Obesity Is a Disease. Should It Be?

This is a short paper I wrote while preparing for my personal trainer certification with the National Academy of Sports Medicine. I went slightly over the one page requirement. (Really? A one page paper? Fucking bullshit.) I got all the point. Because I know what the hell I'm doing.





Obesity
On June 13, 2013, the American Medical Association classified obesity as a disease while other countries such as Canada and the United Kingdom disagree with this designation. One reason for this disagreement is because much of the information regarding cause, treatment, and diagnosis is inconclusive or ineffective.

Mechanism/Cause: A human becomes obese when they carry “too much body fat.” The recommended method for determining if a person is carrying too much body fat is to do a calculation using the Body Mass Index (BMI). Many organizations, including the Australian government, recommend against the use of BMI because of systemic limitations and inaccuracies associated with the tool. One line of thought believes that obesity is caused by the body being taken out of homeostasis by consuming more calories than it uses regardless of the calorie source. Ongoing research, however, suggests that quality of food plays a much more significant role in excess fat storage than simple calorie quantity.

Symptoms: The Centers For Disease Control lists the symptoms of obesity as coronary heart disease, various cancers, type 2 diabetes, hypertension, stroke, liver and gallbladder diseases, dyslipidemia, sleep apnea, osteoarthritis, and gynecological problems.

Who it affects: Obesity can affect all humans regardless of age, ethnicity, gender, or other factors.

Treatments: The standard institutional recommended treatment for obesity is to restore energy balance. That is, intake less energy (calories) than the body expends and the body fat percentage will reduce, thus “curing” obesity. The problem with this recommendation is that has not been proven to work long-term. Obesity rates continue to rise as the energy balance hypothesis continues to be the official medical recommended treatment.

Drugs currently prescribed to combat obesity include Orlistat, Lorcaserin, and Phenterminetopiramate. Surgeries currently prescribed to combat obesity are Gastric Banding, Sleeve Gastrectomy, Gastric Bypass Surgery, and Biliopancreatic Diversion.

Prognosis: The prognosis is bad. Obesity rates continue to rise and effect more populations to a greater extent, including infants. Treatments are often ineffective long term and diagnostic tools are in dispute.  Because of these factors, we must consider that the current understanding of the very nature of obesity may be inaccurate.



Recent Research:
-Two groups of obese patients with type 2 diabetes were tested to see if reduced caloric intake and increased exercise would reduce the likelihood of cardiac disease. The trial was stopped early, after almost ten years, when members of both groups continued to die of cardiac events at nearly the same rates.
The fascinating part of this study was the failure of the intervention group (reduced caloric intake, increased exercise) to maintain weight loss over time while sticking to the regimen as compared to the controlled group who, just given weight loss information, lost weight at a slower rate but with consistency over the ten years.
Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes

-When following 4466 children, researchers concluded that it was not the occasional fast food meal that would lead to obesity, but rather a traditional Western diet that occasionally included fast food. Children who did not eat fast food regularly were less likely to be obese and less likely to eat a traditional Western diet. These findings indicate that the quality or type of food has a greater impact on obesity than the quantity or caloric content of food.
The Association of Fast Food Consumption with Poor Dietary Outcomes and Obesity Among Children

References
Announcement that the American Medical Association designates obesity as a disease

Centers for Disease Control and Prevention list of symptoms of obesity

Australian Government position on the use of Body Mass Index

Drugs prescribed to treat obesity

Surgeries performed to treat obesity

Harvard School of Public Health Obesity Prevention article