About 1/3rd of Americans are obese and another 1/3rd are overweight. If you meet any random person on the street, it’s as likely they are obese as that they’re a healthy weight.
Contrarily, how many people do you think subscribe to the “don’t tell me my obesity is causing my medical problems” and “basic concepts of metabolism don’t apply to my body”?
1%? 0.1%? Lower? I guess I don’t often talk to people specifically about their obesity, but I’ve never met anyone in real life with bizarre attitudes like that. Just a handful of Internet people.
So I don’t think we need to treat obesity like a mental disorder just because of a few crackpots. Mental health counseling may be helpful to understand reasons for over eating, but that’s a far cry from making it the primary treatment or assuming the obese are delusional.
It sounds a lot like making me seek therapy for astigmatism just because a vocal bunch of crazy people start posting on the Internet that Obama causes it.
What I am saying is that there is no linear relationship between mortality and or morbidity and BMI.
Morbidity rates do affect social and medical care costs.
Even IF for instance (as is suggested by the conventional theory) that obesity necessarily causes increased ill health and hastens death in a linear fashion then there will be a paradoxical effect on costs in many ways.
IF someone drops dead of an MI at fifty ?because of obesity, all future medical costs are nil.
IF a lean person remains fit until they are ninety ?because of their leanest, they may require long term hopita’isation and social care, and the longer the remain ill but not dead, the greater the cost will be.
The situation, both human and financial, is complex and no one has shown it to be linear or simple in any way.
It s the case that there is not a linear relationship between BMI and morbidity and mortality.
There are many complex relationships but these depend on many factors- previous history, personal attributes such as genetics, disease process considered, medical treatment, interaction between different disease process and so on.
I am not denying a relationship, just tat it is neither linear nor unidirectional.
It is certainly controversial, but it applies to overall mortality, as well as to various specific diseases. And if such a large fraction of “normal weight” people are only that light because they have some underlying illness that led to weight loss, one has to wonder how “normal” was defined.
In contrast, there are clear health and morbidity costs to being extremely overweight. But, as pointed out above, even if this is partially a mental illness, it is not one we have any effective treatments for, so there wouldn’t seem to be much benefit in treating it as such.
My opinion is that Americans are overweight more because we don’t exercise much than because we eat “too much”. We didn’t evolve in a world with abundant calories and little need to exert ourselves physically, and we aren’t very well adapted to it. Like most adult mammals, we are physically lazy by inclination. And in the pre-industrial world, most people faced some risk of famine, and carrying a little extra fat was adaptive. Neither of those traits are very adaptive in the modern world, but it seems unlikely to me that ordinary overweight or mild obesity are driven by “mental illness” as it would seem they are a natural consequence of putting humans into a high-calorie, low effort world.
Of course, it’s much easier for most of us to gain weight than to lose it, and it seems reasonable for doctors to urge their patients to maintain or reduce their (high) weight. I’m dubious about the movement to accept all weights as okay. I just don’t think there’s much value in a push to get overweight or mildly obese people to take extreme (or extremely unpleasant) steps to reduce their weight.
How many of the subjects died before the end of the trial. Were they excluded or were their medical costs averaged over the full term of the trial?
How many of the > 30 BMI were >40 or >50? What was the result for just those between 30 and 40. I ask this because there is evidence that rates for severe obesity skew the rate for obesity.
How much did physician belief about fears of health problems with obesity affect their treatment programs- were obese people were more likely to be placed on BP or other prophylactics for heart disease, and likely to receive treatment aimed at weight reduction because of the received view.
I have no doubt there is a general cost to obesity but it is neither simple nor linear.
There is certainly merit in looking at mental health and also societal norms and pressures in the overall evaluation of the person’s overall health and well being. So to your question
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should obesity be treated initially as a mental health issue?
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Such a initial treatment should not be ruled out, but considered on the basis of the initial evaluation.
All right, we both kind of win here. Anorexia causes an acute crisis and is responsive to mental health treatments. Obesity is a chronic condition that statistically over a population leads to higher health care costs, but not necessarily in a specific individual.
I think the comparison to the weight/body image disorder anorexia fails, but I agree with you about population-wide costs associated with obesity.
I don’t think I need a cite for the claim that motherhood causes a lot of women to gain a lot of weight. Just look around and the correlation practically jumps right out at you. So here we have an example of something other than mental illness/bad habits leading to a higher BMI. Shouldn’t we at least conclude that obesity is not exclusively a mental health issue, but can arise from other factors?
I accept your correction on “crazy”, sorry about that. Mental health issues carry a stigma and I’m not helping. Here’s an example in your favor to make it up: the Freshman 15. Girls go to college, they stress out and can’t wholly cope, and they often gain weight. They aren’t crazy at all, but you could say they are suffering from an induced mental disorder that might respond to some counseling.
I don’t think we can come up with a single cookie-cutter diagnosis for all cases of obesity.
Funny, that. I plugged my maximum weight and my current weight into the BMI calculator. At my max I came darn close to 30, but not quite.
I started an exercise program and have stuck with it, on and off, for years. I haven’t paid too much attention to diet, maybe cleaning up what I ate, but probably eating more if anything. Now my BMI is solidly normal.
Question is: do I have an irrational belief that exercise drives weight loss? Does it rise to the level of a mental disorder, such that the question works both ways, leading to normal weight in some cases and obesity in others? And how do we explain all those skinny athletes?
My suggestion was that you do more research; more specifically I was suggesting that you review the current scientific analysis of weight loss. Due to the fact that you are relying mostly on personal anecdotal and observational analysis, it does not appear that you have done that - nor does it appear that you consider my suggestion of having a broader base upon which to form your opinion is something you are particularly inclined to do. So be it, to each his or her own.
I’ve come to firmly believe that weight issues are mostly caused by having a victim mentality. I put myself squarely in that camp, too. By having a victim mentality, nothing is our fault: “I have a medical condition that made me gain 100 pounds”, “I’m so busy I don’t have time to exercise, that’s why I can’t lose weight”. It’s all excuses and bullshit.
There are so many ways to excuse your poor choices to make it seem like it’s not your fault. I’ve always tried to be a bit easy on myself and be gentle when I screw up and if I eat a bag of chips when I’m not even hungry and often already full, I say to myself “oh well, you had a rough day”, “you did good all week, it’s ok to have a treat”, “you have your period”, “it’s raining”, “it’s Wednesday”. I convince myself that all of those things are out of my control (poor, poor me) and so eating like shit isn’t my fault. I am a victim.
Even the way I have been eating healthy is like a victim. I meticulously measure things like butter or salad dressing. My afternoon snack is 12 almonds and 4 dried apricots. I don’t even trust myself to know how to eat. I have to get out my measuring spoons, measure out 1 tsp of butter and scrape it over two slices of bread for my meager sandwich (poor, poor me). All of it sets me up to “deserve” a treat, which turns into a binge. But I had a rough childhood and that’s why I over eat (poor me, I’m such a victim).
About a month ago I realized this and decided to cut the crap and own up to my choices and stop being such a victim. I don’t measure anything or count anything. We have to learn to trust ourselves. We know what to eat and we know what not to eat. I lost 70 pounds a couple of years ago. I don’t know how I managed to keep it off with the mindset I’ve had. But since stopping the bullshit I’m down 3 more pounds in two weeks. I say to myself about a billion times a day “cut the crap” and “suck it up buttercup”.
So anyway all that was to say that, yes, I do think mental health plays a big role in obesity.
Obesity in it’s self is not a mental disorder, but it may be a symptom of a mental disorder.
Just as ‘lack of focus’ is not a disorder but may be a symptom of ADHD if it rises to a level that causes either suffering or an impaired ability to function in ordinary life.
I am not obese but I also have to intensely remind myself that skipping a can of soda (138 calories), that I do not get to add a couple of extra slices of cheese (226 calories). So I can empathize with you.
Best of luck in your battle, I would say that mental health does play a role and this is why binge eating disorder was added to DSM-5 to cover cases when it does rise to the level of a life impediment.
This does not mean you or anyone else is “broken” but should be encouragement that the mental health industry is seriously trying to work on diagnosis and treatment.
I never said exercise does not help you lose weight; that’s not even something that is called into question. I believe it does help lose weight, the question was what is the MAIN reason, or largest contributing factor to losing weight. It it the main reason? Is it 50% diet, 50% exercise? I don’t know what it is, I am not an expert in this area - but I do have a difficult time believing weight loss/gain is not at least 50% diet related.
The article you cited does not seem relevant to this question - and I could not find any specific scientific studies that were cited in the article that addressed this.