AMA classifies obesity as a disease (Page 9)

Why do you "fear" anything? Obviously what is happening in the field of weightloss and nutrition is not working to help people lose that weight.. so I echo most of Powerman's posts from yesterday and truly wonder, why the worry? If the AMA is able to provide more support that brings about change.. great.. if not, will we be worse off than we already are? 

I'm not disagreeing but I see the other side too.  I think the fear is that this is just an excuse for the drug companies to pump out more drugs that obese people will see as a magic bullet and a way to not have to change the bad behavior that led them to obesity in the first place.  I'm not a very cynical person (only mildly cynical ) but if I were, I would think that the drug industries have a strong influence on the AMA and swayed this decision.  I freely admit though that I know very little about the pharmaceutical industry so I don't know if I would believe that or not.

If your doctor is that married to the BMI chart they are stupid and you need a new doctor. 

My fear being more of the same (chronic obesity) only now we have an entire new medical classification that will get exploited and tons of insurance money will be thrown around with little to no improvement...

I sincerely feel empathy for those with specific conditions that prevent them from losing weight the way the majority of the world's population does it, by exercise (or physical movement - manual labor etc.) and proper nutrition...

However for all the rest it's a behavior issue that needs to be addressed, nothing more nothing less...

As for your comment about what is currently happening and not working in the field of weight loss and nutrition, that's precisely the problem for so many people.  That is, they look for a quick solution, pill, new way to do a crunch etc., to fix their problem when in reality it's a daily plan around the food we take in and the amount of calories we burn...

is it really the "people", or the weightloss industry itself, preying on those who are vulnerable and desperate. I cannot argue with the idea "eat less lose weight". It makes sense. Wouldn't it be fantastic if the AMA is able to possibly help young people, to address that "behavior" issue? It's EXACTLY the point the doctor made in his interview. 

I'm doing a poor job of stating this case. I think we agree more than we disagree, but we're coming at it differently. And for the record, you will never find me being one of those people throwing around BS excuses like metabolism or disease as being static things out of my control.

What I am saying is that as someone looking to fix and reverse the damage of years of poor eating, the CICO model is woefully insufficient, and does greater damage. It gets people eating 1500-1800 calories, almost always low-fat, they find it unsustainable and revert back to binging on anything.

Kilocalories are a unit of measurement of energy, right? Again, the problem is reducing food to a unit like calorie, and treating them all the same. Look at it this way: when you put gasoline in your car, you expect that for the most part, a gallon of 88 octane in one gas station is going to perform in your engine the same as 88 octane from another station. It's qualitatively the same, standardized product. You can accurately determine mpg every time,

Just because we simplify things and make food=gasoline and body=engine, does not make it a good analogy. There are multiple factors in play that make the number of calories in a thing only a starting point. Of course they matter, but they are not the single unit of measurement to tell us whether we will achieve weight loss, a better metabolism, or health.

But we continue to reduce the problem to "fat people eat too many calories." Ad we all nod as if we all know the obvious answer, yet since the dawn of calorie measurement, we are fatter and fatter all over. Not just guys like me. If you think you have 10-15pounds to lose, go to Europe and you may end up thinking you have 25 to lose.

You already identified where I know we agree, and I think it is a much bigger deal than the increasingly red herring issue of calories: simple carbs. The hormonal response that happens from blood sugar spikes, in non-diabetics as well as diabetics, is a major factor in how the body processes, burns, stores, this energy. The way it coms into us matters. It matters tons.

As to whether one can 1500 and burn 2000 and not lose weight, again, you're making assumptions about how easily you can reduce the actors to know those numbers are accurate. Someone who has been out of whack will need time to readjust to health, or the elusive metabolism will not actually burn the number we assign from whatever standard table we created years ago saying "this activity burns x."

I think the problem here, is that we all know intuitively when someone eats too much and gets fat. Not rocket science right? No need to overthink it. I get it. But the Calorie hypothesis has been used and abused to get away from the real questions that ARE deeper, mainly the hormonal responses. This matters to me when I see others like myself who try to get it together, count accurately and obsessively, do not lose weight, find ourselves hungry, doing everything we've been told, then wondering why we suck so much worse than normal people, why Aren't we strong enough, etc etc.... I take ownership for getting myself here. Bt I refuse to continue to listen to the conventional status quo that ignores all these factors and preaches calories like its the only thing. Wy in the world does the American diabetes association recommend a lowfat diet that includes whole wheat bread? Carbs without fat raise blood sugar. Ad whole wheat bread will do it as quick or quicker than a can of coke. Yu don't hear about that much do you? Why? Because the ADA is like the AMA. Just smoke and mirrors. We know why we eat like crap today. But you start picking on actual foods or "foods" and. You get sued.

I'll end my rant like this. You don't want to believe the half-baked ideas of the raving fat guy, ask yourself this: do you want to take the same nutritional approach as coca-cola would have us do? Whenever I hear words like moderation and calories, they're coming from fast food and soda executives. Hmmmmmmm...... They wouldn't have any incentive to change the conversation away from the question of sugar would they?

Good point of distinction, my frustration is with the industry muddying (sp?) the water for those truly in search of answers... I'm cognizant of the fact that what seems clear and straight forward to me isn't necessarily true for others and vice versa...

I think at the end of the day nobody wants to be obese, however what is needed for us as individuals varys and labeling something a disease that in my heart is a behavioral issue will do more harm than good....

I don't say this often (ask my wife and kids) but I hope I'm wrong on that...

We are definitely on the same page here. My participation in this whole thing, my blog etc, is for people who give a crap and want to find things that make sense and work. The kind of person who gives up and says "outta my hands" has already done that regardless of what the AMA says. My only hope for silver lining in this classification is for people to take to mean that "obesity is not healthy." That would be optimism on my part. I generally feel like the AMA thing is a case of "you're not helping!!" But I a, trying to find a way to use it to further more "now what?" As opposed to "oh well..."

I agree that we're probably much closer in thinking than initially it appeared.  Your comments about CICO make sense overall yet I think you're actually diving into the quality of the calories vs the pure math of taking in less than what is burned...

Sure the thing that gets people to stop with their caloric deficit (diet) is the crappy "I feel starved all the time and have no energy" feeling and that's legitimate but if they stuck it out they'd lose weight.  Again I'm referring to the 98, 99, 99.% + of the population without a defined medical problem. 

It's totally understandable when people abandon a nutrition program that has them feeling awful and not seeing the results quickly enough which is where your argument comes in.  Figure out the mix of calories in your daily diet so you don't spike your blood sugar and you don't feel like you're on a roller coaster with energy etc. etc. etc...

Good luck with your fight, you will make it because you have things figured out.  The hard part is when your inner voice is telling you just this one time you can go off the rails....I hear it all the time I just know how to tell it to shut up OR I punish that voice over the next two days and it usually shuts up...

An interesting perspective on AMA's decision:

http://www.cnn.com/2013/06/25/opinion/wann-obesity-disease/index.html?hpt=hp_t4

DB

This is very complicated and obviously a bit of a sticky wicket.  I think that everyone is different and there is no one size fits all answer that will cure this problem.   As a doctor I actually agree with the decision to classify it as a disease and this is why.

Fat people know they are fat and usually don't want to be that way but if it were easy they would be able to help themselves and no one would be overweight.  They also have to WANT to make a change but when they do I can't get them the help they need without a diagnosis.  i also would rather have the tools to treat them NOW rather in in 10 years when they are diabetic have hypertension and have already had a heart attack at 35.  The cost of treating those diseases long term is far higher than getting someone to a nutritionist and into the gym.  Many people don't want to change and that is a huge problem but I can't force feed people salad or do their grocery shopping for them.  Its all well and good for someone who has never struggled with their weight a day in their life who has a BMI of 18 to call everyone a POS fat slob and just eat less and move more but it is far more complicated than that. 

I once attended a lecture entitled "I didn't mean to eat it but my hormones made me"  Fascinating stuff.  We know so little really.  For instance you woud think weight loss surgery is a simple thing. Make the stomach smaller eat less and loose weight?  Yeah. Not so much.  It actually has a HUGE effect on the hormones that govern hunger etc its NOT just mechanical and that was a surprise to reserachers.  They have also looked at high protien diets vs traditional diets and the increase in insulin prodiuced thru the day follws teh same curve...its is blunted in the high protien group but the curve is the same also an unexpected finding.  It is extrememly complicated.

Certainly there are people who used to weigh 300# who have gotten fit and healthy on their own but they are few and far between.  I think wieght loss surgery has pushed this issue but I also think it should be reserved for the morbidly obese.  Unfortunately people see it as and easy way out (and it is not) and with many insurers defining that you need to be 100# overweight for the surgery people who are say 80# overwieght are GAINING wieght intentionally to qualify for the surgery.  I also believe that obesity is a form of an eating disorder so if obesity is not a disease then anorexia and bulemia are not either?  Really?   

The food industry is certainly to blame presenting our population with fast cheep high caloric food. They study it.  They study what they call the bliss point.......the perfect combo of fat and sugar to make you keep eating and crave more.....the perfect crunch factor of a chip to make you eat more.  Its business in the end and we do have a choice what we put in our bodies.  Anyone can make a chocie to reject the drive thru or eat an apple instead of a candy  bar but its not that simple.  its a start to the correct direction but without educating an obese person I can't help them.  Without giving them access to exercise I can't help them. 

Everyone here on BT is trying to do healthy things for their body.  Instead of crucifying our members who are struggling with weight loss this should be a safe helpful place for people to discuss this issue and get supportive help not be called a fat POS.  There are a LOT of people onthis site trying to loose wieght weather it be 100# or 10#.  These are healthy actice people and yet we still struggle.  Its not the same journey for everyone and we need to respect that.

I would say as generalizations go, it's easy to assume someone who appears healthy and are at a good body weight has no clue what the struggles are for those who are obese.  When in reality, many of us work awfully darn hard and make tough decisions daily when it comes to food choices, exercise etc. 

You touched on the food industry and their faults and I agree 100%.  However you downplay the pharma industry as well as the medical community overall and their readniness to exploit obesity now that it's a disease...

Lastly, only one poster described the obese as fat POS, another was a formerly obese person who actually agreed that a slap upside the head was what they needed.  I'm not a fan of the term and don't use it and want to remind people that those of us arguing AGAINST calling obesity a disease don't by default think the obese are a POS...

 Edit:  I removed a comment regarding anorexia and bulemia and my views on them as disorders.  I believe they are a disorder and not a disease but felt I was getting even more wordy than I already was...

No, actually anorexia and bulimia are considered by the DSM-IV to be disorders, not diseases.

And obesity is not the eating disorder.  Binging/overeating is the disorder.  Obesity is the outcome.

That would be like calling underweightedness a disease or disorder.  It's not.  It's the outcome of the disorder anorexia.

Take a look at the article I posted above to get a perspective on why this new classification scares people, including the obese themselves.

amen

I call shenanigans on that.  As it stood before this change, if a doctor found someone to be pre-diabetic, pre-hypertensive or tests showed they were a candidate for heart disease, the doctor treated those things.  

And if the MD thought that the patient being overweight was the cause of those things, the MD suggested weight loss.  And if the MD felt the patient had an eating disorder, depression, anxiety or anything else that could be a cause of overeating, he/she could refer the patient to a mental health professional.

How does calling obesity a disease change any of that?

I was wondering when the Fat Acceptance movement would have its say here.

Maybe they'd label me a self-hating fat person, but in the case of "you're not helping the situation," exhibit A is the NAAFA.

Talk about changing the language! Holy cow, now they want to try and say that obesity is part of natural variation? Really? How come it only exists in modern industrial affluent society, and those societies now mimmicking it?

I have little hope for society, not because of obesity per se, which I am persnally fighting. I have little hope because our public discourse always gets reduced to statements from these advocacy groups, which stick to a fundamentalist point of view no matter what.

The NAAFA does not speak for me. I'm not interested in staying this way. Sure, I am interested in being treated as a human being at any size, but that's just the best face of their agenda. Their stated agenda is also to normalize obesity and claim it is benign. Dangerous.

Edited by TheClaaaw 2013-06-25 1:31 PM

When did COJ get so snarky.  Geez

Its this thing called INSURANCE.  If its not a DISEASE or a DISORDER and its not CODE-ABLE = no payment for treatment. That means I can't send the person to a nutritionist or a mental health person or to PT or whatever it is they may need.  I know you all will argue that you don't have to see a nutritionist to buy veggies but if all you ate was fast food all your life you need help to change. I agree medicine has failed to push the issue and fails to approach things holistically but honestly you can only beat your head against a brick wall for so many hours a day.  Lead a horse to water and all that.  As an orthopedist I don't write for HTN meds or diabetes meds or any of that stuff but HTN and diabetes are things insurance will pay to treat because they have the all important CODE.  

When people ask "what can I do" I offer them resources and try to help but I have had only a handful of people take me up on it, a few have been very successful but most just shrug their shoulders at me.  Actually a guy who was my rep years ago became diabetic at 300 + pounds turned things around started doing tris and has lost over 80#  He is no longer diabetic and has the tri bug BAD.  I think its awesome.  

http://www.dietdoctor.com/what-happens-if-you-eat-5800-calories-daily-on-an-lchf-diet

When did COJ get so snarky.  Geez

Its this thing called INSURANCE.  If its not a DISEASE or a DISORDER and its not CODE-ABLE = no payment for treatment. That means I can't send the person to a nutritionist or a mental health person or to PT or whatever it is they may need.  I know you all will argue that you don't have to see a nutritionist to buy veggies but if all you ate was fast food all your life you need help to change. I agree medicine has failed to push the issue and fails to approach things holistically but honestly you can only beat your head against a brick wall for so many hours a day.  Lead a horse to water and all that.  As an orthopedist I don't write for HTN meds or diabetes meds or any of that stuff but HTN and diabetes are things insurance will pay to treat because they have the all important CODE.  

When people ask "what can I do" I offer them resources and try to help but I have had only a handful of people take me up on it, a few have been very successful but most just shrug their shoulders at me.  Actually a guy who was my rep years ago became diabetic at 300 + pounds turned things around started doing tris and has lost over 80#  He is no longer diabetic and has the tri bug BAD.  I think its awesome.  

That's great. I hadn't seen that one. His philosophy/hypothesis is something I practice as well and I've turned my health around.

Well, actually they can. They can't "refuse" you coverage, but they can surely make it unaffordable.