Disease

[liv]

So apparently the American Medical Association decided to classify obesity as a disease.

The fatosphere has lots of opinions about this, as you'd expect. Michelle, the Fat Nutritionist, is not impressed. Living ~400lbs has a comprehensive link roundup of evidence against trying to cure obesity through diet, exercise and surgery.

I also enjoyed this piece by David Berreby at Aeon who takes a balanced yet skeptical view. He takes as read that obesity is a medical problem (so he wouldn't be popular with committed fat activists like those in the first couple of links) but he challenges the discourse of obesity being caused by bad lifestyle choices, viz eating too much and moving too little. Really thought-provoking.

On the other side, pw201 linked to a piece by Karen Hitchcock, an Australian obesity doctor who absolutely does believe, based on her medical training and experience, that being fat is caused by eating too much. The thing that's interesting about this piece is that, unlike a lot of the stuff that uncritically repeats the dogma of overeating-makes-you-fat and fatness-makes-you-die, Hitchcock displays empathy rather than disgust for her fat patients.

Comments

[jack]

I'm forcibly reminded of http://lesswrong.com/lw/2as/diseased_thinking_dissolving_questions_about/, not so much for what it says about weight, but for the concept of "what counts as a disease" in general being a question that sounds factual, but carries a heavy implication that it is, or isn't, your fault.

[ptc24]

You know, up until now I had never thought of armour-plating my PhD thesis to improve its effectiveness and chances of survivability when hitting people over the head with it, but Geoffrey Miller (see the balanced yet skeptical piece) has changed all that.

I'm mildly surprised the article didn't mention tributyltin chloride; that's the first compound I'd heard of as a suspected obesogen - in Linda Bacon's book Health At Every Size, which I must finish reading some time.

A hypothetical I've pondered: Supposing the obesogen hypothesis turned out to be true, and that stricter emissions controls on those substances, at a low but non-negligible economic cost (maybe a few people would have to be laid off), would substantially decrease the incidence of obesity, could implementing those controls be the right thing to do? I tend to think "yes", and I tend to think this makes my views incompatible with some of the more radical fat acceptance activists.

I did like the Living ~400lbs link. "Weight cycling industry" is such a good term, I'll have to remember it. The Fat Nutritionist link... jars with me, but I'm sure everyone's fed up with me complaining about that sort of stuff.

[rmc28]

Ironically your post on my reading page is just below one from a friend celebrating substantial weight loss.

[redbird]

On a separate note, it's worth remembering that the American Medical Association is not governmental, nor focused on any specific disease or set of symptoms or patients: it's a lobbying group, and does not represent all or even almost all practicing doctors in the United States. That fact is likely relevant to questions of motivation: the AMA seems to have shifted from defending the independent/small medical practitioner from the perceived dangers of socialized medicine, to trying to defend/support physicians in their conflicts with insurance companies' attempts to tell them what tests, procedures, etc. they may or must do, while demanding ever-more paperwork.

I am much more sympathetic with the latter goal. I don't want to be buried in paperwork any more than my doctor does, and time a doctor is filling out forms is time when she is neither seeing patients nor keeping up with medical advances. Doctors should be able to take time to talk to patients about their health; but it still seems relevant that one possible outcome of this proclamation is that doctors will now be able to bill not just for weight-loss surgery or desired nutritional counseling, but for time spent lecturing a patient about weight loss when s/he has come in for an unrelated reason.

[damerell]

I feel a strong need, reading some of those links, to get a Goldacre "I think you'll find it's a little more complicated than that" t-shirt.

[ironed_orchid]

I felt that Hitchcock may have displayed empathy, but disgust was there too. Right from the beginning with the descriptions of the fat American family and their greasy pizzas. Also the bit where she associates being fat with being unwashed and poorly dressed, as if fat people who don't fit into her stereotype are special unicorns.