Please look at table 2 here:
You will see that people in Obese Class 1 (BMI 30-34) live longer than normal weight. I realize that the people in Obese Class 1 use more health care resources (partly because they are living longer!). However, I am having a hard time seeing this as a big problem to get into a moral panic over.
P.S. On #81. I’m not saying to ignore overweight as a health issue. I’m just trying to give some perspective.
Since we don’t know how to reduce weight except by surgery that has some significant co-morbitities, I’d be willing to look at other ways to reduce their burden on the medical system, such as less use of specialists.
Learn something every day.
I met Constantina Ditta, the gold medalist in the Beijing Olymics’ women’s marathon. I shook her hand (it was like shaking hands with a bird) and asked her how many miles she runs in a week. 140.
She couldn’t have been thinner. What do you think is the cause? I am going to go with all the exercise she gets.
I know some people disdain the first-person-successful-weight-loss subjective view, or the look-at-what-thin-people-do-and-imitate-it view. But if you are obese, take more exercise if your body can handle it. If you eat so much that it overwhelms what you burn in exercise, then you either have to exercise still more or eat less/better. If you exercise like crazy and still gain weight, maybe you have an eating disorder, or maybe one of a list of obesity-causing circumstances is in effect.
Maybe science will find the secret to impulse control and will develop the Prozac for obesity. But really it is pretty simple: obese people should exercise more, and take a look at their diets.
Your entire post here assumes that obesity has the same cause. Same problem and still a straw-man. And now you are moving the goal post by stating “sustained weight reduction”
By the way you structured your claim, the only thing that I can prove is that although there are genetic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities.
Are you seriously suggesting that if you take in less calories than you burn that you will not lose weight? I cannot provide any cite that demonstrates anything you have claimed unless it addresses the reason a person consumes more calories than they burn. People are not obese because of obesity, there are root causes. In most cases, if you could remove all extra weight from them in one step they would still become obese again unless you address the underlying cause, be that medical or psychological.
How about you come back with a) a challengeable assertion. b) quit moving the goal post.
Bariatric surgery evaluations include a psychiatric consult, and this is the major stumbling block when it comes to being approved or denied.
Obesity, or anorexia for that matter, can be a very complex issue, and psychiatric issues are only one factor.
Where did I say that everyone who is obese has a mental illness. Is “behavioral therapy” not under the auspex of “mental health?” The behavioral therapy lower disinhibition scores are exactly what I am talking about and are a direct refutation of Spiritus Mundi’s moved goalpost.
I are not talking about shoving people in rubber rooms or using pharmacology, I am talking about teaching people to identify feelings and triggers and giving them coping skills through a blend of cognitive and behavioral therapy.
CBT is an example of one possible tool, and not the only solution. It allows people to see their behaviors for what they are, not as a blur of emotions. It similar to Optometrist handing you a pair of glasses, although it requires a lot more work.
No - please read carefully and then show where I have made any such assumption.
Absurd. Sustained improvement a necessary component for determining whether a treatment has been effective when dealing with a chronic condition. In a thread predicated upon a deiscussion of long-term societal costs you declare long-term evaluation to be moving the goal posts.
You might as well argue teh benefits of bloodletting and induced vomitting. Those both yield temporary weight loss as well.
I have said exactly nothign about caloric intake. You are debating a figment of your own making.
a) My assertion was simple enough. It requires no change.
b) Quit pretending that when your argument fails it can only be because someone has changed the rules.
Looking at that article I think you are misunderstanding it.
There was* no* statistically significant difference in life expectancy between those with “normal” BMI and those with BMI of 30 to 34.9 (Obese Class 1).
What that article did determine however was that those with Class 1 obesity spent a significantly greater proportion of those same years *in poorer health *- the health adjusted life expectancy index (HALE), based on losses in health related quality of life (HRQL), more so in females than in males.
The increase in resource use is not because they are living longer, they are not, but because they are sicker for much more of their lives.
No need for a moral panic but not something to whitewash over either.
You know what? Debating what you meant to say and dealing with your misstating what I and others have said is of zero interest to me.
How about going over what is apparently agreed upon?
Obesity in the general case is not best thought of as a mental disorder even though some obesity is the result of mental illness and obesity can worsen some mental illnesses, and even though obesity is the result of behaviors.
There is likely a subset of the obese whose obesity is best treated with one or another form of therapy, especially if we are using a broad definition of therapy.
For most, not all, of the obese the brain differences and changes that seem to drive the behaviors and that are involved with the body’s responses at various levels to resist significant change in weight seem to respond best to decreasing hyperpalatable and low satiety foods and to exercise. There is however variation in how different people respond. CBT protocols seem to focus on achieving those behaviors of healthier eating and more activity including problem solving skills and working on decreasing impulsiveness in regards to these behaviors and while the evidence to support them is not very strong the logic behind them is reasonable.
Any one disagree with any of theat?
I used the data of someone whose approach I disagree with. That makes their data a smiggen more believable than if I took it from someone I did agree with.
For males and females taken separately, it was just under. If you combine male and female, which they didn’t in Table 2, it is clearly significant, with the Class 1 obese living longer. Of course, I’m not suggesting that normal people try to become Class 1 obese. Aside from that most long-term normal weight people couldn’t do it if they tried, it would, if it could be done, cause more diabetes. The reason I cite the life expectancy evidence is to suggest that obesity may have pluses and minuses and shouldn’t be treated as one of the great moral, or other, issues of our time.
Here’s one reason:
The health effects of discrimination against fat people
Aside from out and out discrimination, obese people do have medical conditions which they often seek advanced specialist treatment for, making them worse. Because obese people get more back pain, they get more unwise spine surgery. Then there is all the iatrogenic illness coming from weight loss surgery, as documented in the AFAIK only study of bariatric surgery long term outcomes not marred by large losses of patients to followup:
Going back to the OP:
As to whether “obesity [should] be treated initially as a mental health issue,” the answer is: Not at this time. That because there is no psychological or psychiatric treatment for obesity proven to work long-term (10 years plus). I can’t prove a negative, but it seems to me that given the massive number of behavior-oriented weight loss studies, evidence of absence here does equal evidence of absence.
In theory, I think a drug treatment could work. And because of the obesity comorbidities it might be worth it even if the safety profile was slightly imperfect. However, the amount of time – greater than five year followup – it takes to distinguish between long term weight control vs. a pattern of yo-yoing every few years doesn’t fit well with the US FDA Phase 1/2/3 system.
So, for now, the best approach is probably to squash the moral shaming which we’ve seen at the same time obesity has risen. Then substitute calm and conservative primary-care-focused medical management.
Although my emphasis is different, I am OK with your last post 
Two reasonable and well expressed posts in a row. Thanks to both of you.
Cite? That is not what i have heard in my 6 + years on bariatric patiënt forums in the netherlands an Belgium. What i do know is that health insurance compagnies fight tooth and nail to deny applications for surgery. Which is shortsighted, because the net costs for surgery comparered to the net cost for obesity related illness for the insurance company itself is about even and the net costs for society are lower.
Maybe the insurance companies use the psychologic evaluation to deny claims, as there is usually no denying the bmi itself.
Dseid, do you have cites per surgery type? The lapband was the standard surgery 15 years ago, but doctors now choose it less because of the high complication rate.
This is the best I can find.
The number one long term comorbidity, according the full-population study of obese Pennsylvanians who did and did not get bariatric surgery of whatever type, is suicide. Whatever complication surgeons consider when changing surgical procedures, it isn’t that. Most likely they are just looking at a relatively short period after surgery during which patients come back to them, rather than in out-years where cardiac and psychological conditions become the bigger concerns…
One way to think about this: Suppose that there was a proposed diet pill under study that had the same safety profile as the safest weight loss surgery. How much chance is there of that drug getting US or EU approval?
One thing I don’t understand: Why don’t the insurance companies, and European health authorities, require a couple years trial of one or more of the approved drugs prior to surgery? These seem much less often prescribed than surgery. Perhaps it is because there were older drugs that were taken off the market, souring patients on the idea of weight loss drugs. But it may also be because there is more money in surgery.
Obesity rates exploded in America in the late '70s and early '80s. It’s been increasing worldwide for years. If obesity is linked with mental health, then everyone is going crazy? Or obesity makes you crazy?
Either way, I can believe it.
I’ll blame widespread ennui from post-industrial capitalism. Pass the mac & cheese.
Philly Guy,
Um no. There are long term studies easily found.
Indeed though while overall death rate was down, led by a decrease in deaths associated with diabetes, the much smaller (not number one, heart disease was, followed by cancer) subsets of deaths from suicide and accidents increased. Not a randomized study so for both the decreases and increases selection bias can be confounding factor. Were those who chose gastric bypass more motivated to otherwise live healthier lives? Otherwise fitter? Were they more psychologically impacted by their obesity such that chose to take a surgical approach (and those actually more prone to depression and such)? Hard to know if either or both may apply. I can certainly imagine that some had held weight loss as the cure for how miserable they felt with themselves and were all the more depressed when they found that losing massive weight did not make them happy either.
An interesting study looking a huge data set of severely obese individuals found a gain of about 6.7 years of life expectancy at a BMI of 45 but as BMI approached and past 62 “nonsurgical treatment was associated with greater life expectancy”.
As far as the approved drugs go, you do have to realize that their impact is modest. The most effective of the bunch is Qnexa which leads to about a 10% weight loss at a year which is only partly maintained with continued use. Now again, a sustained weight loss of near 10% may be enough to significantly improve health, especially if coupled with improved nutrition choices and fitness … but that reasonable goal is not so out of reach for many without drugs or surgery. Not in the range of weight loss that bariatric surgery accomplishes.
I agree with the OP as long as we’re not saying that obesity is only or primarily a mental disorder.
There’s stacks of data showing that different people have different appetite levels, their bodies have different predispositions to storing fat, different levels of fat hormones, different intestinal bacteria etc. And these factors are gaining more and more weight (pun not intended, but welcomed) in the scientific community.
So although lots of people – especially on the dope – like to see it as a “people with self-control” vs “people without self-control” issue, it’s really not that simple.
And I’m not saying that to make excuses.
In fact, I’ve always been slim, despite largely eating when I want, whatever I want. Heck, I’ve tried to bulk up in the past and been unable to. That’s why I’m confident in saying “willpower” is a small part of this.
I’m going to have to look at your studies more carefully. Do you have a hypothesis why Pennsylvanians, from all bariatric surgery practices, at first glance, do so much worse than that one big Utah practice?
Well if you’ve offered the link to your cite I have missed it, so my best hypothesis is that you are misunderstanding what the Pennsylvania study found.
The only thing that I can find that you might be meaning is this one from PA and that did not make the claim you made … it did not look at all causes of deaths or try to determine what the “number one long term comorbidity” was … it found the same thing the Utah study did: more suicides in those who had bariatric surgery than in those who did not (with the same inability to determine if choosing the option is a marker of risk or a contributor to it).
And this onein Pennsylvania comparing to the general population that found this population had more heart associated deaths and more suicides but not that suicide was number one, heart disease was, several fold higher: