Should obesity be accepted, or should it be viewed as a disease?

[the apples fell]

By accepted I mean saying "beauty comes in all shapes and sizes from very small to very large", accepting obesity as an alternative to being thin or medium sized, etc? Or should it be viewed as a disease, something medically wrong that measures should be taken to protect against?

[thelurkinghorror]

Neither? There's many, many layers of nuance between "eat all you want" and "go away fatty." My answer would go towards the second one if you truly mean obese, and for personal health and healthcare reasons. But people who are on the husky side but not morbidly obese should be trusted to make their own decisions, and it doesn't help if the ideal weight weight is unattainable for most people. Some people aren't the perfect weight but okay with it, some want to lose weight but can't or don't know how to, while others have some physical or mental problem and may feel fine at 400 lbs. You can't treat them all the same.

Ultimately, policy changes should be done (exercise in grade school?) I don't know, something like that. The soda ban mentioned in the GD is a no-go for me though.

[monstro]

I voted that it's a disease and should be discouraged. I don't see any good in pretending that people's expanding waistlines aren't a public health issue. However, I also think that once a person becomes obese, the goal shouldn't be to focus so much on becoming slim, but rather on reducing the risk of developing the diseases that are correlated with obesity. Since skinny people can also develop these kinds of diseases, it makes more sense to get people to focus on more direct indicators of health, such as blood sugar and blood pressure, rather than on variables with looser associations, such as BMI.

[Der Trihs]

It should be treated as a disease; not as a moral fault. Especially since overeating is a common response to anxiety; treating a fat person like they are stupid or scum for being fat is likely to drive them to eat more.

[the apples fell]

Originally Posted by Der Trihs

It should be treated as a disease; not as a moral fault. Especially since overeating is a common response to anxiety; treating a fat person like they are stupid or scum for being fat is likely to drive them to eat more.

Agreed. What they need is sympathy, compassion, and a support system more than anything. Judging and ridiculing does nothing but make it more difficult for them, and acceptance of obesity as an alternative body size fails to acknowledge the health problems that result from it.

[Wesley Clark]

I think it should be accepted. Much of the medical fear of obesity is just a mask for the social climate we live in. Fat people are considered sexually, morally and socially inferior to thin people, as a result we look for ways to become thin to avoid this stigma. The medicalization of obesity fits right into that. Anyone who thinks teenage girls want to lose 20 pounds because they don't want a 40% higher risk of a heart attack in 2050 is lying to themselves. Most people who try to lose weight (but not all mind you) do so for social reasons, they just say it is for health reasons. There is a reason the vast majority (4:1 ratio, I think) of obesity operations are done on women, if it was for health you'd expect a 50/50 ratio of men and women. If people want to lose weight because they feel it'll improve their self image or social life, that is fine. But we shouldn't be mandating that lifestyle on everyone.

If anything being mildly overweight (BMI 25-30) is somewhat less dangerous than being 18-25 BMI if you are elderly. They aren't sure why exactly. Part of it could be the extra cushioning of the fat. part of it could be the extra muscle you build to carry it around.

I believe it has been found that a lot of the CVD benefit of obesity surgery comes from its ability to put diabetes into remission, (a recent study found 30-50% reduction in CVD events, with the majority being due to the effects on diabetes). That is a laudable goal, but if you are obese and do not have diabetes (which describes me), what CVD health benefit is there to the surgery? It brings your readings (lipids, blood pressure) down, but does that translate into a better CVD outcome independent of blood sugar effects of obesity surgery?

I could go on on how the health effects can be exaggerated, the health benefits of weight loss can be exaggerated, and how more benign behaviors (poor sleep, poor social contacts, lack of moderate drinking, etc) are just as bad if not worse for your health. But I guess my point is that since we have so many social stigmas against obesity we medicalize it to justify the fact that nobody wants to be considered disgusting, lazy and unsexy. But we should be honest with ourselves if we are going to discuss the topic.

I vote let people live. If people want to lose weight, that is on them. If people want to be fat, that is fine too. Just like some people prefer high stress jobs and some like low stress. But we shouldn't be trying to eliminate it. We need to separate the social aspects of obesity from the medical aspects (much much easier said than done). Let the medical aspects be treated as a disease (type II diabetes, sleep apnea, etc), let the social aspects be treated as lifestyle choice.

[Rhiannon8404]

Both.

It should be viewed as a medical problem and those who are seeking a cure should be given help with treatment. Also research should continue as to why some people have weight issues and others with similar eating habits and lifestyles don't.

And people who have no desire to lose weight should be left along and not berated or belittled.

[foolsguinea]

The problem is definitional: Too many people who are not obese think they are fat, and too many people who are dangerously obese think they are healthy.

But if your weight is giving you diabetes, or putting a lot of strain on your joints, yeah, the weight is an issue. (It may be symptomatic of drinking to excess, or smoking, which can be the bigger issues; but it is dangerous in its own right at some point.)

[TriPolar]

I think people who don't realize other people's weight is none of their business have a disease that should be prevented or helped.

[Vinyl Turnip]

Originally Posted by TriPolar

I think people who don't realize other people's weight is none of their business have a disease that should be prevented or helped.

I partially agree. A single person's weight is none of my business. The rising number of obese people, however, is something that will impact me (and all of us) directly.

[even sven]

This poll posits a theory of disease that doesn't make sense in the real world.

All disease is biological. We all have individual risk factors, and we all make individual choices that contribute to our risk factors.

All disease is social. We all live in a society that puts us at risk to or protects us from disease. A society with a high proclivity toward multiple unprotected sexual relationships, for example, is going to be at increased risk for HIV. A society with few regulations on chemicals might be at increased risk for cancer.

All disease is political. Political and power structures determine a lot of our social risk factors.

These things cannot be disentangled. Diseases exist in a system.

In any case, I think it make more sense to focus on the social and political risk factors of obesity, rather than the individual ones. But I don't think it's appropriate to shrug it off or say "Eh, some people are just obese." Levels of childhood obesity, especially, are something to really worry about. Children are generally not making a lot of individual choices, but many obese children will end up having to manage obesity for the rest of their lives. We can do better than that.

[TriPolar]

Originally Posted by Vinyl Turnip

I partially agree. A single person's weight is none of my business. The rising number of obese people, however, is something that will impact me (and all of us) directly.

Unless they fall on you, what would be the direct impact?

[monstro]

Originally Posted by TriPolar

Unless they fall on you, what would be the direct impact?

Health insurance premiums. The sicker people are, the more frequently they use health care services, and then insurance rates increase for everyone.

Sicker workers means lower productivity. That translates into unhappy employers, coworkers, and customers.

Sicker children means more days of school lost and more under-educated people.

We live in a society.

[TriPolar]

Originally Posted by monstro

Health insurance premiums. The sicker people are, the more frequently they use health care services, and then insurance rates increase for everyone.

Sicker workers means lower productivity. That translates into unhappy employers, coworkers, and customers.

Sicker children means more days of school lost and more under-educated people.

We live in a society.

If that's true, they should pay higher rates. So should all the fit people participating in dangerous sports activities, and people who are thin but still don't exercise, and people who drink too much, and people who consume too much salt, and people who don't wash their hands often enough, and people who drive too fast, and people who eat bagels (lots of people end up in the ER after slicing incidents), and the list goes on.

There is no need for people's weight to be anything but a private concern.

[Wesley Clark]

Originally Posted by monstro

Health insurance premiums. The sicker people are, the more frequently they use health care services, and then insurance rates increase for everyone.

Sicker workers means lower productivity. That translates into unhappy employers, coworkers, and customers.

Sicker children means more days of school lost and more under-educated people.

We live in a society.

Social isolation is a huge health risk factor. So is poor sleep. So is poor stress management. So is poverty. I'm sure there are tons of other lifestyle factors that decrease human health and cause all of the above.

But we don't have the huge social pressures on those issues, so they are mostly ignored.

[monstro]

Originally Posted by TriPolar

If that's true, they should pay higher rates. So should all the fit people participating in dangerous sports activities, and people who are thin but still don't exercise, and people who drink too much, and people who consume too much salt, and people who don't wash their hands often enough, and people who drive too fast, and people who eat bagels (lots of people end up in the ER after slicing incidents), and the list goes on.

There is no need for people's weight to be anything but a private concern.

If an insurer decided to target the top three lifestyle-related risk factors and obesity was one of them, how would you feel about that?

The "all or nothing!" argument isn't a compelling one, sorry.

[monstro]

Originally Posted by Wesley Clark

Social isolation is a huge health risk factor. So is poor sleep. So is poor stress management. So is poverty. I'm sure there are tons of other lifestyle factors that decrease human health and cause all of the above.

But we don't have the huge social pressures on those issues, so they are mostly ignored.

See my response to TriPolar.

I agree with you that our society is rife with unhealthiness apart from obesity. But it's hard to argue that obesity isn't often a manifestation of this societal unhealthiness. Poor sleep + poor stress management often result in obesity. Lack of exercise + poor diet => obesity.

I'm not in favor of targeting anyone. But it's wrong to say that obesity affects no one but the individual. That's not true.

[Electric Warrior]

Obese people are of course unhealthy. Being unhealthy does not make you:

-Ugly, repulsive, sexually undesirable
-Rude, nasty, stupid, crass, a bad person
-Worthy of ridicule, a joke, not to be taken seriously
-Lazy, incapable of caring for yourself

To understand that obesity doesn't automatically mean a person is any of those things - to me, that's what it means to be accepting. I don't think it's sensible to pretend that a debilitating medical condition isn't what it is, or isn't harmful.

[TriPolar]

Originally Posted by monstro

If an insurer decided to target the top three lifestyle-related risk factors and obesity was one of them, how would you feel about that?

The "all or nothing!" argument isn't a compelling one, sorry.

I would prefer that public health care be more limited because of just this problem. I agree that in fact it has become a public problem because of cost, but I don't agree that it needs to be. I'm also not convinced that even if considered a high priority in public policy that a significant reduction in health care costs would result.

[TriPolar]

Originally Posted by Electric Warrior

I don't think it's sensible to pretend that a debilitating medical condition isn't what it is, or isn't harmful.

Do you have some evidence that obesity is a debilitating medical condition? If that were the case, and the statistics about the incidence of obesity are correct, then I don't see how this country to continues to operate with so many people so severely crippled by their weight.

[DSeid]

What a strange dichotomy to set up. "Accepting" or "discouraging" as somehow related to thinking of something as or as not a disease. Do we discuss accepting or discouraging diabetes, Parkinson's, hypertension, or depression? Odd thought that.

Obesity is a risk marker for disease states and contributes to them. Someone who is obese is statistically a greater mortality risk ... as is someone who is underweight to the same degree. But an obese individual with healthy habits is not necessarily unhealthy and is not per se diseased.

On an individual level obesity is not a disease, in and of itself.

On a societal level, OTOH, the increased prevalence of obesity, and in particular of morbid obesity, is a societal disease. An underweight individual may be at the same degree of health risk as an obese individual is, but there are many fewer of them. Obesity has increased because our modern world is obesiogenic and those with a genetic predisposition will be triggered by that environment without intervention.

The response to the individual is to address the behaviors and to develop behavior patterns that significantly decease health risks, changing their personal environment. Modest weight loss (5-10%) and adoption of those behaviors may leave an individual obese but will have them at not appreciable increased risks for disease. If that be "accepting" obesity then yes accepting obesity it is.

The response to the societal disease of increased obesity prevalence is at the systems level, diminishing those aspects of the environment that are obesiogenic using multiple levels of tools. Disapproval of individuals or "discouraging" them is not part of the effective toolbox.

[even sven]

Originally Posted by TriPolar

Do you have some evidence that obesity is a debilitating medical condition? If that were the case, and the statistics about the incidence of obesity are correct, then I don't see how this country to continues to operate with so many people so severely crippled by their weight.

We do it in part by massive expenditure of resources. The average American takes 5,117 a day (as compared to the Swiss at 9,650). Many of us have lost the ability to walk mid-range distances. I have "healthy" friends who feel winded and sore after walking a mile- barely 15 minutes of light effort.

We make up for this deficiency by strapping ourselves into in average of two tons of steel and using fire to propel us these distances. Lots of people use their cars like absurdly large wheelchairs.

[TriPolar]

Originally Posted by even sven

We do it in part by massive expenditure of resources. The average American takes 5,117 a day (as compared to the Swiss at 9,650). Many of us have lost the ability to walk mid-range distances. I have "healthy" friends who feel winded and sore after walking a mile- barely 15 minutes of light effort.

We make up for this deficiency by strapping ourselves into in average of two tons of steel and using fire to propel us these distances. Lots of people use their cars like absurdly large wheelchairs.

Wow, that's amazing. I can't believe the Swiss take 9,650 a day. That's incredible. I'm surprised Amercans are only at 5,117. But that's still really good right? Because we want more of that, but we have a lot of ... what are we talking about here?

[Ambivalid]

Originally Posted by Wesley Clark

I could go on on how the health effects can be exaggerated, the health benefits of weight loss can be exaggerated, and how more benign behaviors (lack of moderate drinking, etc) are just as bad if not worse for your health.

(my bold)

Surely you jest? Lack of moderate drinking is just as much of a health risk, if not moreso, as obesity?

[Eonwe]

Originally Posted by TriPolar

Wow, that's amazing. I can't believe the Swiss take 9,650 a day. That's incredible. I'm surprised Amercans are only at 5,117. But that's still really good right? Because we want more of that, but we have a lot of ... what are we talking about here?

Steps, I assume from context.

[Omar Little]

Some time in the future, 2 liter bottles of soda and boxes of twinkies will carry warning labels and pictures of constricted blood vessels and rolls of neck fat.

Much of the personal liberty arguments in this thread have been used for decades against regulation and taxation of tobacco products. They haven't worked that well.

[Mangetout]

Originally Posted by Wesley Clark

Anyone who thinks teenage girls want to lose 20 pounds because they don't want a 40% higher risk of a heart attack in 2050 is lying to themselves.

Teenage girls aren't exactly a reliable barometer of anything - I don't know why you'd even bother mentioning this, unless there are indeed people out there telling this lie to themselves (I've never met 'em).

[ScareyFaerie]

I voted for "disease" because there wasn't a "both" option.

[Imago]

From all my experiences as a smallish and now muscular chick who's dated her share of overweight/obese girls, I cannot emphasize enough that making them feel shitty about being overweight is not going to up the chances of them making healthier lifestyle choices. Who cares why its ineffective? The fact is it's ineffective.

I believe a stressed-out person with a fit body will get sicker and likely die sooner than a chubby person with less stress. A lot of the health problems apparently related to obseity are also related to stress- heart disease, certain cancers, stroke, etc. We just stress out all our fat people so much that it isn't obvious enough to be studied yet.

If there's a serious health risk, then there's no reason to pretend otherwise. But before we can actually address any of the health questions related to obesity we need to get to a point where fat people are treated like adults, not like walking bags of fat. Society is nowhere near that point right now.

I did have one girlfriend who lost about 30 pounds while she was with me because she started coming with me to the gym. Why? Definitely not because she was filled with envy or wanted to look better. It was because she knew that if anyone said anything obtuse I was going to tell them off. 80% or so of the fat folks I have known didn't avoid exercise out of pure laziness or overeat due to some primitive lack of impulse control. They avoided exercise because it made them feel like failures and overate because people treated them differently.

[Shodan]

I wonder how much we can affect what we find attractive by societal education and pressure. I for one find it hard to believe that any number of images in the media will convince me that morbid obesity is just another way of being beautiful.

The "1:1.3 waist to hip ratio" standard of female beauty seems to be cross-cultural. One of the many issues in dealing with obesity is that the urge to over-eat seems to be in our genes. The standard for female beauty that says a woman whose belly is bigger than her hips is not attractive may be the same.

Even pushing an opposite standard of near-anorexia, as Hollywood and the magazines seem to be doing now, doesn't "work" all that well, IMO. The subset of people who find extreme thinness attractive seems to be much smaller than those who find a better-nourished figure to be more attractive. I suspect if Hollywood or society in general pushed the idea that real obesity can be just as beautiful as anything else may run into the same resistance, and for the same reasons.

Maybe I'm projecting. But maybe not.

Regards,
Shodan

[Drain Bead]

The standard American diet causes obesity, and it's all anyone really knows. The state of nutritional information and education in this country is abysmal. People are biologically hardwired to eat crap, and crap is readily available. There's no moral issue regarding obesity--most people who are obese (and I used to be one of them, and am still overweight but heading downward) are not obese because they are weak or lazy. They're obese because they don't realize what eating highly-processed foods does to their bodies.

That doesn't mean that this shouldn't be fixed, though. It's a major public health issue (probably THE major public health issue). Goodness knows how, though--getting everyone on a real food diet is damn near impossible.

[Nunzio Tavulari]

Screw 'em. They're as big a load on the health care industry as smokers. Treat them the same way. No assistance, just refuse to sell food to anyone who's overweight. Make them eat at home. Lock up all the high-fat foods at the grocery and make the cashier call for someone with a key.

[DSeid]

Shodan, your post illustrates how the op is a bit of a mishmosh: it conflates standards of beauty with disease.

People are entitled to their opinions about what and is not attractive (does "beauty comes in all shapes and sizes"?) and I am with you in the belief that those opinions are to no small extent based on evolutionarily selected brain responses. We can insist that the obese are treated with respect but no one can mandate that someone find someone else to be a standard of beauty. (I do find it odd however that as the average American has become fatter the typical image of beauty presented to them has become thinner, often likely clinically underweight. Even beefcake albeit to a lesser degree than female images.)

The op does a disservice to the discussion by presenting the choices as either obesity is attractive or obesity is disease. They are very different issues.

Nunzio is I presume, less than serious ... or maybe not ... but the attitude satirized there (even if unintentionally satirized) is the ignorance that is rife in our society where oddly enough people who are usually at least overweight themselves often mock those who are heavier yet. (Over 2/3s of adult Americans are either overweight or obese, using current definitions. Nunzio, if serious, would impose those discriminiations on the vast majority of those in this country, likely him or herself inclusive.)

[thelurkinghorror]

Originally Posted by Nunzio Tavulari

Screw 'em. They're as big a load on the health care industry as smokers. Treat them the same way. No assistance, just refuse to sell food to anyone who's overweight. Make them eat at home. Lock up all the high-fat foods at the grocery and make the cashier call for someone with a key.

Uh huh. And you'd give the keys to the grocery store workers, who are always perfectly fit and therefore have the moral superiority to tell people off? Seen a Walmart employee recently?

[DSeid]

Originally Posted by DSeid

...I do find it odd however that as the average American has become fatter the typical image of beauty presented to them has become thinner...

I had a little time to kill and found some actual support for that contention.

Overall, all anthropometric measures differed significantly over time. Body mass index (BMI) for all women in the idealized groups tended to decline significantly over time, while the BMI for Young Women increased significantly. Models tended to have the smallest bust and hips, Playmates the largest bust, and Young Women in general the largest waist and hips ... Idealized women have a body size unlike that of Young Women and the chasm between the media-defined ideal and reality is continuing to diverge.

In male models I see it reflected in the fairly modern obsession with "washboard abs" which only pop out at absurdly low levels of body fat. BMI may still be reasonable since these models are well muscled as well but beefcake of years past did not have such extremely low levels of body fat.

Images may not impact what we find attractive in others all that much, but I do think it impacts self-satisfaction with our own body images. Anyone with an explanation for the psychology behind the increasing chasm? Why does the media hold up more extreme low adiposity as the ideal almost in lock step as more and more average people go farther to the other pole? Is the media imaging exclusively a response to increased adiposity, or does it, by way of increasing body image anxiety, paradoxically increase contribute to the problem?

[even sven]

Public health interventions DO work. We have, for example, dramatically reduced smoking through public health methods.

China is realizing that with prosperity comes new risks, and it's interesting how they have anticipated these problems. Everyone is strongly encouraged to participate in two different physical activities a day, and there is a strong push to normalize daily activity. And it seems to work- after school, my college campus swarmed with kids playing badminton, elderly ladies line dancing, and little kids playing tag. People had strongly internalized "You get off work and you go do something with your body" as a normal thing.

They've built in spaces for recreation in their cities, with special care taken to provide recreational activities for the elderly. There are ample public parks, and every housing development has a nearby outdoor exercise course, which are especially popular among older people- they will watch the kids play on the jungle gyms while they work out. It's customary to walk after dinner, so in the evening you will see thousands of families on the streets taking an evening stroll.

I'm not sure if it is a government thing, but they've made it extremely easy to run fruit stands, such that the nearest source of food to any given person is probably a fruit stand. It becomes much easier to pick up apples and watermelon wedges than chips and soda.

If we are smart, we'll start looking toward how we can structure our communities to encourage health. Urban planning and transit options have a direct correlation with obesity rates. We can build fat cities, or healthy ones.

[DSeid]

Not so sure if China really makes your point so well, as much as I agree with it.

China now joins the world epidemic of childhood obesity ... In 2005, the prevalence of combined childhood overweight and obesity in China reached 32.5% for males and 17.6% for females in the northern coastal big cities, suggesting that the obesity prevalence in some urban Chinese populations has approached that of the developed countries ...

[Shodan]

Originally Posted by DSeid

In male models I see it reflected in the fairly modern obsession with "washboard abs" which only pop out at absurdly low levels of body fat. BMI may still be reasonable since these models are well muscled as well but beefcake of years past did not have such extremely low levels of body fat.

ISTM that "abs" are not necessarily a modern ideal - witness various Greek statuary such as this and this. ISTM that washboard abs are much more naturally seen as part of the idealized male physique. Not so with women so much, of course.

Images may not impact what we find attractive in others all that much, but I do think it impacts self-satisfaction with our own body images. Anyone with an explanation for the psychology behind the increasing chasm?

In many instances, I would expect that the presenters of the image are trying to raise anxiety levels in their audience in order to sell them diet books or high fashion clothes. Some who is anxious about their self-image is someone with less sales resistance. No hard figures to back that up - sorry.

Why does the media hold up more extreme low adiposity as the ideal almost in lock step as more and more average people go farther to the other pole? Is the media imaging exclusively a response to increased adiposity, or does it, by way of increasing body image anxiety, paradoxically increase contribute to the problem?

Some of it might be a status display, like pale skin was in cultures where the lower classes spent their time working in the sun, or extremely long fingernails to show that the woman did not work with her hands.

Regards,
Shodan

[Arabella Flynn]

You are asking two entirely different things here.

Should obese people be "accepted"? Yes. This is like asking whether diabetic people should be accepted, or tall people, or Presbyterian people. Sometimes you can choose the characteristics you have, sometimes you can't. I personally believe that no one ever has the right to treat you like anything less than a human being, for any reason.

Should obesity be considered a "disease"? Slightly trickier. I certainly think that if your own body mass is preventing you from walking then this constitutes a medical issue; I would like to point out that having a severed spinal cord preventing you from walking is also a medical issue, and that neither of them says anything about your moral fiber.

The only thing the social and medical viewpoints have in common is that the outright demonization of obese people is probably not a helpful thing. Moral panics have happened before, and generally do more harm than good, particularly when there is hard research involved. Nobody ever scienced any better by being hell-bent on proving a particular agenda.

[Der Trihs]

Originally Posted by DSeid

Anyone with an explanation for the psychology behind the increasing chasm?

Because something being hard to achieve makes it useful as a status symbol; if everyone can look a particular way then you can't feel better than other people for it. Like how being fat used to be considered a status symbol because only the wealthy could afford that much food. The harder it is to be really thin and the fewer people who are really thin, the more of a status symbol it becomes. If you invented a magic drug that let everyone set their weight to any desired point, being thin or fat would have little relevance to status anymore.

[BigT]

Don't quite understand why these are opposites. Obesity should be treated as a disease, as it is virtually impossible to cure, but everyone should be accepted, no matter what disease they have.

[Tapiotar]

Originally Posted by Nunzio Tavulari

Screw 'em. They're as big a load on the health care industry as smokers. Treat them the same way. No assistance, just refuse to sell food to anyone who's overweight. Make them eat at home. Lock up all the high-fat foods at the grocery and make the cashier call for someone with a key.

No no no no, not the high fat foods. The high sugar/refined carb foods. A low-fat, high carb diet made me gain weight; a high fat, low carb diet made me lose and lowered blood sugar.

Problem is, we humans have vastly different body types, and what is good for one is very bad for another. We live in highly unnatural circumstances -- stressful jobs that require too much sitting, for example, and people sitting at their computers or tvs or whatever instead of being actively out and about.

And, oh, yeah, of the people I know, which is not a significant sample size, true, the thin people have more doctor visits, more surgeries, make more claims on insurance than the overweight people. (Don't know anyone in the morbidly obese category, but do know moderately obese.)