# Obesity is now an illness. **URL:** \ **Category:** The BBQ Pit\ **Created:** [July 16, 2004, 5:32pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449 "2004-07-16T17:32:51Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![Shayna](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/shayna/32/17976_2.png) [@Shayna](https://boards.straightdope.com/u/Shayna)\ **Post date:** [July 16, 2004, 10:22pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/81 "2004-07-16T22:22:12Z")
**Boldface Type** , while I appreciate your further research, your personal interpretations of the studies are rather meaningless, especially since you seem to be confused as to what, exactly hypo **thyroid** ism is and at least one of your sites doesn’t even state the numbers you claim it does. The study that you say considers obesity and hypothyroidism, does nothing of the sort. It talks about hypo **pituitarism** and hypo **cholesterolemia**. You’ll also note that that study was done on people in Japan, not the United States. Apples and oranges. The other one I can’t even read in its entirety without paying $30 to register, which isn’t going to happen, and I’m not sure how a Swedish study relates to obesity in the United States without being able to read it. Not to mention that what I _can_ read, merely states that treating obesity with the use of thyroid hormones is unjustified, which I’ve also seen elsewhere in my reasearch, is no surprise and really isn’t meaningful in re this discussion. > [@](#): > > Feel free to point out where I said that, and feel free to prove I feel that at your leisure. I believe that the problem mostly lies where personal responsibility and the society of plenty meet. Unless you can provide evidence to the contrary, I will continue to suggest that most people are exercising bad choices, rather than ‘ill’ and thus unable to make good choices. You weren’t the only one who made a comment of that nature, contending that obese people are that way because they overeat [I read as ‘pig’] and it’s entirely under their control [I read as ‘lazy’] – others were more overt, and my post was directed to anyone who feels that way. I should have been more clear that it was not a direct reply to you, and if I misinterpreted your words, I apologize. Also, just so we’re clear, as I stated above, I’m certainly not saying that obesity is always and only caused by an underlying disease or medical condition. A lot of people are overweight because they don’t eat properly and don’t exercise enough. But tens of millions of people suffering from diseases such as hypothyroidism and hyperinsulemia, such as what **phouka** suffers from, doesn’t strike me as “relatively few” whose weight problems are, in fact, due to underlying medical conditions. ---
**Author:** ![overlyverbose](https://avatars.discourse-cdn.com/v4/letter/o/9dc877/32.png) [@overlyverbose](https://boards.straightdope.com/u/overlyverbose)\ **Post date:** [July 16, 2004, 10:26pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/82 "2004-07-16T22:26:45Z")
> [@tdn](#): > > Carrot. And it’s fat free, sugar free, and carb free. And crunchy. 😛 Eeach. Yuck. Blech. Crunchy cake? Are you trying to kill me? ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [July 16, 2004, 10:28pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/83 "2004-07-16T22:28:33Z")
> [@Colophon](#): > > Bollocks. Unless fat people have found a way of violating the laws of thermodynamics, their “illness” is caused by too much piggin’ and not enough joggin’. > > I’m sick, sick, sick, sick, sick of hearing fat people whinge about how it’s not their fault, and the whole world is conspiring to make them eat huge portions of food, blah blah. > > You have lips, right? Well **close** them occasionally to stop those donuts sliding into your mouth. Got that? Dude, sod the heck off. SOME of us happen to be invalids, and I am sorry, I am eating as carefully as I can, but sometimes you cant really cut out any more food unless you want us to go on IV feedings…and they ain’t gonna pay for it, and it ain’t healthy for your guts to not ‘work’ on processing foods. Last time I had anything off my normal diet was a piece of wedding cake for my brother about 10 years ago. Again, sod off. wanker :smack: ---
**Author:** ![Colophon](https://avatars.discourse-cdn.com/v4/letter/c/f05b48/32.png) [@Colophon](https://boards.straightdope.com/u/Colophon)\ **Post date:** [July 16, 2004, 10:37pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/84 "2004-07-16T22:37:52Z")
I have only spent two weeks in the USA, but my impressions of what is responsible for the obesity epidemic are: 1. HUGE portions. Ridiculously huge. And cheap. I could eat less than half of most meals I bought, and yet they were costing me only a few dollars - about the price of a small sandwich in London. Crazy. 2. You can’t walk anywhere! American cities are designed for cars. Trying to walk anywhere you find yourself climbing over barriers and wandering through parking lots. And this was in California and Florida, where I believe people are more health-conscious than average for the US. I was told that these places _were_ pedestrian-friendly, for America! So, it’s not surprising, really. ---
**Author:** ![Colophon](https://avatars.discourse-cdn.com/v4/letter/c/f05b48/32.png) [@Colophon](https://boards.straightdope.com/u/Colophon)\ **Post date:** [July 16, 2004, 10:40pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/85 "2004-07-16T22:40:56Z")
> [@aruvqan](#): > > Dude, sod the heck off. SOME of us happen to be invalids, and I am sorry, I am eating as carefully as I can, but sometimes you cant really cut out any more food unless you want us to go on IV feedings…and they ain’t gonna pay for it, and it ain’t healthy for your guts to not ‘work’ on processing foods. Last time I had anything off my normal diet was a piece of wedding cake for my brother about 10 years ago. > > Again, sod off. > > wanker :smack: Again, I am not including invalids, so don’t get so touchy. This thread was kicked off with a story which included the stat that over 30% of American adults are obese. You can’t tell me that your situation applies to one in three of your countrymen. ---
**Author:** ![Boldface\_Type](https://avatars.discourse-cdn.com/v4/letter/b/b5e925/32.png) [@Boldface\_Type](https://boards.straightdope.com/u/Boldface_Type)\ **Post date:** [July 16, 2004, 10:56pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/86 "2004-07-16T22:56:12Z")
> [@Shayna](#): > > **Boldface Type** , while I appreciate your further research, your personal interpretations of the studies are rather meaningless, especially since you seem to be confused as to what, exactly hypo **thyroid** ism is and at least one of your sites doesn’t even state the numbers you claim it does. Which site? > [@](#): > > The study that you say considers obesity and hypothyroidism, does nothing of the sort. It talks about hypo **pituitarism** and hypo **cholesterolemia**. 1. Hypopituitarism is also known as Secondary Hypothyroid. 'nuff said? No, then see [here](http://cpmcnet.columbia.edu/dept/thyroid/) . 2. See Figure 2 in my cited article, titled ‘Prevalance of obesity in 654 adult patients with hypopituitarism…’. The title of the article is also a giveway, ‘Hypercholesterolemia and obesity in adult patients…’ Who was confused, again? > [@](#): > > You’ll also note that that study was done on people in Japan, not the United States. Apples and oranges. Only if you think that thyroid-related changes will lead to different behaviours in Americans versus Japanese. > [@](#): > > You weren’t the only one who made a comment of that nature, contending that obese people are that way because they overeat [I read as ‘pig’] Well, this is correct by definition - i.e., people are overweight because they overeat. You can feel free to tack on whatever value judgements you like though. > [@](#): > > Also, just so we’re clear, as I stated above, I’m certainly not saying that obesity is always and only caused by an underlying disease or medical condition. A lot of people are overweight because they don’t eat properly and don’t exercise enough. Yes, most people who are overweight fall into this category. It is easy to fall into this category because of way current Western industrial countries - especially the USA - are set up. > [@](#): > > But tens of millions of people suffering from diseases such as hypothyroidism and hyperinsulemia, such as what **phouka** suffers from, doesn’t strike me as “relatively few” whose weight problems are, in fact, due to underlying medical conditions. Proportionately, they are few - unless you have cites to suggest otherwise. Now, if people consider that their obesity is due to an underlying disease, then they can be screened for said disease(s) and - BINGO - treatment can begin if necessary. For those without underlying disease, then they might be offered assistance, but that ain’t assistance in curing a disease. It’s help in a social or psychological sense, help to bolster the fat folk’s will, if you will. ---
**Author:** ![you\_with\_the\_face](https://avatars.discourse-cdn.com/v4/letter/y/ecccb3/32.png) [@you\_with\_the\_face](https://boards.straightdope.com/u/you_with_the_face)\ **Post date:** [July 16, 2004, 10:58pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/87 "2004-07-16T22:58:08Z")
Medically speaking, obesity should be classified as a condition. It arises from a physiological imbalance and/or dysfunction. Maybe the state of being obese also causes physiological imbalance and/or dysfunction, but just being fat does not necessarily mean you will also have the other diseases associated with obesity, such as diabetes and coronary heart disease. But why get bent so out of shape over semantics? I get the sense that the OP is making more out of the word “disease” than is warranted. Labeling a condition a disease doesn’t imply that it is something that just happens to random folk on the street, without regard to behavior. Lung cancer is a product of cigarette smoking and is highly preventable. Calling it a disease does not diminish its preventability. by **Jodi** > [@](#): > > I don’t think we are required to blame obese people for their condition, or to refrain from helping them, simply by acknowledging that a significant component of that condition is, in the vast majority of cases, volitional action. There’s no judgment attached to this, but it is an uncontestable fact. So my chief concern with categorizing obesity as a disease is that by doing so, there will be a tendency to ignore the volitional component and overlook the healthiest treatments (in the majority of cases), which are diet and exercise, in favor of drugs and surgery, because drugs and surgery are how we treat disease in the West. I don’t agree with you. The categorization of obesity as a disease was probably done by the public health community to draw public concern to the problem, so that protective factors such as healthy diet and exercise could be promoted with some urgency behind it, and so that research into the causative factors of obesity (beyond the rather simplistic “eating too much” reasons) could be funded. Everyone knows that fatness is associated with eating more calories than one burns. But why is it so hard for those people who are fat to lose weight and maintain their loss? Why are we eating more calories in the first place? What things can society do as a whole to combat obesity? These are questions that may not be answered if society persists in seeing obesity as a product of a greed and sloth. > [@](#): > > The volitional component of obesity is also why I can see why a person suffering from an actual disease, without an immediate volitional component, would find it obnoxious to hear obese people complaining about their “disease.” I have had a serious disease and I have been (and am) overweight. My experience of the two is nothing alike and, when I was sick, I would not have appreciated having my illness analogized to obesity. But why? Having a disease is not a badge of honor or anything. If I got severely burned in an accidental fire, medically speaking, my trauma would be no different to the trauma of a man who purposefully set himself on fire. Obesity that is the product of factors beyond one’s control is the same condition as obesity that is the product of controllable factors. The underlying syndrome differs, but so what? Does that justify offense? ---
**Author:** ![Carbona\_Not\_Glue](https://avatars.discourse-cdn.com/v4/letter/c/3bc359/32.png) [@Carbona\_Not\_Glue](https://boards.straightdope.com/u/Carbona_Not_Glue)\ **Post date:** [July 16, 2004, 11:10pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/88 "2004-07-16T23:10:02Z")
All I know is that it’s going to be hard for me not to punch in the face the next person who calls me “chubby.” Okay, asshole–you’re welcome to my diabetes, as well as two types of medication that induce weight gain. You’re also welcome to being born a girl who was built like a linebacker with big breasts, shithead. ---
**Author:** ![Crafter\_Man](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/crafter_man/32/458_2.png) [@Crafter\_Man](https://boards.straightdope.com/u/Crafter_Man)\ **Post date:** [July 16, 2004, 11:11pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/89 "2004-07-16T23:11:49Z")
> [@pulykamell](#): > > Budapest was just like Paris. Almost every girl was a size 4 and hot. It was incredible. You just don’t see anywhere near as high a percentage of obese people in continental European cities as you do in America. The reason must be more to do with environment and lifestyle than genetics. I had the same experience when I visited New Zealand and Singapore. I was amazed at how many women had nice bodies. Then I came back to the states, and was visually inundated with a never ending stream of fat ass women. The bottom line is that a _ **lot** _ of Americans are fat. This is almost (98%?) entirely due to lifestyle choices. Americans eat too much, they eat the wrong kinds of food, and they don’t get enough exercise. ---
**Author:** ![Abbie\_Carmichael](https://avatars.discourse-cdn.com/v4/letter/a/49beb7/32.png) [@Abbie\_Carmichael](https://boards.straightdope.com/u/Abbie_Carmichael)\ **Post date:** [July 16, 2004, 11:16pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/90 "2004-07-16T23:16:26Z")
**Believe me, if someone invented pills that could take the place of food, I’d never put a fork in my mouth again.** Hear, hear. I may be fat, but I _hate_ food. Really. ---
**Author:** ![Unauthorized\_Cinnamon](https://avatars.discourse-cdn.com/v4/letter/u/bc8723/32.png) [@Unauthorized\_Cinnamon](https://boards.straightdope.com/u/Unauthorized_Cinnamon)\ **Post date:** [July 16, 2004, 11:30pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/91 "2004-07-16T23:30:49Z")
I have something to say to those who think, “just use some willpower!” is an adequate answer to obesity. I am pretty damn long on willpower. Despite the fact that I had untreated severe depression at the time, I forged ahead through three years of law school, which I hated, because I thought I should finish what I started. Graduated in the top third of the class, too. I had my baby naturally, without pain medication or other medical interventions, at a time when you have to actually fight the medical establishment to do that. I breastfed that baby even though I was bleeding from the nipples and was in horrendous pain for months, and it prevented me from taking an antispasmodic drug which would have dulled the pain of the Foley catheter I had to have for 5 weeks after her birth. (She just turned one, and nursing is fantastic now, btw.) And yet, until recently I assumed I was just a lazy jerk with no willpower, because I’ve never been able to lose weight. In fact, I never bothered to seek psychological help for my obesity, because I thought the way some people here seem to: obesity is an indicator of a deep character flaw, and if us fatasses would just stop being lazy and self-indulgent, we’d stop being the grotesque eyesores that we are. I’m now learning that my particular case of obesity results from many sources, from the simple biological and social clash \*\*gobear \*\* describes to the friend/foe syndrome \*\*Mayflower \*\* so eloquently detailed, to issues of sexuality, and more. It’s difficult to tease out the various motivations that are keeping me fat, but now that I’ve sought professional help for my head, my body is already starting to fall into line. Another interesting thing I’ve learned is that, while eating fewer calories will indeed make you slimmer, research has shown that \*attempting \* to eat fewer calories (dieting) usually seems to make people fatter. Clearly this indicates that psychological factors are terribly important in treating obesity. In the end, yes, I am the only one who can make the final decision about my actions. But having professional help, and realizing that my fat is not tantamount to a moral failing, has been essential in helping me control my actions. ---
**Author:** ![Shayna](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/shayna/32/17976_2.png) [@Shayna](https://boards.straightdope.com/u/Shayna)\ **Post date:** [July 16, 2004, 11:38pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/92 "2004-07-16T23:38:17Z")
> [@Boldface Type](#): > > Which site? > > 1. Hypopituitarism is also known as Secondary Hypothyroid. 'nuff said? No, then see [here](http://cpmcnet.columbia.edu/dept/thyroid/) . > > 2. See Figure 2 in my cited article, titled ‘Prevalance of obesity in 654 adult patients with hypopituitarism…’. The title of the article is also a giveway, ‘Hypercholesterolemia and obesity in adult patients…’ > > Who was confused, again? Well, maybe I’m just a dumbass, but I can’t find any of the quotes you provided on any of the sites you linked to, including here. I click the link in your #1 and find the following text: > [@](#): > > he New York Thyroid Center is dedicated to providing superior medical care and education for patients with thyroid disease. Our members research causes and treatments, as well as develop prevention programs for thyroid and parathyroid diseases. Founded by the esteemed pioneer in thyroid and parathyroid surgery, Dr. Paul LoGerfo, the Center evolved from a long standing thyroid clinic, which was established at Columbia Presbyterian Medical Center more than 60 years ago. Members of this clinic and subsequently the Center include endocrinologists, surgeons, radiologists, pathologists, and ophthalmologists who are leaders in the classification, treatment and identification of thyroid and parathyroid disorders. Their efforts also extend to the medical community so that the standard of care for all thyroid and parathyroid patients may be improved worldwide. Although our Center is based in New York, we provide a referral service to thyroid and parathyroid specialists across the United States. Which doesn’t say anything about secondary hypothyroidism or hypopituitarism. I dig further around that site and still haven’t found this so-called link. I even opened the link to the article on hypothyroidism in a new window and did a ctrl-find on hypopituitarism, and… nothing. You claim your previous link to the Japanese study says, “In this case, approximately 30% of hypothyroid sufferers were classified as obese.” Well, the only text I see when I follow that link doesn’t contain that content… > [@](#): > > Hypercholesterolemia and Obesity in Adult Patients with Hypopituitarism: A Report of a Nation-wide Survey in Japan > > Yoshio MURAKAMI1) and Yuzuru KATO1) > > 1. Department of Endocrinology, Matabolism and Hematological Oncology, School of Medicine, Shimane University > > (Received: December 24, 2002) > (Accepted September 5, 2003) > > Abstract: Dyslipidemia and obesity are common in adult patients with hypopituitarism. Possible contributions of age, sex and hormone deficiencies to hypercholesterolemia and obesity in adult hypopituitary patients were analyzed in 1, 272 Japanese cases based on a database of a national survey on adult hypopituitarism. In patients on routine hormone replacement therapy, 30.5% of male and 40.7% of female subjects were considered hypercholesterolemic. In univariate analysis, hypercholesterolemia was more prevalent in female, aged, untreated Gn-deficient and TSH-deficient groups. In multivariate analysis, sex of female, age older than 40 yr and TSH deficiency were the independent contributing factors to hypercholesterolemia. Obesity (body mass index (BMI) ≥25 kg/m2) was more prevalent in male, TSH-deficient and ADH-deficient groups. Severe obesity (BMI ≥30) was observed in high prevalence in the youngest group. These findings suggest that hypercholesterolemia and obesity were prevalent in different age and gender groups in Japanese adult patients with hypopituitarism. Insufficient replacement of thyroid hormone and possibly gonadotropin deficiency might contribute to hypercholesterolemia. In contrast, hypothalamic dysfunction as well as hormone deficiencies might play roles in obesity in these patients. > > Keywords: Hypopituitarism,Hypercholesterolemia,Obesity So I’m afraid I’m having a hard time following your sources and trying to learn anything relevant from the data therein. Although, why we’re even talking about secondary hypothyroidism to begin with, I have no idea. Nor do I understand this: > [@](#): > > Only if you think that thyroid-related changes will lead to different behaviours in Americans versus Japanese. I believe I linked to a webmd article above that listed quite a few causes of hypothyroidism, including an autoimmune disease, certain medications and (though not mentioned in my post, included in the article), lack of iodine in the diet. I’d imagine there are quite a few ways in which the American and Japanese lifestyle differs in regards to any or all of these issues, thereby affecting the number of cases of hypothyroidism and its propensity to cause obesity in the respective populations. But again, I’m not a doctor or a research scientist so I can’t say what those would be. I’m simply saying that there will certainly be social, medical and environmental factors that differ. And now we’re just getting into the minutia and losing sight of the overall picture. There should be no doubt that millions of people suffer from any number of underlying medical conditions, including the couple that have been mentioned here, as well as many others of which I am entirely ignorant, that can cause weight gain and obesity and the inability to control it with mere diet and exercise. Therefore, the tone and attitude that several people in this thread have exhibited is not only rude and insulting, it’s also based on ignorance of the facts. > [@](#): > > Yes, most people who are overweight fall into this category [overeating]. It is easy to fall into this category because of way current Western industrial countries - especially the USA - are set up. Most? I don’t know what you mean by ‘most’, but all I was answering was your contention that “relatively few” obese people have illnesses that cause their condition. One is not the same as the other. And millions of people with even the one disease I provided any information on is certainly more than “relatively few.” > [@](#): > > For those without underlying disease, then they might be offered assistance, but that ain’t assistance in curing a disease. It’s help in a social or psychological sense, help to bolster the fat folk’s will, if you will. How kind of you. ---
**Author:** ![Daisy\_Mae](https://avatars.discourse-cdn.com/v4/letter/d/46a35a/32.png) [@Daisy\_Mae](https://boards.straightdope.com/u/Daisy_Mae)\ **Post date:** [July 16, 2004, 11:38pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/93 "2004-07-16T23:38:34Z")
> [@Lord Ashtar](#): > > Methinks you didn’t bother to read the very first paragraph in the linked article. > > Underlining mine, obviously. > > Explain to me why my taxes need to go toward diet programs and stomach stapling for people who could lose weight if they would just start taking a short walk after dinner and stop eating a pint of Ben & Jerry’s every time they get depressed about how fat they are? > > Furthermore, how is it “defying medical science and wallowing in ignorance” to expect people to lose weight on their own? Methinks you don’t think past the very minute you’re living in. First of all, Medicare is (for the most part) for people over the age of 65. Yes, there are some people who have early Medicare due to disability but they are few and far between. As an RN who has worked with bariatric patients, I have found that most doctors will NOT accept anyone over the age of 60 as a patient for stomach stapling due to the rerouting of the intestines and other health risks. I seriously doubt that you’re going to see a surge of these bills that poor ol’ you will be paying for. Secondly, paying for the gastric bypass surgery would be FAR FAR cheaper than the bill you’d be footing to pay for their obesity related illnesses if they stayed fat. Heart attacks, strokes, knee/hip replacements, etc etc are not cheap and they are sure to come for the obese patient. When that time comes, should we tell them “Oohhhh no fat person with the stroke. You did this to yourself and Lord Ashtar isn’t about to pay for your health issue because you got yourself fat.” If so, you’ll be denying a lot of health care to a lot of people because MOST people bring about their own health problems in some way or another. Ohhh sorry Mr Car Crash victim, we can’t treat you because you were speeding and Lord Ashtar doesn’t want to pay for your mistake. You too Mr Lung Cancer man, you smoked so no treatment for you. Hey, I see you trying to sneak in there Mrs AIDS Patient. You should have thought twice when you were having sex. If that is how you feel, my sincerest wish is to get to take care of you someday in the trauma center where I work. I’ll be sure to treat you with all the sympathy and care you deserve. ---
**Author:** ![Zoe](https://avatars.discourse-cdn.com/v4/letter/z/a4c791/32.png) [@Zoe](https://boards.straightdope.com/u/Zoe)\ **Post date:** [July 16, 2004, 11:43pm UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/94 "2004-07-16T23:43:33Z")
I am always amazed at how much ignorance still abounds on the topic of weight gain. (Even one of our best moderators has been known to over-simplify.) If you look back at the original link, it is the AP reporter who makes the claim that Medicare has redefined obesity as an illness. That is not exactly what has happened. They have taken out the language which specifically says that it is _not_ a disease. That opens the door for examination of scientific studies to determine when obesity _is_ a disease and, I suppose, when it is not. One of the most common misconceptions is the idea that everyone is alike. “I did such-n-such and I know it works and therefore get off your butt and just do it and you won’t be fat.” People who think like that are just ignorant. Someone in my family had that attitude until she hit 35 and her metabolism changed. Oops! Another common misconception is that obesity is always about will power. I have enormous will power and yet I was obese. I once drank **nothing** but liquids for six months and lost all interest in eating. I would have continued to stay on the liquids but the doctor in charge thought that it was unwise. Besides, that would mean that as generations pass, we have less and less will power. That doesn’t make sense. Obsessive-Compulsive Disorders are psychiatric disorders which are considered illnesses by Medicare. If a man is compelled to wash his hands constantly, is that voluntary? No, not when he is _compelled beyond his control._ Sometimes OCD can be controlled with medication. Guess what. _Sometimes compulsive eating can be controlled with medication too._ The compulsion to eat is “broken.” The medication that I take is Topamax (Topomax?). It was originally developed for controlling seisures and the change in eating behaviors was observed as a side effect. It allows me to stop thinking about food. From some of the studies I have read, science also _generally_ now considers compulsive eating to be an eating disorder along the same lines as anorexia – not just a matter of will power either. I have two other illnesses which have being overweight or obese as a _symptom_. One is clinical depression and the other was originally called Stein-Leventhal Syndrome. Add to that my maternal family’s predispostion to being overweight. Finally, my food choices and lifestyle were not _consistently_ wise. I could take off the weight. (93 pounds on the liquids) But as soon as I had to start eating again, I could not control my eating. I became the junkie who was told to be satisfied with 3 fixes a day. I had been told at the beginning of the program that 95% of people who lose weight gain it all back within two years. Only when it has been kept off for five years is it considered permanently lost. I have “permanently lost” 130 pounds. In order to lose the weight and keep it off I had my stomach reduced to the size of an egg. _But that wasn’t enough._ I also had a a large portion of my intestines taken out. I lost half of my body weight. People did not recognize me until they heard me speak. Although I gained a few pounds back the first three years, I leveled off two years ago. The good news for even the smug, greedy, blatantly ignorant, non-reading, close-minded bullies among us, is that in the long run it will be a cost efficient use of your taxes. My risk for heart disease, stroke, diabetes, blindness and other illnesses has been greatly curtailed as has my need for pain medication. I won’t need that motorized wheelchair or the lift chair as soon as I thought that I would. Of course, without the surgery I probably would have died by now and you could have saved whole bunches of money! So terribly, terribly sorry. ---
**Author:** ![Jodi](https://avatars.discourse-cdn.com/v4/letter/j/7feea3/32.png) [@Jodi](https://boards.straightdope.com/u/Jodi)\ **Post date:** [July 17, 2004, 12:09am UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/95 "2004-07-17T00:09:06Z")
YOU WITH THE FACE – I agree with you that obesity is a condition. And I agree that it does in fact frequently lead to many diseases. > [@](#): > > The categorization of obesity as a disease was probably done by the public health community to draw public concern to the problem, so that protective factors such as healthy diet and exercise could be promoted with some urgency behind it, and so that research into the causative factors of obesity (beyond the rather simplistic “eating too much” reasons) could be funded. Well, as a general rule, I don’t think this is a great way to accomplish this. If we want to draw attention to obesity, or cover it as a condition that merits medical coverage, we should do that. We should not reclassify it as a disease (or provide that it may be classified as a disease) when it isn’t one. In other words, you change the coverage to include new things; you don’t try to shoe-horn new things into the definitions allowed by the existing coverage. If that makes sense. But I have no problem with obesity being considered a covered condition. I just don’t think it’s a disease. > [@](#): > > Having a disease is not a badge of honor or anything. If I got severely burned in an accidental fire, medically speaking, my trauma would be no different to the trauma of a man who purposefully set himself on fire. It obviously would be, because your trauma would not include having intentionally set yourself on fire, your therapy would not have to address why you would have done that, and your interaction with the world would not include the perception that you had done something self-destructive. And frankly, you probably would not appreciate your case being lumped with a bunch of other people who had set themselves on fire on purpose. > [@](#): > > Obesity that is the product of factors beyond one’s control is the same condition as obesity that is the product of controllable factors. If you mean “being overweight”, then sure – Person A is fat and Person B is fat. But if you mean in terms of _treatment_, then it arguably is _not_ the same condition. Person A may suffer from a purely physical cause of overweight – like, say, extended prednisone treatment – while Person B may suffer from a cultural/emotonal cause of overweight, lacking entirely in a physical causal component. In neither case is offense justified, but neither is announcing that the overweight itself, without more, constitutes a “disease.” ---
**Author:** ![Kallessa](https://avatars.discourse-cdn.com/v4/letter/k/7993a0/32.png) [@Kallessa](https://boards.straightdope.com/u/Kallessa)\ **Post date:** [July 17, 2004, 12:43am UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/96 "2004-07-17T00:43:39Z")
First I would like to thank all my brothers and sisters in obesity who have posted so elegantly on the pain of obesity and the contradictions inherent is dealing with it. Intellectually I’ve known that I eat primarily for emotional reasons for years, but in some ways that just made it easier for me to accept that I wasn’t worth the effort it took me to avoid the emotional eating. I’m learning to be compassionate, and am finding more reasons to modify my lifestyle than ever before, but it’s a journey. Next, I would like to point out that Medicare is only considering covering treatment for obesity, and that exactly what it may cover (drugs, nutritionist, specific weight loss programs, surgery) has not been decided. No one has declared that obesity is a disease, the government has simply recognized that there is a problem that affects a lot of people (and a lot more indirectly) and is now considering what role, if any, Medicare should have in addressing the problem. If Medicare does begin to cover some expenses related to obesity, private insuraces will most likely also begin to cover the costs, but they will be able to decide what to cover independently. The point is that diseases caused by or exacerbated by obesity are already costing millions a years. If my doctor suggested that I see a nutritionist to educate me on diet, and to help me create a eating plan that would lead to a sustainable weight loss in order to prevent me from developing diabetes or to bring down my blood pressure, isn’t that a better use of medicare or insurance money than treating me for the rest of my life for diabetes? Just like an alcoholic, some obese individuals may benefit from an in-patient program, and insurance often pays at least some of the costs of these programs for alcoholics. Insurance companies do this because they figured out that it cost less to get someone sober than it did to nurse them through a slow death as the liver fails and the disgestive system shuts down. Now someone is suggesting the same may be true for obese people–prevention is cheaper than treatment, what a radical, revolutionary idea. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 17, 2004, 2:04am UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/97 "2004-07-17T02:04:32Z")
Obesity is due to a mixture of poor lifestyle and succeptible biochemistry, just like 80% of illnesses. Haven’t you heard that most illnesses are stress related? Why aren’t those people chastized for not ‘adopting a low stress life’ while obese people are chastized for not ‘adopting a low calorie life’? With ‘lifestyle changes’ like proper screening, no tobacco, good diet and exercise 50% of cancer could be avoided. But people don’t do them and still get cancer. Why are these people let off the hook while the obese are harassed? [http://medicalreporter.health.org/tmr0197/cancer0197.html](http://medicalreporter.health.org/tmr0197/cancer0197.html) * * * In a comprehensive review of all the available cancer research in humans, the Harvard Center for Cancer Prevention, Boston, Massachusetts USA, has issued a report concluding that lifestyle changes could end at least fifty percent of all cancers and reduce cancer mortality by one-half. * * * I won’t even comment on AIDS. The point is most illnesses are due to a mixture of biochemical succeptibility and environment. Obesity is no different. As far as i’m concerned, this is just a cruel stereotype, to treat obese people differently than anyone with any other illness due to a mixture of lifestyle and biochemistry. Its proof of how deep our anti-obesity prejudice runs in this society. ---
**Author:** ![Snake](https://avatars.discourse-cdn.com/v4/letter/s/50afbb/32.png) [@Snake](https://boards.straightdope.com/u/Snake)\ **Post date:** [July 17, 2004, 2:12am UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/98 "2004-07-17T02:12:21Z")
> [@Kalhoun](#): > > It is an addiction just like **cigarettes** , alcohol, street drugs, or anything else that triggers a behavior that isn’t good for you. It is meaner than the other addictions because you can’t hide it. The addicts are under constant fire for it. It costs this country billions in lost time at work, medical bills, disability…the list goes on and on. We need to deal with it and this appears to be the only way to really put a serious dent in the problem. Right fucking on. Ok , fine , so lets treat it like a cigarette addiction. Lets tax the shit out of pizza, twinkies, ice cream, and food like that to help cover the medical expenses brought on by obesity. If ice cream was $15 a half gallon, I’d expect our chubby friends would cut way down on their habit. It seems to have helped a lot of people quit smoking. When the states get thier share of the billion dollar settlement from the Twinkie Institute, it can go right into Obesity Prevention programs. We can also use some of this money to buy back supports and special insurance for the unfortunate emt’s that hafta carry 800 lbs of gellatinous humanity out to the ambulance. I also think we can raise money for Obesity Awareness by having various Pay Per View specials. For example : take the parents of the 5 year old kid that weighs 200 lbs and sell chances to whack 'em with a stick like a pinata. I’d pay $10 to see a few hours of that. I’m also strangely curious to see what would come out. Maybe after that, instead of dragging their plump kiddies onto the Maury Povich show, they’ll start telling the kid NO when they want soda. While I do sympathize with the small percentage of people that do have a condition which causes them to be obese, count me among the group of ignorant, unfeeling assholes who don’t want to pay higher insurance premiums because Freddy’s _disease_ won’t let him live without his Tastykakes. Fuck Freddy. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 17, 2004, 2:13am UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/99 "2004-07-17T02:13:54Z")
> [@Wesley Clark](#): > > The point is most illnesses are due to a mixture of biochemical succeptibility and environment. That should say ‘biochemical succeptibility, lifestyle and environment’. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 17, 2004, 2:20am UTC](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449/100 "2004-07-17T02:20:10Z")
[http://www.recordonline.com/archive/2003/09/24/healthmain.html](http://www.recordonline.com/archive/2003/09/24/healthmain.html) She cites an American Academy of Family Physicians survey showing that 60 to 90 percent of illnesses treated by primary care doctors are caused or worsened by mismanaged stress. Among them are killers like cancer and diabetes. So consider that stress, proper screening, good diet, exercise, avoidance of toxins and an endless variety of other dangerous factors are under the individuals control, and all are huge factors in most illnesses. Why are these people not chastized? Why aren’t the 60-90% of people with stress related illnesses harassed for not ‘getting another job’ and told to suck it up when they say its hard to just quit and get a new job? This is a hypocritical prejudice directed against a socially inferior subgroup, plain and simple as far as im concerned. And i’m 90% sure nobody can **prove** it to be anything else. [Previous page](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449.md?page=4) [Next page](https://boards.straightdope.com/t/obesity-is-now-an-illness/255449.md?page=6)