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Allen Steadham is founder and director of the International SizeAcceptance Association, based in Austin, Texas.
The term "obesity" has metamorphosed over the years from simplydescribing a state of fatness to now being synonymous with disease and death.A thorough and unbiased closer look, however, reveals that obesity is, infact, not a disease at all.
First of all, many of the medical conditions, including mortality,associated with obesity are actually a result of sedentary lifestyle and poorfood choices. This was highlighted in the often misreported "300,000deaths per year" associated with obesity by McGinnis and Foege inJAMA.1
This figure was misreported so often that McGinnis and Foege subsequentlyreleased a statement noting that "obesity" was not even listed asa factor in the causes of mortality in their originalfindings.2 And yet,as recently as this year, the U.S. Surgeon General used this statistic whendefining obesity as a greater hazard than weapons of mass destruction.
Second, a significant source of decreased health on the body is cyclicalweight-loss dieting and fad diets. These lead to decreased metabolism, raisedset points, lost muscle (including heart muscle), and overall stress andstrain on the body, while denying the body necessary nutrients forsurvival.
In contrast, increased mobility through mild but maintainable activity, incombination with improved food choices, decreases stress and increases healthand energy, whether or not actual weight is lost.
A study by the Cooper Institute showed that men who were fat but fitoutlived men who were thin but notfit.3 Weight mighttemporarily increase from exercising, as muscle weighs more than fat. We haveseen the alternative, though; cyclical weight-loss dieting leads to greaterand greater weight gain and progressively decreased health.
Third, a recent study from the Rudd Institute at YaleUniversity4 showed aclear "anti-fat, pro-thinness" bias among physicians specializingin the treatment of obesity. This bias is felt by fat patients who aresometimes misdiagnosed, or whose treatment for significant, non-weight-relatedconditions is delayed while some physicians insist on weight loss first.
Some physicians are ill-equipped to treat fat patients, for instance, nothaving large-size blood pressure cuffs, which can lead to a misdiagnosis ofhigh blood pressure and prescription of unneeded medicine. Worse, more fatpatients are steering clear of their physicians, to avoid the anti-fat biasand condemnation they feel.
Obviously, this is no good for anyone and leads to later strain on thehealth care system, as neglected conditions become more difficult andexpensive to treat. Physicians would benefit their patients greatly byencouraging light physical activity and presenting them with information onmaking healthy food choices, instead of encouraging weight-loss diets, drugs,or surgery.
Obesity has been assigned "disease" status prematurely. What isclear is that people need information on how to become healthier withoutfocusing on weight loss alone. People can become healthier through mild andmaintainable exercise and by learning how to make healthier foodchoices.
Physicians should educate and equip themselves to meet fat patients' needs.They should eliminate any anti-fat bias they may have toward any of theirpatients. If people feel more comfortable with their physicians, they are morelikely to seek them out before their conditions become unmanageable.
References
2. McGinnis JM, Foege WH: The obesity problem. N Engl JMed 338: 1157, 1998.
3. Lee CD, Blair SN, Jackson AS: Cardiorespiratory fitness, bodycomposition, and all-cause and cardiovascular disease mortality in men.Am J Clin Nutr 69:373–380, 1999.
4. Schwartz MB, Chambliss HO, Brownell KD, Blair SN, Billington C:Weight bias among health professionals specializing in obesity.Obes Res 11:1033–1039, 2003.[Medline]
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