“Disease or not a disease…”

… that is the question currently being debated in response to the American Medical Association’s (AMA) decision to classify obesity as a disease.

Yes, a disease…  right up there with diabetes, heart disease and the big C.

Advocates agree this classification is necessary; critics say it is ridiculous; everyone else falls somewhere in the middle. There seem to be countless ways to view the decision; and the judgement is endless.

In my opinion – because, hey, why not? – the AMA’s intentions seem positive. They want the medical community to pay attention; they want to increase the doctors/patient conversation; and, ideally, they want insurers to provide more coverage of weight loss treatments. These are all good things no?

I think any organization that puts obesity in the spotlight deserves a pat on the back. It is a major problem in this country; and I am all for addressing health concerns head-on. Seriously, I want everyone to be happy and healthy and to live their life to the fullest. 

But my gut response was still, “is disease the right word? There is something about the term “disease” that, to me, pushes aside self-responsibility.  A disease is often, rightly or wrongly, something that “happens to you,” not that you cause yourself.

Of course, obesity is not always self-inflicted. Many people suffer from ailments that cause weight gain, or require medications that cause weight gain. The term disease encompasses many of these conditions, as well as the conditions that result from obesity, say, hypertension and heart disease. Yet, just the same, there are those who do not.

The day the announcement was made, one of the many e-newsletters I receive linked to both a story about the AMA’s decision, and right under it, not coincidentally I am sure, an infograph about the consumption level of fruits and vegetables in the U.S.

It depicted the Median Daily Vegetable Intake Among Adults in the U.S., based on the CDC’s State Indicator Report on Fruits and Vegetables. The chart was broken down into the following: less than 1.5 times, 1.5, 1.6, 1.7 and equal to or more than 1.8. These were depicted by a pretty range of colors, starting with a light green/yellow shade for the lowest, to a deep spinach green for the highest.

Now, before I begin a confusing explanation of who eats what, let’s take it a step further. To add some relevancy to the issue at hand, I looked up the CDC’s data on prevalence of obesity in different states. The data considers a person with a BMI of 30 or more to be obese, resulting in more than 35% of adults across the country, according to 2011 data.

The top ten most obese states are:

1. Mississippi
2. Louisiana
3. West Virginia
4. Alabama
5. Michigan
6. Oklahoma
7. Arkansas
8. South Carolina
9. Indiana
10. Kentucky

So, how did these states do on the veggie-eating chart you ask?

  • Mississpippi (#1) and Louisiana (#2) residents’ median vegetable intake daily is <1.5 times a day;
  • West Virginia (#3),  Oklahoma (#6), Arkansas (#7), South Carolina (#8), Indiana (#9) and Kentucky (#10) fall into the 1.5 category; and
  • Alabama (#4) and Michigan (#5) are at 1.6 times a day.

I am no scientist or expert in the field, so I will not pretend to draw any conclusions. But it seems to me that there is a bit of a negative correlation between the frequency of veggie-eating going on and the number of obese residents, hinting that there could be a lack of self-care partially at fault. Again, I am no expert.

To me, calling obesity a disease is similar to calling “drunk” a disease, which would sound pretty silly if we heard that referenced as such. But Alcoholism, sure, although self-inflicted, it is a disease – it is an addiction.

Ahhh, there is a good word. Addiction. Is that not what over-eating is? An addiction to food, whether it be an emotional dependence or a physical addiction to the actual ingredients (read: chemicals) in food.

Food addiction is the hardest type of addiction to overcome – you can not completely withhold food the way you can alcohol, tobacco or a drug. You have to eat, but control the way you eat. Try telling an alcoholic to “drink but control how much he/she drinks.”

There are so many facets to this problem. Each person is different. Each obese person’s problem is different. Each solution is different.

The problem with calling it a disease is that a disease often has a “solution” or a handful of possible solutions. There is no one, two, three or 50 solutions to this epidemic.

Therefore, I do not think each person with the BMI of more than 30 should be labeled as diseased, but if a “disease” classification lifts the taboo off the topic while the patient is sitting on the doctor’s table, then it can only help.

The AMA has the right intentions and they are making moves. For that I give them a two-handed high five.

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