image source: obesitymyths.com by Dr. Deanna McCrary, ND
Recently the American Medical Association (AMA) declared that having a fat body makes one "diseased." To reach the criteria to be declared diseased one must have a body mass index (BMI) of 30 or above. There is valid criticism—even within conventional medicine—of the AMA's decision and especially of the use of the BMI to declare someone "obese."
To read more about the pitfalls of using BMI as a diagnostic criteria please read my fact sheet, "BMI: Obesity-Detecting Bullet or Bunk?"
The AMA is the nation's largest physician group and currently is the spearhead for determining medical diagnostic criteria in the US. Ironically, the AMA's decision to declare obesity a disease actually went against the recommendation of their own Council on Science and Public Health, which studied the issue for a year prior to the AMA's decision. The council determined that obesity should NOT be considered a disease mainly due to the inherent flaws in using BMI as a diagnostic criteria. According to the counsel, “Given the existing limitations of BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes." Think about it: if someone has a BMI of 29 and gains two or so pounds, giving them a BMI of 30, does it really make sense that they then are "diseased"? It seems pretty absurd. BMI does not distinguish between weight that is due to muscle, bone or fat. According to their reported BMIs muscle-bound actors Sylvester Stallone, Tom Cruise and Mel Gibson are all technically "obese."
It's not clear why the AMA ignored the advice of their own committee, though the decision will no doubt promote pharmaceutical interventions and surgeries such as gastric by-pass (stomach amputations) and lap bands as a "cure." Some have speculated that the multi-billion dollar economic interests of parties who provide "weight loss" interventions may have influenced the decision.
But is excess body fat really a disease? It is true that excess adipose (fat) tissue has been linked (correlated) to metabolic disorders such as diabetes, high blood pressure as well as liver problems and certain cancers. However I would like to strongly note that not one study has proven that excess fat is the cause of any disease. Correlation is NOT causation. This is great news! It means that even if lack of activity or inadequate nutrition intake resulted in excess fat, the diseases that those choices can lead to can be reversed even if the person does not lose one single pound. For example, there is solid evidence that regular vigorous physical activity can make cells more sensitive to insulin thereby reversing the effects of type 2 diabetes. Optimal intake of fiber, essential fatty acids and antioxidants can lower cholesterol and help to reduce high blood pressure—no matter one's size. In keeping with the AMA's logic of using correlation instead of causation, we must conclude that very thin people are diseased as well because very low BMIs are correlated with an increased risk for bone disorders such as osteopenia and osteoporosis as well as fertility troubles. Who's left?
This point is brought home dramatically on each season of the TV show "The Biggest Loser." I'm not a fan of this show for many reasons but one thing has stood out to me the few times I have watched it: the metabolic disorders (high blood pressure, diabetes, etc) that some of the contestants start the show with are often greatly reduced or even completely eliminated after just a few weeks on the show's extreme exercise and nutrition protocols—and this occurs while the contestants are still 100+ pounds above their goal weight! It wasn't the weight loss that reversed the condition but rather the metabolic re-conditioning of the contestants. I would never recommend the extreme measures that the TV show subjects people to as they are not sustainable and can cause injuries, create eating disorders and other health problems in the long run, but the point is made clear, though it is sadly overlooked: one can reduce, prevent or even reverse the conditions associated with obesity and still be very fat. This is Health at Every Size® in action!
What is further confounding about the AMA's decision is that it flies in the face of the robust pattern in recent epidemiological literature which has been named the "obesity paradox“ wherein obesity is associated with longer survival in many diseases. For example, obese persons with type 2 diabetes, hypertension, cardiovascular disease, and chronic kidney disease all have greater longevity than thinner people with these conditions. Also, obese people who have had heart attacks, coronary bypass, angioplasty or hemodialysis live longer than thinner people with these histories. In addition, obese senior citizens live longer than thinner senior citizens. And let's not overlook a 2008 study that showed one quarter of “normal weight” people also have metabolic abnormalities, and more than half of “overweight” and almost one third of “obese” people have normal profiles, as reported by Abigal Saguy for Time Magazine online.
All of this makes one wonder: is the AMA's concern for the health of fat folks genuine or is it the result of something else such as innate prejudice against larger-bodied people or caving into pressure from outside economic interests ... or maybe both?
I do believe the AMA is very misguided in their decision. To call fat a "disease" creates even more of a stigma on a population that already battles prejudice in the medical community. Promoting health regardless of one's size, understanding, loving and appreciating the bodies we have right now can lead directly to a cultivation of compassionate self-care. That is sustainable health.
© Deanna McCrary, ND and LifeJOY Natural Medicine, 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Deanna McCrary, ND and LifeJOY Natural Medicine with appropriate and specific direction to the original content.
Recently the American Medical Association (AMA) declared that having a fat body makes one "diseased." To reach the criteria to be declared diseased one must have a body mass index (BMI) of 30 or above. There is valid criticism—even within conventional medicine—of the AMA's decision and especially of the use of the BMI to declare someone "obese."
To read more about the pitfalls of using BMI as a diagnostic criteria please read my fact sheet, "BMI: Obesity-Detecting Bullet or Bunk?"
The AMA is the nation's largest physician group and currently is the spearhead for determining medical diagnostic criteria in the US. Ironically, the AMA's decision to declare obesity a disease actually went against the recommendation of their own Council on Science and Public Health, which studied the issue for a year prior to the AMA's decision. The council determined that obesity should NOT be considered a disease mainly due to the inherent flaws in using BMI as a diagnostic criteria. According to the counsel, “Given the existing limitations of BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes." Think about it: if someone has a BMI of 29 and gains two or so pounds, giving them a BMI of 30, does it really make sense that they then are "diseased"? It seems pretty absurd. BMI does not distinguish between weight that is due to muscle, bone or fat. According to their reported BMIs muscle-bound actors Sylvester Stallone, Tom Cruise and Mel Gibson are all technically "obese."
It's not clear why the AMA ignored the advice of their own committee, though the decision will no doubt promote pharmaceutical interventions and surgeries such as gastric by-pass (stomach amputations) and lap bands as a "cure." Some have speculated that the multi-billion dollar economic interests of parties who provide "weight loss" interventions may have influenced the decision.
But is excess body fat really a disease? It is true that excess adipose (fat) tissue has been linked (correlated) to metabolic disorders such as diabetes, high blood pressure as well as liver problems and certain cancers. However I would like to strongly note that not one study has proven that excess fat is the cause of any disease. Correlation is NOT causation. This is great news! It means that even if lack of activity or inadequate nutrition intake resulted in excess fat, the diseases that those choices can lead to can be reversed even if the person does not lose one single pound. For example, there is solid evidence that regular vigorous physical activity can make cells more sensitive to insulin thereby reversing the effects of type 2 diabetes. Optimal intake of fiber, essential fatty acids and antioxidants can lower cholesterol and help to reduce high blood pressure—no matter one's size. In keeping with the AMA's logic of using correlation instead of causation, we must conclude that very thin people are diseased as well because very low BMIs are correlated with an increased risk for bone disorders such as osteopenia and osteoporosis as well as fertility troubles. Who's left?
This point is brought home dramatically on each season of the TV show "The Biggest Loser." I'm not a fan of this show for many reasons but one thing has stood out to me the few times I have watched it: the metabolic disorders (high blood pressure, diabetes, etc) that some of the contestants start the show with are often greatly reduced or even completely eliminated after just a few weeks on the show's extreme exercise and nutrition protocols—and this occurs while the contestants are still 100+ pounds above their goal weight! It wasn't the weight loss that reversed the condition but rather the metabolic re-conditioning of the contestants. I would never recommend the extreme measures that the TV show subjects people to as they are not sustainable and can cause injuries, create eating disorders and other health problems in the long run, but the point is made clear, though it is sadly overlooked: one can reduce, prevent or even reverse the conditions associated with obesity and still be very fat. This is Health at Every Size® in action!
What is further confounding about the AMA's decision is that it flies in the face of the robust pattern in recent epidemiological literature which has been named the "obesity paradox“ wherein obesity is associated with longer survival in many diseases. For example, obese persons with type 2 diabetes, hypertension, cardiovascular disease, and chronic kidney disease all have greater longevity than thinner people with these conditions. Also, obese people who have had heart attacks, coronary bypass, angioplasty or hemodialysis live longer than thinner people with these histories. In addition, obese senior citizens live longer than thinner senior citizens. And let's not overlook a 2008 study that showed one quarter of “normal weight” people also have metabolic abnormalities, and more than half of “overweight” and almost one third of “obese” people have normal profiles, as reported by Abigal Saguy for Time Magazine online.
All of this makes one wonder: is the AMA's concern for the health of fat folks genuine or is it the result of something else such as innate prejudice against larger-bodied people or caving into pressure from outside economic interests ... or maybe both?
I do believe the AMA is very misguided in their decision. To call fat a "disease" creates even more of a stigma on a population that already battles prejudice in the medical community. Promoting health regardless of one's size, understanding, loving and appreciating the bodies we have right now can lead directly to a cultivation of compassionate self-care. That is sustainable health.
© Deanna McCrary, ND and LifeJOY Natural Medicine, 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Deanna McCrary, ND and LifeJOY Natural Medicine with appropriate and specific direction to the original content.
RSS Feed