Question about Health and Weight

[lydy]

Why does the medical establishment use a disease model for obesity?  How is this beneficial?  They don't do this for other symptoms which have multiple possible causes.  If you see your doctor because you are short of breath, they don't tell you to breathe better.  They look at heart health, lung function, possible neuromuscular disorders, medications, and maybe even psychological issues.  There are a lot of reasons that one might be short of breath.  They might even put you on oxygen if your blood oxygen levels are low while they try to figure out the exact cause.  

How is being overweight different?  Why do we treat obesity as if it were the disease, and not the symptom?  There are a lot of reasons one might be carrying more weight than the doctors prefer.  But lifestyle choices is only one of them, and even there, those choices are often intertwined with other issues like joint pain and time management problems and poverty.  But by using a disease model when looking at obesity, it seems like they are getting their causality wrong a lot of the time.  People in pain move less, which increases weight, which makes it harder to move, which increases weight.  But seems like you want to tackle the pain, first.  

I also want to bang my head against a wall every time someone says "obesity epidemic."  To the best of our current knowledge, obesity is not contagious.  So using an epidemic model is just nuts.  It seems like this impairs communication, not improves it. 

I think that I would be much more willing to talk about my current weight with my doctor if I had a feeling that we weren't going to be scolding me, or recommending drastic solutions like a gastric bypass, and instead were looking at it as a symptom with an underlying cause.  But "you weigh too much" is, um, not helpful?  It's not new information.  

Comments

[mount_oregano]

I know a lot of people who do everything "right" to lose weight and it doesn't work. I'm convinced that something else is going on, something outside of our control. What? I wish I knew. Probably multiple things, and at least a few things we don't understand and might not even know exist.

[lydy]

There is certainly some weird stuff about fecal transplants and speculation about gut bacteria that may or may not be related to obesity. If that does pan out, then, maybe it is an epidemic in the same way that cholera can be an epidemic. But right now, as far as we know, you can't catch obesity from something.

[thewayne]

I've heard about fecal transplants being extremely effective for fighting c.diff infections, which can definitely be life-threatening, and also for some autoimmune problems, but that's about it. I'm at high risk for the latter since my antibody production went on permanent hiatus, so it's a topic that we keep half an eye on.

[lydy]

Oh, lord. I had a c.diff infection. They gave me a six week course of Flagyl, which was not worse than shitting my brains out, but remarkable less of an improvement than one might like. (The c. diff was iatrogenic in origin. They decided they didn't believe me about my risk of an STD, and gave me a big-assed shot of antibiotic, which killed off all the good bacteria in my gut. Oh, lords, I was so sick.)

The one report I saw was very hesitant. The person received a fecal transplant from a relative, and I can't remember which way it went, but the recipient either became obese, or lost weight, and their weight became similar to their donor. I think it was gaining weight, maybe? So they thought maybe something about the gut bacteria affected weight? Very, very tentative.

[pameladean]

There's a lot of evidence that gut bacteria can affect weight; the studies I saw were of populations who acquired different gut bacteria through diet. There isn't enough knowledge of the mechanism for it to be possible to make a real plan to do anything, though.

P.

[pameladean]

It's a real dilemma. The diabetes educators I've dealt with don't fat-shame people. But they do want you to adhere to a fairly strict eating regimen, and then all the little tricks they talk about are just exactly the same as any fad diet over the past forty years would tout, and they tell you a lot of the same lies about how you'll get used to artificial sweeteners or you'll really prefer eating this weird way that lacks a lot of things you really like. It's the blood sugar numbers they focus on rather than the scale, but at least with me it eventually ended up making me feel as terrible as trying to lose weight used to.

Parts of the medical profession seem to be coming around a little bit. My last couple of doctors have discussed weight only in terms of whether losing it would improve certain conditions -- hypertension, which it won't because I already tried that and it made no difference at all; and diabetes, which it will because it has. But they don't address it otherwise. Then again, I haven't asked them to, either.

And I did have one doctor who toed the HCMC line of not harassing people about their weight unless it was really necessary; but she obviously didn't like not being able to harass me about it. So it's hard to say, as you said, how your doctor would react. Do you think saying that you don't want a weight loss plan since they don't work over time for 95% of people, but you'd like to know if anything in particular is going on, would work? Is that what you want to know?

P.

[lydy]

At the moment, I don't really have any questions about myself, personally. I think I pretty much know what's going on, and I am not willing to increase my exercise enough, or reduce my calories enough to make much difference, so there's not really a conversation to be had. But the thing is, I don't even want to try. If there was something going on, I have no particular reason to believe that anyone in the medical profession would be interested in looking for it. They'd be all "diet and exercise" and I'd be all "nope".

I really am curious, though, why the professionals have decided to use a disease model. That's a choice. So, what drives that choice? What are they trying to accomplish? I understand why professionals use a disease model for mental disorders and for addiction, and it has some clear benefits (as well as some drawbacks). But I am struggling to find any benefits to that choice in regards to obesity.

[batwrangler]

I wish that I had NOT spent so much of my life struggling with calorie limits and exercise because so far as I can tell, it's just INCREASED my baseline weight. When I STOPPED making moral judgments about my food choices and exercise and just focused on doing what I could when I could, I dropped back to one of my lower baseline weights, but really, fitness isn't directly correlated to weight, and in terms of mortality, being underweight is arguably a bigger indicator of potential problems.

[lydy]

The one time I lost a lot of weight was about ten years ago. I was in school, extremely stressed, and only eating one meal a day. I wasn't hungry, and I lost, um, eighty pounds, all told. I knew this was a temporary situation, But I dropped to a dress size 8, and looked quite good by conventional standards. I was actually frighteningly underweight, and people who saw me nude were very concerned. Once I got a job and life settled down, I gained it all back, plus another 40 pounds. I was unsurprised to gain it all back, but am not entirely happy with the additional 40 pounds that came along for the ride. I am, at this point, unwilling to do the changes to my lifestyle that would help reduce that additional 40 pounds.

[pameladean]

That additional forty pounds is what happens to most people when they lose a lot of weight. It's almost universal. Bodies don't like being starved and they institute changes to prevent its having such a ravaging effect the next time. Which makes the diet industry complicit in weight gain. Not that they care; it means that they have a continuous supply of increasingly desperate customers.

P.

[pameladean]

This culture's attitude towards obesity is a witches' brew of horrors. But isn't it historically the case that socially nonconforming behavior, especially in women, is pathologized and made a medical issue so that the people engaging in the behavior can be controlled? I think that's part of it. Also the obesity industry makes a lot of people a lot of money.

P.

[lydy]

Good points.

[thewayne]

And then we have the lovely BMI charts that have no medical research to justify them, just a convenient formula that someone came up with.

I'm low-end obese at 5'6" 200 lbs, the charts dictate that I should be 150 lbs to not be officially obese. I haven't weighed that since early high school. I'm down 15 lbs since my wife and I married 13 years ago and she's concerned about that because I haven't done anything specific except stopped eating out for lunch even though it's been gradual.

Epidemic is definitely not the right classification. It would be lovely to have our Chubster In Chief, who feasts on Big Macs, to be labeled as obese by a hard-nosed Navy doctor, but that'll never happen.

[lydy]

I HATE BMI charts. They make no distinction between muscle mass and fat, they don't consider nutrition, they are just total stupidity on the hoof. But it's a really easy number to enter into a chart. I'm convinced one of the reasons doctors fixate on weight is because they can measure it. So much about health isn't really measurable.

excess weight is a symptom

[haertstitch]

I think the old approach is seriously flawed.

so much of it is biochemistry.

one doctor could tell by a guys hands
and over all bigness
that he had a pituitary tumor
that was pushing the body to grow.
but not every one has tumors-
but it can be a family trait.

the thyroid working over time or not working.
the adrenals going nuts.
the bodies in ability to use insulin- insulin intolerance

all of these will drive the human
to hold on to fluid,
make fat cells inflate or reproduce rapidly.
creating fibroids in an attempt to repair
damage you don't even know you have
and make things worse bu not stopping.

they will cause the inactivity and odd diet choices.

when a person feels better
they will move and become active
and will eat foods that are better for that activity.

just looking at the numbers
and attacking a person?
and saying you must eat ... et yadada
the menu they have memorized

not asking what is your diet
what is your activity level
your emotional state
is bogus

there needs to be a set of tests to find out
what organs need help to undo the missed balance.
that part fo medicine needs a serious overhaul.

I remember when mom's knee was messed up
the first time- it never was fixed- she slowed down
and the you must stop eating command was planted

the knee only got worse. needed replacement.
the inactivity did not help it heal.
the harassment over diet only dug at her self esteem
after the stroke she needed to eat more
to repair her affected tissues.
but because of the programming and fatigue she ate even less
she was proud she lost 5 pound a week
cumulatively it was part of what killed her.