Posted by: notdeaddinosaur | June 23, 2009

Obesity is NOT a Disease

I’ve had enough!! It’s time for another lesson in basic terminology. Words like “disease,” “risk factor” and “epidemic” mean specific things, not just whatever someone happens to want them to mean at any given moment. Pronouncements from government and even from organized medicine about the “obesity epidemic” are meaningless. Let me tell you why.

Obesity is a risk factor for diabetes, high blood pressure, and a host of other medical conditions.

Now listen up, because I’m only going to scream at the top of my lungs until the blood vessels in my eyes burst say this once:

HAVING A RISK FACTOR FOR A CONDITION
IS NOT THE SAME
AS HAVING THE CONDITION.

Really. It’s not. A family history of colon cancer is not the same as colon cancer. Smoking isn’t the same as chronic lung disease. Alcoholism isn’t the same as cirrhosis of the liver. A blistering sunburn isn’t the same as skin cancer. And obesity is NOT THE SAME as having diabetes and high blood pressure.

In fact, obesity is different from all the other risk factors above, in that all “obesity”, defined as a body mass index over 30, is so not created equal.

Here’s what I tell my patients:

  1. If your blood pressure is normal, and
  2. If your cholesterol is normal, and
  3. If your blood sugar is normal, and
  4. If you don’t smoke, and
  5. If you are active (defined as 30 minutes daily of walking too fast to talk), then
I DON’T CARE WHAT YOU WEIGH.

As it happens, it’s actually pretty tough to be really morbidly obese and have all the above points apply to you. Then again, look at Sumo wrestlers. Still, if you don’t actually have any of the conditions for which obesity puts you at risk, AND if you continue to get monitored for those conditions on a regular basis, what’s the big deal? Answer: it isn’t.

So for everyone who wants to charge for health insurance on a BMI sliding scale, get your head out of your ass and start looking at what really matters: the presence of actual medical conditions like diabetes, hypertension, and so forth. Metabolic syndrome? Osteoarthritis of the knees? Weight loss is absolutely the treatment of choice; no argument there. But quit blaming every complaint on someone’s weight if the BMI happens to be over 30.

From the standpoint of public health policy, absolutely encourage walking and exercise, a varied, healthful diet low in processed foods and high in fruits, vegetables and whole grains, and discourage smoking. But quit wasting time and resources railing against the “obesity epidemic”, a meaningless term that detracts from real medical issues.

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