Is it good policy to call obesity a disease?

[BeyondGeography]

The federal Medicare program has ruled that obesity is a disease, a decision that opens the door to insurance coverage for weight loss therapies, stomach stapling and behavioral and psychological counseling.

Those who applaud the decision say it's time that a major health problem in America was recognized as such and that funding treatment will result in positive public health outcomes.

Those who oppose it say there's no scientific evidence to suggest obesity is in fact a disease, people are in effect being relieved of their personal responsibility for eating properly and exercising, and that the decision could result in skyrocketing health care costs with no guarantee of public health improvements.

From where you stand (or sit on the couch), how do you see this issue?

http://www.washingtonpost.com/wp-dyn/articles/A52835-2004Jul15.html

[lastknowngood]

1. If you can call golf a sport then being fat can be a disease

n/t

[Bluebear]

2. People are so quick to judge....

I hear people making comments about heavy people and it's thoughtless. For instance, being on steroids like Prednisone can make you gain a stupefying amount of weight...look at the recent Jerry Lewis. Hypothyroidism, Cushing's, antidepressants, seizure medications, many things can cause weight gain, not only Big Macs.

I think it is an economic problem too, poorer people often eat prodigious amount of starches which fill you up and can't afford good sources of protein, etc. OK, off the soapbox now :)

[DemBones DemBones]

7. Amen. I keep saying I'm going to

get a tee shirt that says "I was thin before Prednisone."

It's horrible to be disabled, unable to exercise normally, AND have to take a drug that makes you gain weight.

[Snoggera]

3. I don't know where my mind stands on this yet

obesity a disease or a creator of various diseases?

I feel the same about alcoholism. A disease, or the result of life choices that create diseases?

I'm glad that medical help is being offered.

I'll have to give it some more thought.

[Moonbeam_Starlight]

5. I think alcoholism

and other addictions are spiritual/emotional diseases with very real physical symptoms.

[Snoggera]

6. If I look at it this way

that obesity or alcoholism are diseases of the mind/body/spiritual realm, to begin with, and spawn a myriad of other diseases, then it makes perfect sense.

I'm thinking!

[Moonbeam_Starlight]

8. See?

And as a recovering addict of something I won't name, I know all too well that this is true.

I go to 12 step meetings weekly, I never miss. I have a sponsor, read the literature, work the steps, etc. Been abstinent from my addiction for 2 1/2 years now. Never felt better in my life.

[MissMillie]

30. Unfortunately

Food addicts can't just be abstinent from their addiction.

[rhino47]

45. Way to go Moonbeam !!!

:kick: :yourock:

[DemBones DemBones]

10. I think most in the medical profession agree that

there is a genetic tendency toward alcoholism, and also toward obesity, and both "run in families." You probably know people who drink a lot without becoming alcoholics, and people who eat a lot without becoming obese, which suggests to me that those people just don't have the genetic propensity, since they are "exposing themselves" to what triggers the problem in others.

[DemBones DemBones]

4. The article said they "stopped short of calling obesity a disease"

but will now consider funding treatments for obesity. I think it's a good idea, particularly if they help pay for nutritional counselling in the beginning of treatment.
I am not a supporter of stomach stapling, however, because of the serious complications that follow in so many cases.

When you think about what it costs employers when people are sick, and how obesity contributes to other medical problems, it would be wise of the government to provide universal health care and fund community gyms and exercise programs as well. Many people have difficulty finding a safe, convenient place to exercise.

[classics]

9. What this means is.

Fat people on Medicare can now be forced to undergo gastric mutilation, medically supervised starvation or doping with dangerous drugs in order to obtain other appropriate medical care. No medication ever approved for 'obesity' can make people thin, but they generally do a good job of killing a lot of fat people before they are finally banned.

Previously a person on Medicare could obtain treatment for other conditions seperately, but now because its considered a disease, any fat person can be forced to undergo 'treatment' such as gastric bypass, or they can be branded 'non-compliant' by thier doctor and refused all care.

Thats basically a death sentance to someone with advanced diabetes or one of the other conditions that plauge those already suffering from obesity.

I wonder if they will reverse thier decision to remove obesity completely as a reason to claim disability now that is a real disease.

Somehow I dont see that happening, no cash in it.

[prolesunited]

28. What a strange perspective

Why do you think that people would be FORCED to undergo dramatic procedures. What substantiation or previous precedents can you cite for this?

"Medically supervised starvation"? Is that what you call a diet?

You act as if this is an attempt to kill people rather than help them. Given the number of health issues that result from obesity, including diabetes, why would making treatment available to people a BAD thing?

[classics]

60. Its a perspective from someone who cares for these people.

>Why do you think that people would be FORCED to undergo dramatic procedures. What substantiation or previous precedents can you cite for this?

This is a common occurance for those whos medical insurance covers weight loss procedures. Even patients who undergo starvation regemins and gastric modification yet fail to lose weight are often labelled 'non-compliant' by physicians whos knowledge of fat people ends at 'eat less - weight less'.

Patients experience 'non-compliance' issues more with Medicare than with private insurance, so the rate of this practice is going to increase.

How do you explain your ignorance of this fact?

>"Medically supervised starvation"? Is that what you call a diet?

Would you feel more warm and fuzzy about it if I used the word 'fast' instead of starvation? Starvation is what eating 450 calories a day in powder form is. Its starvation intended to produce rapid loss of fluid, fat and muscle weight. What part of that is unclear to you?

[BeyondGeography]

11. Walking is safe and convenient

in about 99% of the country. It's also great for you, physically and mentally. Unfortunately, the suburbs are anti-pedestrian. Suburban sprawl has been accompanied by waistline sprawl.

We are perhaps culturally prone to obesity. When I was a kid, back when dinosaurs roamed the earth, we played ball for hours, unsupervised. Television sucked, there were three networks and only one or two came in clearly, there were no VCR's, DVD's, computers, video games...all the stuff of sedentary entertainment. And junk food marketers were just getting started.

There are plenty of reasons why we've gotten bigger and bigger. I'd like to see a broader (if not wider) discussion of this topic.

[DemBones DemBones]

22. I dispute your claim about walking being safe and

convenient in 99% of the country. In many places, walkers are endangered by cars, dogs, muggers, or have no sidewalks to walk on, or have very uneven sidewalks or ground to traverse. Such things are more dangerous as a person ages or when a person is disabled, as I am.

I just read an article yesterday that said walking was the most dangerous form of no-equipment-needed exercise for the elderly and disabled because of the danger of falls. I'll assume everyone knows that the elderly are more likely to break bones when they fall and that can be quite debilitating, even setting up a downward spiral ending in death. Osteoporosis is a factor, of course. People with disabilities may also have similar problems, regardless of age, depending on the disabilities involved.

Walking is great, I agree. But falling is disastrous. I'm not elderly but I've had some falls that caused me pain for years afterward, even when no bones were broken.

I was in 2nd grade before we had television and I had a very active childhood before and after tv. But I'll point out that our parents and grandparents didn't play ball for hours, jog, work out at a gym, or even walk, and yet few were obese. (One of my grandmothers walked but that was considered rather odd, attributed to her being English.) Desserts and breads were eaten regularly, along with plenty of meat, potatoes, gravy. I think the nature of food has changed, with the ubiquitous addition of high fructose corn syrup, for example, and we are also eating hormones that were fed to cattle, pigs, chickens, turkeys. It would be interesting to see what would happen to people who ate as we did in the fifties -- meat and potatoes and gravy, breads, desserts -- but all free of hormones and HFCS. Would they get fat? As fat as people eating a "modern" diet?

[Nikia]

26. I think that has something to do with it

People used to walk more, not necessarily for exercise. If there was a neighborhood grocery store a few blocks from their house, for example, they'd often walk there instead drive. Children would walk to school. Walking to get somewhere was not considered weird.
I read an editorial a few months ago saying that there is a direct correlation between obesity and time spent in a car. You don't hear much about that though. It is better for the economy if you drive to the gym, which you pay to belong to.

[DemBones DemBones]

59. Yet out of the three grandparents I remember,

only one grandmother walked, and she was the heaviest of the three! The other grandmother had a congenital heart condition and was unable to be very active her entire life. The grandfather I remember had a club foot and walked as little as possible since walking hurt his foot. He ate the sort of food I've described, and wasn't obese.

But it is a problem today that it's so difficult to walk safely and comfortably in many places. Good sidewalks really make a difference to older and disabled people. Uneven terrain is difficult to cope with if your balance isn't good.

[Nikia]

63. I know that sidewalks are a problem

In some newer housing areas, there aren't even sidewalks. Sometimes property owners oppose them which I don't understand. My family always has walked, and I recommend it for all those who are able and where it is convient. Planned exercise can get boring but taking a 10 minute walk to somewhere you needed to go anyway is an esay way to get a little bit of activity in.

[BiggJawn]

12. So my HMO will pay for a new Trek 5900 for me?

Hey, it's "weight loss therapy"...

Somebody said that obesity is a spirital/emotional disease that leads to other diseases. I can ride with that. I've not exactly been what you'd call a happy camper most my adult life.

Life getting you down? Have a snack. Lonely? Go get a rack of ribs from BBQ Heaven. Girlfriend dump you? (the third one that year) Go have some Haagen Daas...
And when the food din't make me feel better any more and I was a blimp, then I climbed inside the wine bottle.

Got that straightened out 6 years ago, now I'm working on the ravages of too damn many goodies...

Not too sure I like the idea of it becoming a "disease". Doctors get kind of shitty when you turn down their treatment plans...

[jpgray]

13. This disease seems to be concentrated in rich countries with lots of food

Tell starving in kids in North Korea that they should hope to 'catch' that obesity bug. Un-fucking-believable. Oh well, you make a herd of the people, you may as well fleece them twice.

[YellowRubberDuckie]

14. I don't have myself to blame...

I exercise daily, and work off what I put into my body...But I also have a metabolic problem. So, I have to work out three times as hard to maintain my weight. I get so pissed off when people see fat and ASSUME it's that person's fault for being lazy.
Duckie

[MissMillie]

31. Well, and don't forget

A person who weighs 300 lbs. has to expend twice the energy to perform the same task as a person who weighs 150 lbs.

So it just may be that a big person's life is so exhausting that it makes it that much harder for them to ADD activity.

[Redhead488]

32. If they were expending twice the energy, they would be

expending twice the calories as well. Damn! That means they must also be EATING twice as much!

[EstimatedProphet]

33. No it does not

And that's a narrow way of looking at it.

[Redhead488]

34. Yes, it does

Since a calorie is nothing more than a unit of energy. If one is expending twice as much "energy" as another, one is also burning twice as many calories as another. Facts is facts.

[EstimatedProphet]

35. No it does not

What isn't facts is that someone who weighs twice as much as someone else and must burn twice as much energy, HAS to eat twice as much. The body doesn't work that way. The way the body stores energy is very complex, and often it doesn't follow the model of "more energy burned equals more weight lost". For example, it's been shown that people who increase exercise and cut back on calorie consumption tend to plateau in their weight loss, and will only start to lose weight again after they increase their food consumption. According to what you're saying a person will lose weight at a proportionate rate to their food consumption, always. That's just not true.

[Redhead488]

37. The "so I can EAT twice as much" part

was sarcasm...the fact remains, burn more calories than you consume and you will lose weight. A person will lose weight at a proportionate weight to the calorie deficit the create and maintain.

[EstimatedProphet]

38. Actually, not really

A maintained constant weight loss program will also hit plateaus and quit being effective in short order. There has to be some variation built into the program, differences in extremes in exercises and calorie intake, before it will be truly effective. This is one of the reasons so many weight loss programs are ineffective.

[Redhead488]

39. Yes, really.

True, one will hit plateaus as one's body becomes more efficient at "work" and therefore expends fewer calories for the same level of activity, BUT the fact remains: if you expend 3,000 calories and consume 2,000 calories, you WILL lose weight. Period. It may become harder to expend 3,000 calories every day (as your body adapts to increased activity and becomes more "efficient"), but that is where will, desire, and discipline come into play.

[EstimatedProphet]

40. OK

Yes, if you expend 3,000 calories and consume 2,000 calories you will have a deficit of 1,000 calories, and lose weight. I agree.

[Redhead488]

41. Will you also agree

that we have probably been in agreement all along? :-)

[EstimatedProphet]

43. OK, I will

What set me off was the implication at first that fat people are fat because they eat more. My point is that weight loss is still very difficult, for the reasons I listed. A lot of people do try, and try very hard, and are unsuccessful. I myself have 2 busted knees and a torn rotator cuff to show for it, and I now weigh more than I did before I started.

[mrboba1]

49. True - a calorie is a unit of energy

but a heavier person does burn more calories to keep the body going. everyone has a unique "resting metabolic rate" (RMR) and the heavier you are, the higher the RMR.

It may not be true that twice the weight=twice the RMR (not to say that it isn't I just don't remember), but it is noticably different.

[YellowRubberDuckie]

46. This is true.

[Endangered Specie]

15. Obesity is not always the persons fault...

things like drug treatments, poor nutrition (due to parental or economical), corporate brainwashing and exploitation, or traumatic childhoods come to mind.

[jpgray]

16. Almost 50% of the population has those problems?

In Italy, the obesity rate is 6.5%. This is like the old prison joke where everybody's innocent, according to what they'll tell you. People will rationalize away their personal culpability quicker than a shot, but that doesn't change the fact that many people simply are experiencing the consequences of their own actions. It isn't totally the individual's fault (even in the prison example), but personal responsibility has a HUGE place in there, and given more excuses to ignore that part, people will jump to do it. We all do.

[Endangered Specie]

17. Its different if obeisity occurs as a child...

parental responsibility is often lacking, obese parents tend to raise obese kids.

[classics]

18. Tall people tend to raise tall kids too.

Sick.

[jpgray]

19. There is height variation in poor nations

Ask about the 'obesity epidemic' in Sudan or the Congo, and you might get some blank looks. What makes you tall and what makes you fat are not directly analogous.

[BeyondGeography]

20. Actually, we're getting fatter AND shorter

We're now way behind the Europeans in average height. We used to be even. Lack of height , or height stagnation and decline, is associated with rising levels of human misery.

Maybe we qualify...

http://www.emediawire.com/releases/2004/4/prweb117435.htm

[Nikia]

56. Could this have anything to do with ethnicity changes though?

There have been an increase in Asian and Hispanic immigrants in the recent past. Those ethnic groups seem to be a bit shorter than Europeans in general. That would bring the average down.

[gpandas]

53. jp overwhelmed by sarcasm n/t

[YellowRubberDuckie]

50. Life styles are different in Italy...

their rate of heart disease is very low too, due to all the red wines they drink. They also eat differently than we do here. Sure, it's lots of cheese, bread, pastas, but their meals last hours, whereas ours last minutes.
Duckie

[Liberal Classic]

21. Though obesity is not communicable, the War On Fat jiggles forth

I believe that in the interest of public health, that the government should be involved with combatting the spread of communicable disease. However, while I do not suggest obesity has no negative effects on people's health, it is certainly not contagious.

[DemBones DemBones]

23. A lot of thin people have no room in their

hearts to understand what it's like to be overweight. Like Republicans speaking of the poor, they're sure "those people" could pick themselves up by their own bootstraps and get thin.

[Redhead488]

29. Expend more calories than you consume - simple process

in which you are GUARANTEED not to gain weight. It's not really that difficult of a concept to grasp.

[classics]

55. Your 'law of physics' argument has been disproven.

as pop-culture 'common sense' junk science decades ago. It his based solely on the belief that fat is the result of the sins of sloth and gluttony.

If you would spend about 10 minutes actually reading any sort of medical literature on human physiology you will find that its far more complex than that.

For your argument to be true everything in human physiology would have to be a fixed constant with no variation from person to person, including the cost of energy to perform an action, all the metabolic processes related to production, storage and release of energy, the amount of energy that can be absorbed and stored in relation to the amount eaten, etc.

If any of those things vary from person to person, and of course, they do, wildly; your belief is pretty much destroyed.

Even varying one thing, such as the amount of energy absorbed and stored per raw 'calorie' consumed vs. the amount discarded in feces, will make a huge difference in the amount of reserve energy a body keeps.

If you need some 'common sense' proof that doesn’t require any knowledge of human physiology, I suggest you look at the LONG TERM results of forced anorexia through gastric bypass. After 5-6 years, nearly all the patients who are not killed by the modification (or mutilation, depending on how you look at it) or the effects of starvation begin to regain weight.

Now keep in mind due to bypass or removal of a large portion of their normal healthy digestive system, these people are living with unstoppable, non-reversible anorexia and malnutrition. Its literally impossible for them to eat enough of anything to 'gorge', even trying will result in severe pain, vomiting, and possibly death from intestinal hemorrhage. What little they do eat can never be properly absorbed and without artificial nutritional suppliments for as long as they survive the modification, illness and death occur as would in any animal not able to properly digest its food.

How do their bodies gain weight in your law of physics argument?

[DemBones DemBones]

58. You are obviously one of the people

with no compassion in their hearts, sure you will never get fat. Life may have some surprises in store for you.

[kiahzero]

24. I see "taxing junk food"...

How about subsidizing healthy food, so it doesn't cost more than twice as much to eat nutritional food? Speaking as a college student, it's far easier for me to eat crap than to eat well.

[JackDragna]

25. It should depend on the nature of the person's obesity.

Health insurers should not be held liable for the costs of those who become obese through overeating and activity. At the same time, money should be available to help those who become obese as a side effect of other health problems.

[MissMillie]

47. What if....

the cost of treating obesity ends up being less than the cost of treating the commorbities of obesity (arthritis, hypertension, sleep apnea, GERD, diabetes, etc)?

[sendero]

27. Here's the thing.....

... if we're going to call alcoholism a disease, then obesity should be also.

Now the fact is, IMHO, alcoholism and obesity are only usually what I would call a disease. But I don't want to punish the real victims just to get a few slackers.

[noonwitch]

36. If it will get my health insurance to cover joining a gym/health club

My insurance, a good PPO, will cover bariatric surgery, which I am about 25-30 pounds short of meeting the standard for, but won't cover the fee to join a health club. My boss said to just gain the 30 pounds and get the surgery, but it seems to be a very unhealthy way to lose weight, by gaining it first?

[Bridget Burke]

42. That's totally wrong.

More exercise (with a wise diet) is the best way to control your weight. Ideally, your insurance should encourage those methods first.

The surgery should only be a last resort.

[YellowRubberDuckie]

51. That surgery makes people miserable and sick...

Please, don't do it. And the best way to lose weight is slowly and with diet and exercise. Several people have started dying because of this surgery. The YMCAs in this area are affordable. If you have one in your area, they have workout rooms, water aerobics, and different classes to help you work out.
Duckie

[Nikia]

57. My insurance covers up to $50 per year for gym/health clubs

That usually doesn't cover it, but at least it helps a little bit if I would want to join a gym.

[CO Liberal]

44. As Long As Medicare Doesn't Fund Weight-Loss Surgery

That's just mutilation, IMHO.

[DemBones DemBones]

62. Stomach stapling is becoming more and more

common, it seems. The topic came up in a small group of friends and acquaintances not long ago and I was surprised that several people had a family member or friend who'd had it done.

I think it's a way to get thin for a time while ruining your health forever.

[Commendatori]

48. It should be case-by-case, judged by doctors.

I'm all for hekping the naturally obese, but I'm not willing to subsidize laziness. I know a bunch of obese people who were ex-military, and none of them got thrown out because of weight standards - they just let themselves go.

Not everyone who is obese is at fault, but is Medicare covering all it needs to right now? Will it ever? Since the answer to the first (and almost certainly the second) is no, why put more strain on the system than necessary?

[eyesroll]

52. I think, from a business standpoint, this makes a lot of sense

You help pay for people to lose weight, and you don't have to pay for the much more expensive obesity-related-illnesses later.
For the same reason, I think smoking cessation, and drug and/or alcohol addiction treatment should be covered by insurance. A few hundred dollars now for counseling, the patch, etc. can save thousands of dollars for later treatment.

For that same reason, I think contraception should be covered by insurance. $30 a month for pills is a lot cheaper than prenatal care, labor and delivery and postpartum and new-baby care.

Some people say we're rewarding people for their bad choices (even though smoking is really the only 100% choice up there). So let's take morality or "what we believe is a disease" out of it -- what makes sense from a "saving our healthcare dollars" standpoint? I'll take ounce of prevention, thanks. It's not like we're telling smokers we won't treat their lung cancer, or pregnant women that we won't cover their delivery unless they swear on a stack of bibles they got pregnant on purpose. We're treating the outcome of people's actions; we might as well help them avoid those actions in the first place.

[DemBones DemBones]

61. Thanks for a sensible post! HELPING

people with problems like obesity, alcoholism, or smoking makes the population healthier, potentially saving money in healthcare costs down the line.

[Bridget Burke]

54. Texas Governor Perry's obesity fighting plan

The annual Texas Roundup Festival has a 10K run & participation by Texas communities to foster fitness statewide. Fine idea.

Perry's just announced that Martha "Marty" McCart will be the director, paid $40,000 per year for a 30 hour work week--working out of her house.

Guess what? Her husband is a bigtime lobbyist!

The position was not listed, giving no chance to any employees of the Health Department, currently dealing with staff reductions of 5% due to budget cuts.

www.chron.com/cs/CDA/ssistory.mpl/ap/tx/2684853