What is your evidence for this?
Obesity as a Disease
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What is your evidence for this?
Unconscious decisions are still our decisions. We are still it's creator even when we are not aware of them.
It's a cultural responsibility. Allowing the sugar industry to lobby like they do and then placing the guilt on the individual after what they're lobbying for works, you're giving the consumer the absolute worst of both worlds. This is a societal problem, which is proven by statistics. We've got enough guilt in today's culture. Let's get rid of that, then let's build up a healthy society instead.
You have absolutely shit clue what you're talking about. Here's a book for you: Suicide by sugar
You have absolutely shit clue what you're talking about. Here's a book for you: Suicide by sugar
Emerson
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Being a medical professional myself, years of school, full time practice, endless hours of conversations/consults with other physicians including neurologists?
The metaphysical kind of debates you're going on about do not currently have much of a place in the practice of the vast majority of physicians. Go ask your family doctor about diabetes and obesity and see if he lectures you about whether humans have free will, or if he tells you to stop eating shitty and start exercising.
Quoted for being perfect.
This is completely muddling of two things. Any doctor should tell you to get your shit together. That has nothing to do with what Opiate said. The problem stems from the hormonal response system and the way sugar throws off homeostasis. Its way of ruining mineral synergy and otherwise thrashing your body, it is seemingly more addictive that heroin. Classifying it as a "you're just lazy and stupid" is not what medical professionals (that at least relate to the field in a non GP sense) will make of it. But he should tell you to get your shit together.
Those are diseases, though.
I am also deeply embedded in the field and have not experienced this (although I am not, myself, a doctor). It is certainly true that doctors do not interface with patients this way directly, but that doesn't mean it's what they actually believe.
I'll ask several of my best friends, who are physicians. In fact, we've already talked about it, at length. They certainly agree with my position, but also agree that it isn't how one interfaces normally with people on a day to day basis and which may not produce constructive results even if it happens to be true. I don't think you understand my argument: a central point is to insist that what is true may be a separate thing from what is most effective at changing a person's behavior.
No surprise that the medical establishment is utterly failing at battling the ongoing obesity epidemic, then.
Yep, that attitude says it all.
I am obese. My weight dances around the 300 pound mark. I do not have a disease.
I make poor dietary choices by working at an office surrounded by woefully unhealthy places to eat. I also fail to get adequate exercise (though this part comes mostly from gout and arthritis - I DO exercise whenever the pain is manageable).
I don't blame anyone or anything but myself for my current size, and anyone that tries to is just trying to make them themselves feel more like a victim and less responsible for what they did to themselves.
I don't like the way that I currently am. I get depressed about it and shudder when I look in the mirror sometimes. I will not stay this way, though. I lost 30 pounds a few months ago because I got my shit together and my gout left me alone long enough for me to get some real exercise in 4 times a week. But then I got a major flare that affected both knees and had to be put on a steroid regiment for a while month - the weight gain during that month was insane, and I'm right back where I started. I won't give up though. The path of hard work and exercise begins again tonight.
I make poor dietary choices by working at an office surrounded by woefully unhealthy places to eat. I also fail to get adequate exercise (though this part comes mostly from gout and arthritis - I DO exercise whenever the pain is manageable).
I don't blame anyone or anything but myself for my current size, and anyone that tries to is just trying to make them themselves feel more like a victim and less responsible for what they did to themselves.
I don't like the way that I currently am. I get depressed about it and shudder when I look in the mirror sometimes. I will not stay this way, though. I lost 30 pounds a few months ago because I got my shit together and my gout left me alone long enough for me to get some real exercise in 4 times a week. But then I got a major flare that affected both knees and had to be put on a steroid regiment for a while month - the weight gain during that month was insane, and I'm right back where I started. I won't give up though. The path of hard work and exercise begins again tonight.
maniac-kun
Member
This post deserves a high five. Because this is a cultural and societal problem. I'm disgusted that people having a hard time with their weights are told they're lazy, especially with what we know of leptin today. If you've been so unfortunate to not have had the inclination to choose what you eat in a healthy way (which, mind you, no generation before the ones alive today have ever had to do), you're also faced with the overwhelming task of losing that weight by being told to "suck it up"? The loss of leptin will basically forever cripple the feeling of satiation these people feel, and they'll battle every day a battle skinny people never have felt, but they are the lazy ones?
Are we saying overweight two year olds are lazy? Poor life style choices? Or do sugar sedate and fuck up your physiology?
How would you classify non-genetic mental disorders such as depression, then? Is it just a "poor lifestyle choice" of being sad all the time?
I think there is legitimate debate about whether obesity is a disorder or a disease, for example.
......and why do you think what applies to you applies to everybody?
Funny given that treating it as a disease is quite literally causing people to fail. If you have a disease that could be cured by closing up all the McDonald's nearby and making you walk more, then it isn't a disease.
Case in point. I admire your hard work, and even facing such a quagmire with an attitude like that. But society should help you, not frown at you. I could explain what happened to your weight relapse, but someone else should've already done that. There's a missing net of care for people in this situation. This is not something that you can just "get your shit together" from, so if you do decide to do that, I admire it, but know that we can't do everything ourselves in life.
That classification is very recent so I'd like to know how you know it's causing people to fail?
Emerson
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Then we need to ask the question of whether Opiate, when he says "doctors" is conflating physicians with "scientists." In his original post he referred to neurologists, which is a physician who treats brain disorders. Physicians are generally, in my experience, wildly pragmatic people who don't usually have a lot of time or concern for metaphysical debate.
The conversations you're talking about are squarely in the realm of neuroscientists, who are found in university labs and writing books, and don't have much experience actually treating disease. This distinction, I'll point out, is all I actually said in my first post.
All of which several people in replying to me have taken as me implying: "Your post is bullshit," which I wasn't. I am not a neuroscientist. I have no doubt much of that is true. The science is new enough that it hasn't worked its way into the average physician's practice. Furthermore, as Opiate has said multiple times, something being true doesn't make it beneficial for people to know. I very much doubt a physician telling his patient "well your leptin levels are out of whack, I'd blame the sugar industry, anyway you have no free will anyway so you're fucked" will ever be more beneficial or effective than the doctor telling the patient "eat less and exercise more."
I was describing a frame of mind that appears to take place when a label is presented describing obesity. As you and other people have noticed, it does not apply to other situations and is really trying to fit a square peg in a round hole. The thing that makes the AMA's categorization interesting is that a word is being freshly applied to describe obesity and that this changes people's behavior - that part is undeniable.
So, all obese people eat at McDonalds?. And "walking more" is a legit therapy for diseases like hypertension.
HalfBakedProphet
Member
I agree with this a lot. As a society, we've been given very poor food options under the illusion of choice. A lot of people seem to ignore that these unhealthy foods are DESIGNED to be addictive.
D
Deleted member 17706
Unconfirmed Member
Lung cancer from a life of smoking is the result of a "lifestyle failure" as well, but that doesn't mean it's not a disease.
If being fat is a lifestyle choice then you have to explain the epidemic of obese newborns and six month olds.
Fact of the matter is, obesity is a global pandemic. Why are huge sections of the human populations obese? It is it a collective failure of decision making? If it is, why are such bad decisions being made on such a staggering scale?
It kind of points to something deeper than choice when it's so damn pervasive. Obesity rates far exceed addiction rates for any substance encountered in our history. We humans have never dealt with a pandemic as pervasive as this. It is something that is being experienced by all cultures right now.
So it is just a species level failure of good decision making? Or is it a foreseeable and predictable outcome of new external stimuli reacting with biological function?
Science seems to be saying the latter.
Fact of the matter is, obesity is a global pandemic. Why are huge sections of the human populations obese? It is it a collective failure of decision making? If it is, why are such bad decisions being made on such a staggering scale?
It kind of points to something deeper than choice when it's so damn pervasive. Obesity rates far exceed addiction rates for any substance encountered in our history. We humans have never dealt with a pandemic as pervasive as this. It is something that is being experienced by all cultures right now.
So it is just a species level failure of good decision making? Or is it a foreseeable and predictable outcome of new external stimuli reacting with biological function?
Science seems to be saying the latter.
Society has created the obesity epidemic. Medicine largely treats the downstream impact of the epidemic (diabetes, hip replacements, heart disease, depression etc et etc). However, the social constructs are creating the obesity epidemic. As physician, I know that my responsibility is both to help the people I treat daily, but also to advocate for change in our society.
People have a personal responsibility to demand change in the environment and priorities of our country.
People have a personal responsibility to demand change in the environment and priorities of our country.
I'm gonna go w/ depression and obesity are seen as disorders, I wouldn't classify them as "diseases".
hockeypuck
Member
The article does not include a demographics table, which is almost always the first table in a clinical study. This article is written by three psychologists, who are not physicians. Although I quickly skimmed it, I could not determine whether the number of obese and non-obese participants were randomized to equal sample sizes between the control and the "disease" arms.
And why are so many people in this thread using "neurological" and "psychological" interchangeably? The research article does not use a single word with "neuro-" in it. This is a social science study, with very subjective Y-axis scales in their surveys.
Edit: Here's Fig. 2 from the study, which is from a "9-point" survey. Why are there only 7 levels? Why does it go from 3 to 6? On "9-points," how truly different is a 4 from a 5.5? Different enough to be statistically significant? I don't know, because this shitty figure doesn't tell me. What the hell is going on?
I wonder how different a 5 is from a 5.5...
Edit2: None of the figures in this study even include standard error bars (or something analogous). Come the fuck on.
And why are so many people in this thread using "neurological" and "psychological" interchangeably? The research article does not use a single word with "neuro-" in it. This is a social science study, with very subjective Y-axis scales in their surveys.
Edit: Here's Fig. 2 from the study, which is from a "9-point" survey. Why are there only 7 levels? Why does it go from 3 to 6? On "9-points," how truly different is a 4 from a 5.5? Different enough to be statistically significant? I don't know, because this shitty figure doesn't tell me. What the hell is going on?
I wonder how different a 5 is from a 5.5...
Edit2: None of the figures in this study even include standard error bars (or something analogous). Come the fuck on.
D
Deleted member 17706
Unconfirmed Member
The classification will help. For far too long has the responsibility been placed entirely on the individual and whether or not he or she is lazy or a glutton. This kind of nonsense, along with the "a calorie is a calorie" is exactly the kind of mentality that producers of garbage food and drinks want to push. It helps their bottom line and gets them off the hook of the damage they are doing to society.
FriedConsole
Banned
Nope. The education is out there. People know they are eating shit. If I want to eat shit every once in a while, I shouldn't be deprived of it because other people can't control themselves.
You are being vague on what "change" is. You should describe out some of these "changes" so we can all can have fun poking holes in on how they won't work.
I don't really feel it's a metaphysical debate, just a neurological one. It's simply a materialist approach to the question, which has thus far sufficiently explained the phenomenon without requiring a "mind" making "choices."
I definitely agree, as stated. The dichotomy you're making here I would frame in a slightly different way: there are physicians (or doctors) who must take a pragmatic approach in their daily practice, and others who are not bound by pragmatic concerns but who can focus exclusively on scientific reality, whether that reality has immediate practical applications or not.
You know, a psychiatrist telling me that my depression wasn't my fault made all the difference in the world, of course that discourse was followed by a treatment. Had I been told instead that "get your shit together", I would have killed myself years ago. Also, as an obese man (that is doing something about it, btw), doctors constantly telling me "get your shit together" mostly achieved me avoiding medical advise all together, since I would feel shit after a consultation with little results to show after, resulting in an adverse reaction.
Sorry to say, but you're fucked either way. The issue has basically now hit critical mass.
Either we start to regulate this as a big government holy shit things are going apocalyptic sort of thing, or we run out of money to fund the world's health system due to strain from diabetes, gout, heart disease and the other consequences of metabolic syndrome.
That isn't hyperbole by the way, current projections predict that Medicare will run out of money to pay for treatments by 2025.
Emerson
May contain jokes =>
Yeah I don't think blaming the primary care docs is the solution. I feel bad for them as they are poorly paid, overly booked, and vastly outnumbered by specialist docs in the USA when the whole ratio should really be flipped around.
Are there bad PCPs out there? No doubt. There are also tons of patients who can't be helped and will continue their lifestyle regardless of how hard the doctor tries.
Well first, just because I said I might approach obesity that way, you shouldn't assume that I would approach depression that way. Mental illness is a specialty and it requires a specialty approach.
Generally here we're getting into what we call the art of medicine. Different patients respond to different approaches. If I were a primary care doc I wouldn't tell every obese patient to sort their shit out. I was using that as an amusing colloquialism for practical advice. Some patients need encouragement, positive reinforcement. Many need some psych issues explored and you have to handle that carefully. Some patients do need a doctor to confront them and literally tell them to get their shit together. Parsing all this is one of the things that separates a good doctor from a competent one.
Or how hard the paitent tries.
That's key. There are a hell of a lot of people out there trying to diet, get their lives in order but ultimately fail.
Something else that indicates that there's something underlying going on. When huge amounts of people try to make a lifestyle switch and fail it can't just be bceause 'everyone's too lazy'.
Either;
1) Our approach isn't working because it's a poor solution.
or
2) Our approach isn't working because of externalities.
You physically put things in your mouth with your hands. You can't blame anyone else for what goes inside. Dieting does work, it's just not easy with all the temptations.
Same goes for substance addiction? It's all their fault? Despite extensive mapping of the psychological and physiological mechanisms at play during addiction?
D
Deleted member 17706
Unconfirmed Member
The problem is that this is the focus. It shouldn't be about controlling temptations and exercising willpower.
The whole nonsense concept of boiling everything down to simple calories was such a boon for the processed food industry. They can push all of the responsibility on the consumer and laugh their way to the bank all while selling cheap garbage for profit and making the world sick.
And because humans are generally shitty to each other, we (as a whole) self-enforce this broken logic. Many thin people, people who are not grossly obese, or people who succeeded in losing weight get to feel superior to the rest society and making scathing comments about everyone else just being too lazy. Very much like "bootstraps" comments from the privileged in regards to the impoverished.
No doubt. You can't force patients to do anything they don't want to.
I feel like with addiction you can honestly say to someone, yes it was your rational and clear choice to have the first beer, that first pill, that first joint, but anything subsequent....it's down to your biochemistry and I would not have any confidence saying to someone that it was their fault they got addicted.
Basically how the diet industry works.
Basically how the diet industry works.
Why shouldn't it be? That's what LIFE is. You're on the highway, of course you want to floor it, but you don't because you'll get a ticket. See a hot girl, want to touch? Ohh, a nice new TV, I want it.. but I really shouldn't because I don't actually have it. Mmmm, a pizza where the dough is made from chunks of deep fried chicken, that looks good, or should I be eating this?
FriedConsole
Banned
The whole a certain disease causes health care costs to raise is crap. Technology to treat diseases are just getting more expensive. It is a complex problem but a rise in certain diseases do not significantly raise costs because people are going to sick and die eventually.
wtf....
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