Response: A.M.A. recognizes obesity as a disease

I have seen a lot of responses to the recent declaration: Obesity is a disease. The responses are mixed. I am somewhat surprised that the ACSM supports it – but the announcement likely means more money in their pockets (with the Exercise is Medicine campaign). Who wouldn’t support an idea that puts more money in their pocket?

Me!! — I would rather see individuals succeed. A diagnosis of obesity does not set the platform for success – in fact it is counterproductive.

My reaction

I was initially outraged by this announcement. Obesity is NOT a disease. Suddenly, we are assigning another label to individuals. Supporters of the movement will argue that by defining obesity as a disease, those suffering with obesity will receive better medical assistance and insurance coverage for treatment. The problem? Sure, this could increase coverage for gastric bypass, lap band, etc – but is this really helping individuals? Is this a solution to the overwhelming problem?

Let me break this down to logical pieces and terms.

Obesity

Obesity is an abnormal accumulation of body fat, usually 20% or more over an individual’s ideal body weight. The most common measure used for obesity is BMI.

Disease

A disease is a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.

At first read, you might think that obesity does fit this definition. The above definition is quite vague and as stated could fit the equally vague definition of a disease. But one word jumps out at me: symptoms. Overweight/obesity is a symptom.

It is a symptom of overconsumption of calories (it is NOT the symptom of underactivity as a standalone).

It is the symptom of a metabolic condition.

It is the symptom of hormone imbalances.

With that said. Can a symptom of symptoms of it own? Or is obesity a symptom that correlates with other symptoms of a true disease or condition?

Symptom

Another vague definition. A symptom is: subjective evidence of disease or physical disturbance or something that indicates the existence of something else.

It is unclear to me as to whether a symptom and disease can be synonymous terms. I could get technical – since disease is used in the definition for a symptom and you cannot define a word by using the word itself in the definition, then symptom and disease cannot be one in the same.

Like my logic?

A Real Life Story

Let me put this into perspective. Medical professionals can now assign an individual with the disease of obesity (another wonderful label, by the way, for individuals already struggling with self-esteem, body-image, and stigma). How do doctors quantify obesity? Body Mass Index, or BMI. I have written about BMI and why it is not a good measure, please read the previous post by clicking the link.

I fluctuate between being overweight and obesity on the BMI scale – depending on the season and what I may be training for. However, my appearance and my body fat percentage clearly indicate otherwise. Does this mean that the doctor would approve liposuction for me as a non-elective alternative? In the past, I have had a doctor tell me that I needed to lose weight – because she did not bother to actually look at me and only looked at my BMI. Today, that same doctor would have labeled me obese, and that would have gone in my medical history and I would be dealing with the long-term effects of that being on my medical record (and there are implications! I have learned this, having arthritis in my medical record from age 16 – it creates huge battles with the insurance companies).

The bottomline

I have given a lot of thought to whether obesity is a disease – long before this announcement. It is not. And sadly, this new definition will not solve the nation’s obesity epidemic. We have added stigma to an already debilitating label.

What about self-esteem?

What about self-worth and empowerment? A disease implies there is not much one can do about it – when the number one method of prevention and treatment of overweight obesity is empowerment. Seems to me that we may be going in the wrong direction with this diagnosis —

But some people will be making a lot of money.

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MYTH – If you are skinny, you are healthy

You know your friend, the one who is skinny as a twig, but lives on candy, chips, and ice cream? And to add fuel to that envious fire burning inside you, she does not exercise – unless of course carrying laundry down the stairs counts as exercise to you, but it does not in my book.

Now ask yourself, do you consider her healthy?

I have news for you: Simply being thin is not akin to being healthy. There is such a thing as being skinny-fat. Being skinny-fat is about much more than physical appearance. In fact, your dress size has absolutely nothing on the much bigger issue – YOUR HEALTH. In many cases, the skinnier you get, the more you’re actually at risk for health problems! Low body weight could mean someone has low lean muscle mass.  And low muscle mass and high body fat percentage has been linked to an increased risk of heart disease and stroke, diabetes, osteoporosis, high blood pressure, metabolic syndrome, and even cancer.

We live in a culture obsessed with weight, but there is a difference between being thin and being healthy. That difference lies in body composition.

What is body composition?

Most medical offices and health insurance companies use Body Mass Index (BMI) to measure body composition – because it is easy. Unfortunately, easy and accurate are not the same. According to BMI, most of my colleagues and I are classified as overweight to morbidly obese. So what does that have to say about health and fitness professionals? BMI does not account for lean mass!

Body composition is a measure of lean and fatty tissues. A healthy body composition is determined by the percentage of body fat versus lean muscle mass. Ideally, you want your body fat percentage low and lean muscle mass percentage high. An altered body composition arises when the percentage of body fat is too high. The ACSM recommends adult men to have between 10-22% body fat, while women should have between 20-32% body fat.

Being overweight is often used synonymously with an altered body composition; however, excess body weight is not a definitive assessment for altered body composition. Just as thin is not synonymous with fit and healthy. Extreme athletes or weight lifters can have a body weight that is considered outside of a healthy reference range (BMI), but their body compositions may be optimal due to the high amount of lean muscle. Muscle actually weighs more than fat. That’s easy to forget sometimes! This is one reason stepping on the scale can be so frustrating and why it’s important to get measurements taken every four weeks.

The best advice I can give: Judge your progress by how your clothes fit and feel, not by the number on the scale. This is how I typically do it and I tend to avoid the scale.

How can you improve your body composition?

Certain weight loss programs can actually be harmful and counterproductive to improving body composition. In some cases, weight loss programs result in excessive loss of muscle along with fat. Why? Because our energy reserves are in our muscles. An example of such a program is The Biggest Loser.

When we deprive our bodies of energy (e.g., restrictive dieting), we force our bodies to dive into those energy reserves.  It’s far more important to focus on FAT LOSS. Studies have found that the most successful way to slow the aging process is to maintain a healthy muscle mass along with eating a balanced, low-calorie diet. And unfortunately, maintaining muscle mass as we age is difficult because we naturally lose muscle—unless we work to keep it.

  1. Losing weight does not mean you have a healthy heart. On the other hand, getting fit and eating a healthy diet can dramatically improve heart health.
  2. Losing weight alone does not lower your cholesterol, but regular exercise and healthy eating will.
  3. Simply losing weight is not going to lower your risk of contracting certain types of cancers, but regular exercise and mindful eating can.
  4. Losing weight cannot prevent osteoporosis, boost your immune system, lead to healthier pregnancies and childbirth, improve your physical performance, or prevent the loss of muscle. However, by adopting a regular exercise routine and a healthy eating plan, you can!

So what does this mean? Losing weight is not the important part of getting healthy. The important things to consider are healthy eating, regular exercise, and generally taking care of yourself! Skinny-fat or fat-fat your #1 priority should be to adopt a healthy lifestyle and get fit for life!

Response: Our Imaginary Weight Problem

I have now read Paul Campos’ editorial in The New York Times, Our Imaginary Weight Problem, twice. I chose to read it a second time because I originally read it on a day that I read a series of other ridiculous articles published to begin this new year. I wanted to be sure that I didn’t misread it in a biased mental state. It frustrates me to no end. Why does the media have to lie (or distort truth)? The whole ‘problem’ would likely disappear if the media would tell the truth and publish what most qualified professionals already know! Instead of blaming the weight loss industry or pharmaceutics companies, how about bringing it back to science instead of gimmicks and fads that make the industries look bad?

Who’s to blame?

If there is anyone to blame, it would be two groups: the Nixon Era and health insurance companies. The Nixon Era is at fault for highly subsidizing the production of high fructose corn syrup and significantly increasing the availability and affordability of this ‘food’ product. The health insurance companies can be blamed for developing the Body Mass Index (BMI) which is still used in most medical and research communities to this day. BMI is not representative of health – there may be correlations, but correlation does not equate to causation. And to read the research and conclude that body composition has no relationship to medical conditions and/or mortality is a pretty bold judgement.

Who’s living longer?

Campos states himself that research doesn’t account for any other factors that may contribute to mortality. What about the fact that a great majority of America’s overweight/obese population are athletes and physically fit individuals who maintain higher levels of lean muscle mass and take considerable care of their bodies? Are these the ‘overweight/obese’ individuals who are living longer than the ‘normal’ weight individuals?

Who’s going to read NYT and jump for joy?

The unfortunate result of such an editorial is that we will now have individuals read this and tell themselves and others that they do not need to lose weight or become healthy. As a society, we have associated weight with health – we need to separate these two. But the world is ready and anxious to hear, “You don’t need to lose weight. You ARE healthy just as you are!” When health is actually comprised of so many factors.

I have trained many clients who will exercise as much as I ask them to – but will not change eating or drinking habits. They’ll use this research to try and argue with me and justify themselves. I’ve had clients who exercise, eat right, but do illicit drugs – they maintain the excess weight and now have another ‘reason’ to be complacent with the additional weight. Humans are resistant to change and want to hear that they are already doing the right thing – particularly when it relates to health and well-being.

The bottomline…

This is yet another bogus claim. Is the weight problem overinflated? The BMI problem and it’s associated labels of overweight and obese is overinflated. If we looked at the whole person, the data and associated research would be a whole lot different. Unfortunately, the science is trying to classify groups of individuals – and seen as we ARE all individuals, it makes it difficult to classify based on such a narrow set of data.

But what do I know? I’m just a girl…and I don’t know anything about Paul Campos. But I do know that I will now read his book, The Obesity Myth: Why America’s Obsession With Weight Is Hazardous to Your Health, and maybe that was his ultimate goal?