 45kg which is double the normal weight for age. In almost all cases there is no underlying pathology present. There are no medical reasons whatever that this child is accumulating vast amounts of excess body fat. The simple truth is that these children are eating considerably more calories than required; probably every day of their lives. Whilst the reasons for this are complex and emotive, the plain truth is that obesity in children is not a disease; and nor is it in adults.

One of the unfathomable features of obesity is the disturbance to homeostasis (the body's ability to balance itself) which does not allow the body to return to a normal weight. However, for those battling with their weight, following a diet they will tell you that homeostasis does work, but sadly in one direction only. This is described as the asymmetry of appetite and is probably due to a gene trait that favoured weight gain against a frugal evolutionary background and calorie sparse existence. Furthermore, as weight increases physical activity decreases (an inverse relationship) perhaps because exercise becomes more difficult and less enjoyable or maybe it is that lower levels of activity drive obesity - is it cause or effect? It is simply not known!

There is now growing evidence that the foods that are thought to cause obesity do so by initiating addictive associations towards the high fat high sugar combinations that they invariably contain. These unnaturally high calorie combinations act to interfere with satiety mechanisms by blunting reward circuitry in the brain, therefore over time, you need to eat more to get the same feeling of satisfaction and fullness. A further spanner in the works of weight management for the very overweight, is the effect of obesity on sleep. As weight increases, quality and quantity of sleep reduces and sleep disturbance has a strong link to obesity. This may be due to its effect on the appetite hormones, or just that it is harder to make wise choices and feel in control when we are tired. Sleep deprivation may merely act to make one more fatigued and lethargic and this more sedentary. Add to all of the above increased levels of low self-esteem, depression and psychological disturbances that obese people experience, and it is clear to see how obesity becomes a vicious downward spiral of despair and frustration.

One thing that I have learned over 20 years as a weight management practitioner is that the heavier people get, the more difficult it will be to return to a normal weight. I suspect that this is a combination of both behavioural and biological forces at work. However, I have also reached the conclusion that it is never too late to start weight management and obviously the sooner the better. At the right stage in a person's life with the right support in place, people can go on and achieve their weight goals and literally turn their lives into something they could only have imagined - it happens all the time. Having said this, where children are concerned, society must take the responsibility of prevention rather than cure (there is no cure as there is no illness).

In the final analysis, all that the AMA have achieved, is to further the cause of the vast financial medical machine and remove responsibility from the individual, the parent and the Government. If obesity is a disease, let's just all wait around for the right pill and wash it down with a Coke!