
Physicians group labels obesity a disease - codegeek
http://www.cnn.com/2013/06/19/health/ama-obesity-disease-change/index.html
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uberalex
I have lost quite a lot of weight recently, and went out of obese to normal
weight range for now.

I do think that there is a clear difference between 'I should cut back on the
cakes'-type overweight, and 'I have inadequate control over my eating'-type
obesity.

It's not as simple as 'eat less', 'put the fork down chubby' or 'get out and
run/lift/whatever'. I have trouble with controlling my appetite, and I have
issues with knowing when I should stop eating (it's quite hard to hold back
when every body signal indicates you are still very hungry).

In my view obesity is a disease, but it's false to think of it as being like
the 'flu. It's a chronic issue, like high cholestorol, blood pressure or a
peanut allergy. There are environmental factors and behavioural reasons why it
is a health risk, but the underlying cause has a physiological source.

~~~
BorgHunter
It seems like calorie counting would be a good first-line treatment for
difficulty controlling one's appetite. This requires a fair amount of
discipline, but it's also free of side effects and tools already exist to help
you. Do you think at least knowing A) what your basal metabolic rate is, and
B) knowing how many calories you're eating (and consuming via exercise) is
effective in combating this misfire in a body's signals?

I think a lot of the resistance to this is people are worried that the first-
line treatment will be things like drugs, which can be expensive (to society,
since costs are largely socialized even in the U.S. through the mechanism of
health insurance) and have side effects. Look at, say, jrs235's comment (
[https://news.ycombinator.com/item?id=5912203](https://news.ycombinator.com/item?id=5912203)
) elsewhere on this page. That's a valid concern. But obesity also comes with
a lot of costs itself. If calorie counting is an effective approach, I think
that it could address the problem in a cost-effective way. (And in a software
way, too.)

~~~
uberalex
I calorie count, that's how I get through the day. However, it's worth noting
that calorie counting is a depressing thing to do. I've experienced very much
the feelings that I read about for diabetics (type 1) and people who are
severely impoverished. Every cost has to be counted, every extravagance
planned for, every unexpected event has to be compensated for. I overate at
the start of the week, so I need to cut back at the end. It's difficult to
count calories when I don't have the figures, which means I can no longer be
the spontaneous social eater I want to be. I miss that badly.

I like to say it's like going from never having to think about how much money
you spent to having to count every.single.penny. It's not 'I should skip that
holiday in the maldives this year', it's 'Can I afford that trivial
expenditure (a single piece of fruit) today? will I be too hungry to sleep if
I cut that out of tonight's dinner?'

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jrs235
Great.

1\. So now they can prescribe more drugs to more people. 2\. Insurance
providers will have to pay for more drugs continuing to drive health insurance
prices up. (I'm sure the government will mandate that providers can't have
plans that omit coverage for weight related services and drugs).

P.S. I'm trying not to be mean, just pointing out the harsh reality and truth.
We as a populace have become lazy and complacent. Rome II is about to crumble
unless we stop addressing the symptoms and focus on the disease.

~~~
ap22213
That's quite a bit of hyperbole.

My view is quite different. The Human body evolved to survive in certain
ecological niches. And, very quickly, those environments changed. So, it's not
surprising that the body hasn't kept up.

Your moral angle has a good ring to it, but I think it's misguided. From a
moral standpoint, I think it's much better to use our evolutionary strengths
(big brains, etc.) to let us invent technology to overcome the slowness of
evolution. What benefit is there in forcing people to tough it out when their
biology simply wasn't made to cope?

Plus, it's actually probably cheaper to invent new drugs to treat obesity
(curbing appetite) than the more intensive, invasive treatments for diabetes,
heart disease, etc.

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glenra
My guess is that eventually we'll confirm something like the "fat virus"
hypothesis and be able to immunize kids (to some degree) against becoming
obese.

There exist human cold viruses such that if you give that particular cold to
an animal, the animal gets fatter. We don't directly test these viruses on
people due to ethical concerns - we're pretty sure they'd make people fat too,
and there's no cure. But you can look at biomarkers for exposure and verify
that people who've been exposed are more likely to be fat than those who
haven't.

Here's a study:
[http://www.ncbi.nlm.nih.gov/pubmed/17908526](http://www.ncbi.nlm.nih.gov/pubmed/17908526)

Quote: "This review discusses the 5 animal viruses and 3 human viruses that
have been shown to cause obesity and examines the evidence to date for virus-
induced obesity. [...] Ad-36 causes obesity in chickens, mice, rats, and
monkeys and was present in 30% of obese humans and 11% of nonobese humans. In
twins discordant for infection with Ad-36, the infected twins were heavier and
fatter than their cotwins."

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fcorr
_On the other hand, AMA 's declaration could help increase funding for future
obesity research. It could also lead to payment for doctors who want to simply
talk to patients about nutrition or exercise -- time that's not currently
reimbursed by insurance plans._

I don't know enough about medicine to discriminate well between a disease,
condition, syndrome etc., but some of the points made in the article make it
sound like this new designation of obesity as a disease is mainly to do with
appearances.

~~~
strasser
Probably we're overthinking the whole thing. When I was a kid, obese people
just ate too much.

~~~
glenra
Some obese people do eat a lot, but the causality direction is unclear. It's
likely they eat a lot in large part _because_ they're obese.

The human body in general is amazingly good at calibrating how much you eat
versus how active you are to stay within a pretty consistent weight range - if
it weren't, we'd all starve or become morbidly obese in response to tiny
inadvertent changes in diet or exercise. But in some people, that calibration
mechanism is off - they feel hungrier than they should or their metabolism
works slower than it should given their size, and the mismatch leads them to
become obese. We don't yet know why and we don't yet know what can be done to
reliably change or fix it.

We've almost certainly been underthinking the whole thing.

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gailees
This is huge and, regardless of what you think of its labeling, will forever
change the way we treat obesity. It's become a real problem in the US and as
much as we would like to blame obesity on an individual, the country as a
whole is suffering bc of it. It impacts our health, our relationships, and
even our economy, and it's time to step up to make some real changes here.

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JimmaDaRustla
My take - shouldn't be a disease.

Reasoning: most diseases have a direct "cause and effect" \- if you can't eat
healthy because you weren't forced to eat anything other than chicken nuggets
as a child, that may well be a disease. (My GF suffers from this; she says we
will serve mini hamburgers and chicken fingers at our wedding...) But obesity
in general, to me, is not a disease.

However, if labeling it as a disease can help people in any way to get on the
path to a healthier lifestyle, then it doesn't bother me. Calling it a disease
should not be a crutch, but hopefully a way to address the problem. I believe
insurance companies will have to cover operations that can help people lower
their weight.

I believe in Canada our health plan covers that, kind of bugs me though
because it comes from my taxes rather than paid insurance.

~~~
uberalex
There is something to suggest that obesity is more than simply having a bad
diet. Obese people react differently to food, and it appears to have a genetic
correlation.

One paper suggests that there is a dopamine response difference in the obese:
[http://www.ncbi.nlm.nih.gov/pubmed/11210998](http://www.ncbi.nlm.nih.gov/pubmed/11210998)

The causal direction is open to interpretation, but I still think that there
is a difference between 'overweight' and 'obese'

~~~
stinos
"genetic correlation"

this probably plays a part in it for some, but only a small part if I would
have to guess, there's way more to it.

First sign there's much more going on than just 'a disease' is the fact there
are way more obese people in the US for instance than in most other countries.
And also for instance that children where both parents are obese are more
likely to develop obesity as well. First comes down to culture, second to
lifestyle. Not two things I'd directly associate with words like 'genetic or
'disease'.

~~~
uberalex
I can't say I agree with this analysis. In the first instance, the fact that
both parents' obesity is a factor could be argued to point towards a stronger
correlation. In a broad sense, it's also important to note that chronic
diseases always have some behavioural and lifestyle component. For example,
physical malformations can be caught early and given therapeutic redress --
Scoliosis correction might be a good example.

You're not condemned to be obese if your genetics give you the propensity for
it, but it's also fair to say that the genetics mean that disease-like
interventions are necessary. [http://www.hsph.harvard.edu/obesity-prevention-
source/obesit...](http://www.hsph.harvard.edu/obesity-prevention-
source/obesity-causes/genes-and-obesity/)

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angersock
I wholeheartedly look forward to the lavish dinners at doctor conferences
where they discuss this malady.

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roller
Joining alcoholism in the area of diseases you can get yelled at for having.
Damn it Otto, you're obese!

