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.