Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
26 Jun

Is Obesity a Disease?

obesitydiseaseYou’ve probably heard that the American Medical Association recently classified obesity as an official disease. I’m still mulling the whole deal over, and I’m not quite sure what to think about the decision. First, what exactly is a disease?

A disease is defined thusly:

  1. A disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.
  2. A particular quality, habit, or disposition regarded as adversely affecting a person or group of people.

By those literal definitions, obesity could be considered a disease. It’s caused or characterized by disordered diets, disordered hormonal responses to food, and disordered energy intake/absorption/expenditure ratios. Furthermore, obesity can lead to other, worse diseases, like heart disease, diabetes, and cancer. It’s also a “quality” (a preponderance of body fat) that adversely affects a person (increases the risk of other metabolic diseases, increases impact on joints, impairs physical ability, etc.).

But I’m not sure if obesity is actually a disease in the sense that most people imagine it, nor am I sure it should be called that. When people hear words, they don’t consult the dictionary to determine their meaning and mount a response. Unless it’s for language class, they care not for denotations, but rather connotations - commonly held cultural or emotional responses to words or phrases. This tendency of ours is not by choice. It’s simply how language works in the real, immediate world made up of actual thinking, feeling humans. So, what are a few connotations aroused by the word “disease” and how might they affect an obese person’s response to such a “diagnosis”?

Diseases are:

Immutable – A disease “stays with you.” Everyone knows that. It’s here to stay, and nothing’s going to change that unless you’re taking some serious pharmaceuticals or surgical interventions. You, a layperson, couldn’t hope to get over a disease all by yourself. Why try?

Deadly – You get over sicknesses, which are just minor annoyances. But diseases kill. This will either light the fire of god underneath you or fill you with despair.

Out of your hands – Disease strikes. It acts upon you, and you have no say in the matter.

Diseases require:

Medical intervention – You can’t beat this by yourself. A medical professional – an “expert” – needs to intervene and save you.

Pharmaceuticals – You’re probably gonna need a pill or three to get over or manage this, costs be damned.

In other words, for many people, having a “disease” may remove their sense of urgency and give them the idea that they need someone else to fix their problem. They can’t fight it, so why even try? Though other people may be motivated to “cure” their disease, they’ll likely do so through “official” routes, i.e. doctors, prescriptions, and dietitians. You could get the odd professional who has actually delved into nutritional science and won’t tell you to cut out the butter and eat more whole grains, but I wouldn’t bet on it. Either way, the obese end up frustrated with the ineffectiveness of the prescribed plans or resigned to their condition. And probably still obese.

That’s too bad. Obesity is preventable. It is avoidable. And, once “afflicted” with the “disease,” the obese can cure it simply – but not necessarily easily – through lifestyle modification.

I’m torn, though. While obesity is largely up to the individual, I see no reason to make obesity a moral failure worthy of social stigmatism, and calling it a disease may help in that regard. We individuals have gotten bad advice – advice that we’re supposed to draw upon to make health decisions – from the experts to whom we bend the knee. We’re told to “eat less” and “move more,” we’re reminded about “diet and exercise” (without any useful details, as if everyone already knows what’s healthy), that you just need to flex your willpower muscle, that fat people who stay fat just “want” to be fat, that eating animal fat and red meat will make us fat and give us cancer. I assume the same advice would be given to the medicalized obese to similar (non)effect.

Now, obesity is solely a problem of the body. This could be cool if they end up exploring the physiological origins of obesity with tons of research money, but I strongly suspect it will only lead to further ignorance regarding the external origins of obesity, like corn subsidies, lobbying from the processed food industry, the emergence of dwarf wheat, the pushing of the USDA food pyramid (what, you think the AMA’s gonna stop pushing their ideal dietary recommendations?), the preponderance of industrial seed oils and the subsequent condemnation of animal fat, the evolutionary mismatch between our genes and the modern environment, chronic stress, sleep disturbances, and all the other circumstances over which we have little to no control but which have immense consequences on our weight. Until the medical community accepts – or at least acknowledges as worthy of study – these factors, I fail to see how calling obesity a disease will do the obese any actual good.

I do see how it might cause some issues, though:

Now, the overweight kid in school isn’t just fat; he’s sick and fat. That will do wonders for self-esteem.

Now, instead of checking out a free Primal blog for helpful advice, the overweight single mother might assume she has to fork over the money for a physician-sanctioned registered dietitian. Ineffective advice that comes with a co-pay (if you’re lucky enough to have health insurance)? Awesome!

Now, the obese man won’t even think about looking into lifestyle modifications. He’ll just add the next big anti-obesity drug to his daily cocktail, right between the statins and the beta blockers.

I also worry about the legal fallout from this decision. Are people writing those free Primal (or any diet) blogs full of advice on losing weight now subject to governmental regulation because they’re dispensing medical advice regarding an officially recognized disease? A similar thing already happened to Steve Cooksey, who committed the egregious sin of dispensing nutritional advice to people with another recognized disease: type 2 diabetes.

I also question the motivations of the people ultimately responsible for the decision. As Dr. Davis wrote last week, the Obesity Action Coalition, a non-profit, spearheaded the initiative in order to “change the way the medical community tackles this complex issue that affects approximately one in three Americans.” Sounds nice, doesn’t it? Until you learn that the OAC board is made up of bariatric surgeons and the coalition is funded by pharmaceutical companies with big stakes in weight loss drugs and surgical supply manufacturers with big stakes in weight loss surgery. In other words, the very people who stand to make a ton of money from medicalizing obesity are responsible for medicalizing obesity. I don’t doubt that they care, on some level, about people’s health, but their motivations appear to be clouded by other interests, and that makes me wary.

As I said before, I’m torn. I don’t think obese people should be blamed or made to feel like moral failures. Even if it were true that all obesity is caused solely by personal irresponsibility, saying “you’re fat because you’re lazy and eat too much” simply does not help people lose weight. They “know” that; it’s the implicit message all around us. But I doubt this is the right way forward.

We need a balance, not a diagnosis. On one side is “obesity as a disease,” with patients assuming it’s out of their control and a medical intervention is necessary. On the other side is “obesity as personal failing,” with the obese feeling a deep sense of shame and hopelessness, especially when their willpower fails to deliver them to the promised land. But you and I and everyone reading this know that it’s a lot greyer than either position. We know that the real story is a tad more complicated.

What do you think, folks? Is obesity a disease? What impact will this decision have on obesity in this country?

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Maybe it’s just me, but I think this might do some good for nutrition and fitness research. And in all reality, it’s probably going to blow over quickly and people won’t think twice about it. Kind of like climate change/global warming–people freaked out about it, vowed to cut their CO2 exhaust, and those same people still use the same amount of CO2 as before and now don’t believe that climate change/global warming exists. There will be people who want to define obesity as a disease and not do anything about it, but there will be people who want to make a difference in their lives by improving their health too.

    Charlayna wrote on June 26th, 2013
  2. Richard Dawkins coined the word meme to mean an “an idea, behavior, or style that spreads from person to person within a culture.” He meant it to be analogous to a gene. Gene’s carry physical characteristics that are passed on through reproduction; memes carry ideas that spread from brain to brain. A defective meme is like a defective gene – it can lead to dysfunction and personal or social malaise just like a defective gene can lead to physical disease. The SAD diet and the current consensus on health and nutrition are the defective memes causing real physical maladies in humans. Richard Dawkins is pretty smart. What we need is meme therapy.

    Mantonat wrote on June 26th, 2013
  3. Here’s a similar question. Is anorexia nervosa a disease? I knew a girl who had it, and she always made a conscious choice not to eat. In a way, it was her decision each time. She could have chosen to eat at any time and ended the disease. Similarly (most) obese people become so by choosing to eat too much or the wrong food. A smoker chooses to to light that cigarette each time. He can just choose to never pick up a cigarette again.

    While it is clear that the anorexic, the obese person, and the addict all can decide to stop perpetuating these wrong choices, I’m not so quick to dismiss them as diseases. The willpower to do so is too much for most people, and they do need help. Physical changes have been shown to take place in the brain in addicts, affecting the ability to access this willpower. A lot of these people have troubled lives and addiction is a source of comfort, an oasis of pleasure in a day of suffering.

    I can certainly sympathize, but ultimately, they’re not diseases.

    Miryem wrote on June 26th, 2013
  4. The AMA’s decision has nothing to do with actual disease in the realm of such ailments as diphtheria or influenza. Because you either have or you don’t have diphtheria or the flu. There is no wiggle room, no arbitrary numbers. The way “obesity” (like cholesterol and diabetes) is determined is according to a largely arbitrary set of numbers that somebody made up. in the case of weight, these numbers were invented while some guy was creating an actuarial chart. No. The AMA made this decision for either political or economic reasons. Or both.

    The question is not whether obesity is or isn’t a disease. The question is who has a vested interest in the AMA’s (or any of these so called professional associations) pronouncement? It is a sad situation indeed when so much our culture has become so blighted by economic interests that every bit of expert advice must be viewed though a jaundiced eye and taken with a grain of salt. Pun intended.

    So now, when your doctor gives you a sidelong look, rubs his chin and says, “Hmm. You are obese. Let me refer you to the bariatric surgery division of our hospital.” There is an ulterior motive — since many physicians’ practices have been bought out by hospitals — having to do with the almighty dollar.

    Donna wrote on June 26th, 2013
  5. Obesity is a symptom, not a disease. It is the result of a disease. MDs need to find and treat the true cause of the obesity, which may be emotional, physical, the habit of overeating, etc. As mentioned by so many here, pills and surgery should not be the treatment of choice. Let’s try diet, exercise, emotional support, counseling, homeopathy first. I agree with those who are fearful of big pharma and big medicine.

    Linda wrote on June 26th, 2013
  6. I don’t see obesity as a disease, Its a condition that comes from what we are taught by the main stream medical world and the government.
    Take out all the information that has been put out there in the last 50 years and go back to eating what grew locally, leaving out processed foods. We would be fine.

    Shirley wrote on June 26th, 2013
  7. Obesity is often a symptom for an undiagnosed medical problem. Clearly if a person has dramatically altered their diet (aka eat less, exercise more) and the excess weight does not normalize or even go down, then it’s a medical issue, not a lifestyle issue, and it needs to be addressed as a medical problem.

    Lifestyle obesity results from bad food and exercise choices and diet modification usually results in weight loss. Most people who go from an SAD diet to Paleo will see their weight normalize and will feel great.

    Medical obesity is where the person is making great food and exercise choices (like Paleo) and getting all the wrong results. Often, things get medically worse along the way.

    Lots of us who have gained unwanted weight have made dramatic changes in diet and lifestyle, yet see no weight loss. We remain obese or morbidly obese despite eating very, very modest amounts of clean wholesome organic food and exercising as much as feasible.

    The failure to lose weight when really making an effort to do so, is a symptom of some underlying systemic problems not a lack of willpower and the plate. And it’s frustrating and discouraging and having bouncy athletic 20 somethings tell me all I have to do is “x” when I’ve already done “x” without results. It is unkind.

    It’s really, really, REALLY difficult to get the medical pro’s to grasp that I became metabolically sick and as a result gained 100 pounds in 2 years and haven’t been able to drop any weight over the last 13 years despite major changes in lifestyle.

    It’s a big difference in approach to treatment if the doc sees you as a person who makes bad choices or a person who has a metabolic imbalance. Declaring obesity a disease is not going to help much because doctors, too, only see a ‘fat person’ as someone who eats too much, not as a person who gained weight because of an underlying problem.

    I’m sticking with the Paleo diet because it’s an easy way to avoid problematic foods. But I am an obese Paleo person and without some sort of dramatic breakthrough in obesity or metabolic research, I am likely to remain an obese Paleo person.

    Jean wrote on June 26th, 2013
  8. Yup. Obesity is a disease. LOL

    The pathogens that cause this disease line the shelves of supermarkets across the country…

    Dave, RN wrote on June 26th, 2013
    • See those two letters that Dave proudly claims after his name? RN?

      Yup, the pathogens that line the Road to Bad Medicine that this country has traveled.

      Arrogant sumbeach. Thinks he knows it all – thereby ensuring that the patient feels worse, AND gets no help.

      Shame on you – true healers WANT to help. Judgemental @$$es don’t.

      Ray wrote on June 27th, 2013
  9. I agree – labeling it as a “disease” may take the responsibility out of some people’s hands. They will think there’s not much they can do about it and leave it up to the doctor to “treat or cure” them. However, some dietitians will provide great, more primal-focused advice. I think there is a shift happening in dietitians towards no only more whole, real foods but also eliminating gluten and changing their mind on saturated fats, etc. There’s even a great Facebook group (“Paleo RDs”) if any other RDs are out there. :)

    Lauren wrote on June 26th, 2013
  10. A lot of people seem misinformed that the AMA decision has an effect on insurance. There was already a billing code for obesity and obesity was already recognized by the FDA as a target for treatment.

    The AMA recognizing obesity means nothing. It doesn’t even mean anything to the AMA, which has been running articles about the disease of obesity in their Journal for years.

    Mary wrote on June 26th, 2013
  11. I think it is all a big power play by the feds and big pharma. They now will have the clout that they need to keep people sick while they profit from it. :(

    Suzy wrote on June 26th, 2013
  12. While still a concern, it’s not my biggest concern how the medical establishment and big Pharma will have a hardon for all of the new ways they can make money off of this new disease. I don’t like the label for the simple reason of: ACCOUNTABILITY.

    Former fatgirl here: I was FAT because I chose to eat the wrong things, not move my body and drown myself in all of the things that were wrong for me. I self-medicated with food instead of doing the HARD WORK of looking inside myself and dealing with the issues that prompted the eating. I was not a victim to the tragedies of a freak accident or cancer – I chose to consume foods that would cause weight gain and health issues. I was responsible for my actions and the outcome.

    I just see obesity becoming the new scapegoat. I see people not owning their responsibility for their own health and I see labeling it a disease allowing more people to shift the blame elsewhere and I see obesity becoming a larger epidemic than it is — just with this one action.

    Kathleen wrote on June 26th, 2013
    • Thanks for your comment, Kathleen. Such honesty is rare when it pertains to such a touchy subject. I fully agree that accountability is the element that’s lacking in most cases of obesity. Labeling it a disease will hurt more than help.

      Shary wrote on June 26th, 2013
  13. I have mixed feelings about this but feel the need to comment that for many people food is their drug of choice. Drug & Alcohol addiction is easier to hide.

    Lucylu wrote on June 26th, 2013
  14. I agree with most of what Mark says and I’m similarly conflicted. On the one hand, a classification as “disease” may help to overcome the stigma that fat people have in our fat-shaming culture. Right now it’s mostly believed to be due to bad behavior, failed willpower. People really do believe that fat people are there by choice or have some mental failing.

    Saying it’s a real medical thing may make the doctors more likely to try “science” instead of repeating the old wives’ tales about it. Sadly, most of the science is paid for by drug companies who have an agenda, and nobody is paying the same millions to research the health effects of reducing grains and bringing back fats. I truly believe “low-fat” diets are killing people, and not just people on low-fat diets, but everyone who is exposed to the popular media message that “low-fat means it’s good for you”. I hope science gets us out of that mess, but probably many thousands still have to die before we “get it”.

    I really wish there were some other “markers” that would confirm the “obese” diagnosis, like certain blood panels or whatever. Just looking at BMI doesn’t cut it scientifically. Hopefully they can use more actual science and address that down the road.

    I have personally lost 100 pounds following a paleo plan (look for my story soon :) but I have been the fat kid / fat guy all my life and fat shaming still has an effect on me. So I still see “fat” as part of my identity. We need to stop blaming fat people and shine the light where it needs to go-big agri-business and our failed health-care systems. We have let the “war on obesity” become the “war on obese people”.

    Greg C wrote on June 26th, 2013
    • That is a really excellent concept- the war on obesity has turned into the war on obese people. Well said!

      Mary wrote on June 26th, 2013
  15. I want to help fat people lose weight. I am pretty sure it’s going to be easier with a coach to motivate, encourage and keep you accountable. If you are serious, can afford to pay me, and live in SF Bay California, I am interested to start a new career as a Weight Loss Coach. I train regularly in Thailand with MMA fighters, these are guys who know how to cut weight. The relationship I intend to establish with you is coach, friend, taskmaster, advisor, and benevolent drill sergeant. If you do what I tell you to do, you will cut weight. I will work with you to increase your metabolic rate, have fun, sweat, and burn calories. I will hold you accountable to eat clean and advise you on all things wellness related. If you think the cost is too much, consider the cost of obesity.

    Bill Berry wrote on June 26th, 2013
  16. I do not think obesity is a disease. Things caused by it are – diabetes. Just like lung cancer is a result of smoking – another bad habit. Is it easy to reduce body weight? No, but that does not make it a disease.

    kittypalmbeach wrote on June 26th, 2013
  17. I am a doctor who specializes in obesity treatment with low carb whole foods. This decision by the AMA will help patients get access to care and reimbursement for doctors that address it. Right now for most insurances a physician can not get paid for seeing someone for their obesity. Trust me, no doctors are getting rich from treating obesity (well maybe bariatric surgeons). This is a good thing for patients and will hopefully motivate other doctors to get some extra education. ASBP is a great resource to share with your doctors.

    Leah wrote on June 26th, 2013
  18. When a person discovers they are an alcoholic, then they are told alcoholism is a disease. Is it? Or is it that alcohol is a poison that they were addicted to and they just can’t ever drink it anymore or they could become addicted to it again. Obesity is caused by sugar. Plain and simple. like alcohol, it is metabolized in the liver the same way and causes insulin resistance. insulin resistance is the disease the medical community need to be worried about. Obesity is a side effect of insulin resistance. and then people who have insulin resistance BECAUSE of having it, they become “sloths” and “gluttons” because the biochemistry of the disease drives behavior, not the other way around. If the AMA and FDA weren’t in the pockets of the sugar industry (and wheat, corn and soy) they would BAN sugar as a toxin. Sugar is made in almost the same way cocaine is made and that is a banned drug. People just need to eat REAL FOOD. Meat, fruits and veggies basically and little of anything else. Doing that can reverse insulin resistance and then people actually FEEL like exercising.

    monte wrote on June 26th, 2013
  19. Hi all, great posts. Mark is right on as usual. “Torn” is a good way to describe it. I think obesity is a disorder more than a disease per se. Doesn’t matter what you call it, the medical establishment is going to profit big time and that is what will become foremost.
    I want to express sympathy for those who have struggled all their lives with overweight/obesity. I too was born too chubby for my height and have tried everything there is to fix it with varying results. Paleo has helped the most with weight loss, but here is a very stubborn problem: Low/normal triglycerides but very high (225) LDL. Should I worry? I recently read that people with the gene ApoE (3 or 4) can’t metabolize fat very well at all. They can metabolize carbs better. Boy, I didn’t want to hear that! Has anyone ever heard of it. Good luck to all.

    ShaSha wrote on June 26th, 2013
  20. I don’t think is a disease, it causes diseases!

    adriana wrote on June 26th, 2013
  21. Obesity is not a disease, it is a symptom.

    Brandi wrote on June 26th, 2013
  22. No.

    Dr. J wrote on June 26th, 2013
  23. I didn’t bother reading all of your comments (there’s so many of them!) so I don’t know if anyone else has said this, but… what about all of us who are “overweight” but not sick? Fat but healthy? I’ve already lost 100 pounds, and my body has decided that it wants to stay at this weight range. I’m happy with that because I’m healthy and strong, but my doctor would probably look at me and tell me that I was diseased and that I need a pill or surgery.

    Obesity isn’t a disease. It’s just a marker for disease. And sometimes people are just built bigger than others!!

    Julie wrote on June 26th, 2013
  24. I featured you on a blog post that I am posting today.

    Betty Taylor wrote on June 26th, 2013
  25. I, too, wish we could place more responsibility on the patient and it’s distressing to have one more excuse at the ready. My hope is that this was done to encourage insurance companies to cover nutrition and physical/exercise therapy over surgical options.

    In my part of the country nutrition counselors recommend vegetables, protein and fat, with daily carb intake between 60-145grams. This is in-line with what is taught in med schools as well…or at least that’s what we were taught. Now, I would love to see the next step of eliminating breads, pastas, etc..but cutting back significantly is better than recommending a high carb diet.

    Many of you seem unaware that the AMA represents less than 20% of practicing physicians. The view of the AMA does not in any way reflect the views of most physicians.

    Hobertah wrote on June 26th, 2013
  26. Obesity is a disease in the same way that alcoholism, drug addiction, and yes sex addiction are a disease. It has as detrimental effects on the body. The nature/nurture debate will continue in terms of root causes. I tend towards nurture by and large.

    Lets be clear on what we mean by obese though. I know that the BMI is contested but it is one measure that, in the main, can be useful. We also need to account for body type and “normal” variations in size across the population. However, even controlling for those factor, there are people who do have this medical condition. And it is a medical condition insofar as it is a contributing factor for a lot of diseases.

    I agree obesity as a condition/disease/health issue needs to be treated. The issue is how should it be managed and treated. Clearly, a more comprehensive approach is necessary. That includes diet (specific on kind), exercise (type), and psychological counseling.

    My fear is that this is going to open the gates for increased bariatric surgery as access is going to be made easier through insurance and medicaid. I still think this should be a last resort but already it is growing in popularity and I can see it increasing notwithstanding that I am not aware of any longitudinal studies on the effectiveness of it that would make increasing access justifiable.

    There is a lot of shame and social stigma associated with body image in general and handling obesity is challenging for that reason. I think Mark’s approach has been sensitive and on target.

    George wrote on June 26th, 2013
  27. If obesity is classified as a disease, then you take the means to heal it out of ones hands and put it into the hands of Medicine / Pharma. It could be a trap for many people, giving them the impression they can’t do anything actively against it, because they are struck with it. No more self responsibility, no more awareness how it came about, no more research what onself can do about it. Medicine would like that scenario, helpless people whom they can prescribe drugs for a lot of money. I’m glad I discovered the Primal/Paleo diet already, before they stop people getting access to the knowledge of how we can heal ourselves. And I made use of it, changed my life to the better. Don’t need medicine or dietitians to tell me how to lose weight and get healthy. Got it all in my brain and genes now.

    Margit wrote on June 27th, 2013
  28. Why don’t primal/paleo people have the same amount of disdain for obese people as they have for “establishment” people who “knowingly” dispense bad advice? Those people are expected to know better, but obese people are not? And even if they are, then why are some “non-establishment” people able to turn away from “expert” advice while other (the obese) are not? Don’t they at least deserve our disdain for that failure?

    Hank wrote on June 27th, 2013
  29. Being overweight/borderline obese from my mid 30’s and trying different things to get to normal weight again I was happy to discover Paleo half year ago and hoped to find some answers in this approach. Lot of answers and ‘aha!’ moments I did find, my overall health has improved, my (for long time resisting) husband lost some weight – but I remained the same…Mind you, not too many people know about paleo approach in South Africa (books are not available in bookstores, only via internet). Also it is very difficult to find out if you are purchasing right food (meats, veggies, fats…) and I am worried that many of the foods we buy are not what they are supposed to be, and that they are not really helping…As far as my weight is concerned – I have NEVER been a glutton, I always strived to prepare (daily!) fresh healthy meals, but my lifestyle changed and become sedentary, my stress levels skyrocketed, depression kicked in, etc…And I am certain that the whole of chemistry and metabolism in my body went wrong way..and, even if obesity was treated like a disease in South Africa I do not believe that I could find a doctor that will know the ways to check what is really ‘off’ in my body and give me straight advice how to fix it. ..It is just too complicated and very different for each person, and there will not be simple, same approach for it any time soon.
    We, overweight folks, can give up – which I’m not – or go ahead and patiently keep trying to mould dietary/lifestyle approach that is going to help our body regain proper proportions and great health. It is lot of work, but I believe I ‘ll get there, and I ‘m grateful for MDA and blogs alike that are source of advice, information, support and inspiration.

    ljiljana wrote on June 27th, 2013
  30. I think obesity is a disease in the sense that AIDS in a disease. In other words, obese people may be affected by ailments as a direct/indirect result of being obese: atherosclerosis, myocardial infarction, diabetes, hypertension etc. One does not die of ‘obesity’ in the sense that one does not die of ‘AIDS’. One dies of the complications of these diseases.

    Janna wrote on June 27th, 2013
  31. Thanks for the information. I think obesity has been increasing at a higher rate in people along with sugar and B.P. We should control it before it become worse and result in laziness. .

    Anup wrote on June 27th, 2013
  32. “Now, obesity is solely a problem of the body.” Worst sentence ever to appear in a Mark’s Daily Apple post. Following that thinking, so is “cutting” (the cut’s on the body are the only problem), so is heroin addiction (before the heroin enters the body there’s no problem, so heroin, like obesity, is solely a problem of the body–after all, before the food enters the body, there’s no problem). The real problem here is that in many, many, many, obese people (including myself at one time), there absolutely IS an addiction element present in their relationship to food. And that carries with it a significant, mental component. It’s a component that processed food manufacturers take advantage of in many ways, from advertising and packaging, all the way down to the manner in which the processed ingredients act on the brain. Keeping this primal: we evolved to have pleasurable (mental) reactions to certain tastes: salty, sweet, and fat. Why? Because the foods with those tastes carry so many of the nutrients we need. Primal ancestors with a natural/genetic attraction to those foods would survive and thrive better than those that didn’t have that attraction; they then reproduced offspring who also inherited a natural predisposition to those foods, and thus the virtuous cycle of evolution led to more and more positive/healthy ends–healthy homo sapiens attracted to healthful foods. But highly nutritious foods in nature also deliver satiety. On the other hand, modern junk foods trigger our pleasure centers (salty, sweet, fat) but are stripped of nutrients, so we don’t experience satiety and simply keep on eating. That is by design. It is the MENTAL, pleasure response in the brain that keeps us going despite all the PHYSICAL evidence we should stop–why would an otherwise sane 300-pound person eat an entire bag of Doritos? Lots of physical proof that it’s bad–yet the behavior continues. Thus, Mr. Sisson has it almost completely reversed. For many obese people, the problem is primarily mental. Remove that mental, pleasure-searching component from our food intake, and we can eat sanely. That’s my experience, and I hope that is helpful to someone.
    Now, the question arises, why would Mr. Sisson make such a demonstrably false assertion? After all, I just demonstrated with ease that his assertion is false. I’m sure I know the answer–and it’s not just about on which side his (coconut flour) bread is buttered. It’s not just economic. It’s a bigger issue than that.

    Joey wrote on June 27th, 2013
    • I’m pretty sure that it’s a typo. Reading the following sentence(s) I get the impression that he meant to write “isn’t solely”

      Stefan G wrote on June 27th, 2013
      • I don’t think it’s a typo. There’s nothing following it that talks about the mental aspect. There’s nothing following it that would support the statement “obesity isn’t solely a problem of the body.” He immediately starts talking about how cool it would be if the idea of obesity as a disease led to greater research into the “physiological (not psychological) origins of obesity.” I’m certain he meant to write what he wrote. And in two seconds I’ve shown that he’s just plain wrong on that. If he didn’t mean it, if it is a typo, he can certainly come in here and fix it. Then I’ll happily stand corrected (at my standing work station!).

        Joey wrote on June 27th, 2013
    • I think Mark means that in the eyes of the AMA, and therefore the public obesity is now considered just a body disease.

      Of course Mark himself doesn’t believe that; he’s been writing about the mental aspect for years. Mark is just giving his interpretation of what OTHER people think.

      oxide wrote on June 27th, 2013
      • I can see how it can be read that way now that you point it out. I didn’t read it that way at first. It’s unclear at best. I want to think that you’re right. That’s why I responded as forcefully as I did. If he’s making that statement in earnest, it would be truly mind-boggling. I guess he’s saying that “Now,” meaning once you define obesity as a disease, “obesity is solely a problem of the body.” If that’s right, then my response was misguided (still true, just aimed at the wrong target). I hope so. Thanks!

        Joey wrote on June 27th, 2013
  33. I don’t think it is a disease, it is a coping mechanism against a dysregulated metabolism (could be hormones, energy use, bad gut flora, whatnot, going completely beyond reasonable limits). I tend to think that becoming obese is actually what keeps people from being completely screwed by this dysregulation, it is a safety valve. To me the standard collective response to obesity IS the disease, which is a COMPLETE LACK of empathy.

    James wrote on June 27th, 2013
  34. Obesity is not a disease, it is a potential combination of a number of issues. Some people are genetically predisposed to storing fat more easily than others and so need to either eat a very low fat diet or increase exercise.

    The problem is that for many people they are too busy trying to earn a living and look after their family than go out of their way to eat a healthy and nutritional meal. How cheap and easy to fast food outlets make meal times these days?

    Obesity needs to be tackled with knowledge and encouragement rather than a dismissive categorization of calling it a disease. Just my 2 cents worth!!

    Mike A wrote on June 27th, 2013
  35. Love this quote which pretty much sums up my opinion on this topic: Medicine is not healthcare–Food is healthcare. Medicine is sick care. Let’s all get this straight, for a change. source unknown

    Obesity is not a disease. Sorry.

    kate wrote on June 27th, 2013
  36. An interesting article. I’ve enjoyed reading the articles and they spurred me to get my lifestyle back under control. I dont think obesity is a disease and calling it so will probably make it harder to deal with because it is another excuse.

    We are blessed with the ability to learn, to read, to discover and to exercise free will. We choose what to put in our mouths and can just as easily choose not to eat something. We often choose not to eat something because we don’t like its taste so we are clearly able to exercise restraint in given circumstances. Fat people also believe that diets work ergo they accept that modifying their food intake can help weight loss.

    In the UK we have an obesity problem just as severe as the US. However it is difficult to deal with; the NHS as well as being the largest employer in Europe, provides our primary and secondary healthcare and principal point of contact for people with health issues including obesity; yet it is acknowledged that over 50% of NHS workers are overweight or obese. Not a great example!

    I saw an NHS dietician after suffering a heart attack 13 years ago; her knowledge and advice was woefully inadequate. watch your calories,eat 5 portions of fruit or vegetables a day, eat whole grains and exercise. I was already doing that but the advice was non specific.What sort of exercise? I was doing 3 gym sessions a week, aerobic for about 60 minutes each time, sailing at the weekend, walking the dog 3 times a week. It kept my weight stable for a while but it crept up again.

    I discovered the Paleo diet about 3 years ago and started it in eanest when my wife and I separated. I chose what I wanted to eat, not what I was presented with, I ate a cooked breakfast every day, I had lunch every day and I had a hearty dinner every night. I lost about 40 pounds in 8 months. I slept well every night, i had plenty of energy, my blood pressure fell from 138/90 to 122/80 and my cholesterol levels dropped too. I never felt hungry and if i did i had a snack. It works.

    Last year I lapsed, the weight went back on! 6 weeks ago I started eating primal and the weight is falling off once again.

    Obesity is not a disease, it is the product of ignorance and misguided though well meaning advice from the health service.
    however, there is another factor at work here. There probably aren’t enough resources available for the whole world to eat Primal, the popuation has grown too big. Bread and starch keeps the masses quiet and their bellies full and in former times it killed them off, now medical intervention keeps them alive with drugs, gastric bypasses etc at enormous cost and they receive disability payments.

    We are born with free will but it isn’t neccessarily convenient for governments if all of us exercise it. And amazingly most don’t.

    My friends ask me how I have lost so much weight, I tell them and their response is “i couldnt do that”, “isn’t that unhealthy” or “i dont really need to be that extreme” Even my doctor who congratulated me on the weight loss, lower blood pressure etc when he asked how I had done it didn’t really want a website or link for other patients.

    I tell everyone who asks how Primal or Paleo works and how healthy it is but most people dont seem to want to exercise freedom of choice.

    Simon wrote on June 27th, 2013
  37. Ladies and Gentlemen, I am obese, weighing in at 500+ lbs. This article hits home. I have looked into the “bariatric” surgery and other dietary/surgical means to lose weight, which scares me to death. I do not want to take pills for the rest of my life. This site alone has literally started me on a path of recovery. I know that there is a long road ahead of me, but this eating primal/paleo has made a huge impact. Right now I am on week 3 and I can definately feel the difference. I am limited to what I can do right now, but I am making progress. The whole point here is, lifestyle change for the better, I will not let doctors give me pills or do surgery for my obesity, I will do this myself, one step at a time. There will be more to come in the future.

    Jamie wrote on June 27th, 2013
    • Good luck! Please visit the forum and let us know how you’re doing. You will find plenty of support. :-)

      oxide wrote on June 27th, 2013
    • What a great attitude! I’m sure this will be the start of good things for you.

      Cat wrote on June 27th, 2013
  38. Some very good arguments have been put forth but isn’t it inevitable that society will eventually wake up and recognize that obesity is something we have done to ourselves through our misguided eating and lifestyle habits? The big shift will occur when enough of us Primal types have produced the results that have eluded the majority of society. In the mean time; let’s just continue to quietly succeed at letting nature take it’s course via the Primal approach.

    Gord, Vancouver wrote on June 27th, 2013
  39. Mark, do you consider Celiac a disease? While it’s technically not caused by lifestyle choices (technically, one has Celiac regardless of what they eat, it’s just that some things cause the autoimmune reaction), the only effective treatment for it is dietary changes. Thinking about such parallels may help your thoughts on the matter.

    Additionally, having a disease doesn’t necessarily give you a free pass to do nothing but pop a pill. If you’re Diabetic (Type 1 or 2), if you’re content with just shooting up with insulin every time you eat, so that you can eat all the crap you want, you’re going to end up destroying your body, very likely in a very gruesome, piece by piece way, as doctors try to save you from the gangrene and necrosis eating at you from your feet up. And even then, you still have to have enough responsibility to inject the correct amount of insulin, or you’ll just kill yourself right then and there with either too much (dropping your blood sugar level too low) or too little (and having your blood sugar skyrocket).

    That said, while I agree that the decision is a double-edged sword, I think there are some positives that you’re overlooking, and I can use myself as an example.

    As much as I’d love to be a PB success story, the simple truth of the matter is that I won’t be able to until I go on what you may consider “anti-obesity medications.” This is because, despite following the PB for the past year (and yes, being very active, and keeping my carbs down, and, for the “in vs out” crowd, eating less than I should be burning), I’m still obese, thanks to polycystic ovarian syndrome. PCOS, by nature, is nearly always has insulin resistance as a comorbid, and elevated androgen levels, both of which, in women, make it very easy to gain weight, and very hard to lose it. For me, it’s proven impossible to do so without medical intervention.

    I’ve been dealing with PCOS for at least four years, now. However, both my primary doctor and my gyn had decided that my being fat and not losing any weight was entirely my fault. That I wasn’t “trying hard enough” or that I “wasn’t doing it right” (because I wasn’t on Weight Watcher’s, or because I wasn’t engaging in Chronic Cardio). It wasn’t until I went in to see my doctor for pelvic pain (which my general doctor, despite diagnosing it as an ovarian cyst, never connected it with the other outward symptoms to even so much as question whether there was something deeper) and a follow-up with my gyn, where I had to specifically request the tests that would confirm that my weight issues were caused by elevated androgens.

    I went to both of them a year ago, trying to ask for the very same tests, only to be told that my weight was my own fault and that nothing was wrong with me (despite having elevated androgens and insulin resistance in the past). Never mind the fact that both my diet and exercise regimens should have seen the weight falling off of me. It wasn’t until just last week that one of them actually listened to me and ran the tests, which did, in fact, come back with badly elevated androgens and “impaired insulin sensitivity” (and that was after being Primal for the past year, and dropping my carbs under 75g for the past month or two!).

    I’m not saying this to say that I think obesity is a disease. However, I do believe that treating it as such could make it more likely that people like me would be able to get the medical help that we desperately need (and want! I don’t want to be overweight!), before it turns into a miscarriage, or cardiovascular disease, or endometrial cancer, or autoimmune thyroiditis, or even just another upward tick of the hundreds place on the scale. Perhaps if the medical community recognizes it as a “disease,” they’ll be more willing to try to find an underlying cause for a person’s weight, instead of being so quick to dismiss someone for “not trying hard enough” or “not doing it right” or otherwise blaming a person’s weight on motivational/willpower failures, despite a good faith effort to lose weight through making lifestyle choices that should support weight reduction.

    Shauna wrote on June 27th, 2013
    • To Shauna,

      As someone who suffered with PCOS much of my life, I encourage you to seek a progressive integrative or functional medicine practitioner….quite often, PCOS is actually a symptom of poor thyroid function. Do not let a doctor tell you that your TSH ‘is within range’. As a matter of fact, the TSH is rather useless for many. I encourage you to get your Free T3, Free T4, Reverse T3 as well as both thyroid antibodies – TPO and TgAb tested. You may find yourself with a reason why PCOS is still hanging on despite treatment and proper nutrition. The book – ‘The Hormone Cure’ by Dr. Sara Gottfried and ‘Stop the Thyroid Madness’ by Janie Bowthorpe are quite eye opening. Janie’s book literally saved me life. Good luck.

      Kathleen wrote on June 27th, 2013
      • Thanks for the books Kathleen. I have found a functional medicine practitioner, due to the issues I had with my old general practitioner, but I only just had my first appointment with her (in part due to the blow to my confidence created by having both my old GP and my gyn, who was the one who originally found out about my hormonal issues, blame me for not being able to lose weight). As such, I haven’t been able to *get* treatment, and I’ve been left on my own to handle the “proper nutrition” aspect.

        And that’s the point of my initial comment – most doctors are too quick to blame the person for their weight, even if they are, in fact, doing everything “right” when it comes to nutrition and exercise. Perhaps by making a declaration that obesity is a “disease” (or medical issue, not necessarily a result of someone being lazy and eating too much and not actually trying to lose weight), then some more attention may be paid to the real underlying medication issues that are keeping many people from being able to get the help they need.

        Shauna wrote on June 27th, 2013
  40. It is NOT necessary to “medicalize” something in order to avoid blaming the person with a health derangement. To do so is a flimsy excuse to financially exploit the condition. Once you “medicalize” something, the next step is justifying a pharmaceutical intervention. Once this is done you open the pathway for new drugs with fresh patents and lots of potential for $$$.

    The AMA does NOT represent physicians. Less than 20% of physicians are members. The bulk of the AMA’s income comes from the publishing of the CPT and ICD10 manuals that are used by government payers of healthcare (with commercial insurers following suit). The more diseases classified and coded means a more solidly entrenched Big Agra-Big Pharma-Big Medicine-Big Govt. Complex.

    It is entirely possible (and preferable) to reverse obesity without ever seeing a medical professional of any type. Your success stories archive proves this. Obesity by definition is therefore NOT what the AMA says it is.

    More to come in the Primal RX

    Doug McGuff, MD wrote on June 27th, 2013

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