OBESITY - is it a disease?

OBESITY was classified by the American Medical Association as a disease. Obesity is defined by a value called “body mass index” which is a measurement that uses one’s height as well as body weight. BMI is an imperfect way of defining a disease. Some people will have an elevated BMI that falls in the category of obesity but actually have very little body fat because they have very high muscle mass. Others have complications of adiposity but have normal body mass index. Some have high levels of body fat more no evidence of diabetes, fatty liver, or any hint of metabolic disease while others manifest diseases of excess adiposity at lower body weight.

Nevertheless, when we define obesity as a disease and acknowledge that excess weight carries risk of type 2 diabetes, fatty liver, hypertension, vascular disease, cancer, arthritis, sleep apnea and other conditions. When we define obesity as a disease then we can research it further, develop targeted treatments, and develop comprehensive plans for care.

Limitations of our historic approach to obesity and falling short of "first do no harm':

Physician’s are taught early in training to “do not harm”. One of the first requirements for this to occur is to be knowledgeable of a patients condition. Even if we are well intended, if we do not know how to assess or understand a patients condition, our advice or treatment may cause harm.  Sadly medical school and clinical training does not prepare most physicians in understanding obesity or having an approach to the treatment of obesity.

We end up saying things like “you just need to lose weight” or “eat less and move a bit more.” Not understanding the condition we also may blame a patient for their condition or lack of success. In fact when we do not consider obesity as a chronic disease we also become negligent in providing evidence based care.

We now have an effective framework to help a patient achieve their best weight through behavioural change, medical therapy, and surgical therapy. Sadly, not only is our physician work force behind in understanding the basic principles of obesity management, we also see bias and stigma in the whole medical system.

Our health care system is not resourced properly to help patients living with excess eight. Unless a patient has private insurance there is no coverage for essential medications that treat obesity. Furthermore wait lists for surgical management (whose cost effectiveness is superior to cardiac bypass surgery) is more than 5 yrs. All too often in this case a delay in care is actually a denial of care.

Despite these shortcomings it is exciting that there are effective treatments to assist a patient in achieving their best weight and being engaged in a patients journey is one of the most rewarding experiences a clinician can have. Let’s consider obesity and its management based on three analogies: the symphony, the thermostat, and the computer. By understanding these different aspects to obesity we can also appreciate its management.

Understanding Obesity and Its Management

The Symphony, The Thermostat, and The Compuer

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