Written at the request of Alex "Mephysteaux" Reiff in response to the AMA's recent awarding of "disease" status to obesity.
Before I get into why obesity is not a disease, it should be known that the AMA itself admits that their reclassification is a pragmatic action aimed at altering the popular perception of the condition, as well as the methodology of its treatment by the medical community. This is a purely social/political/economic matter, which will undoubtedly be exploited from every angle by those institutions whose profit can be superficially linked to "health". There is no biological merit to naming it a disease, so if you take that position, please understand that you are wrong.
Obesity is the condition of exceeding the government dictated weight which corresponds to one's height, gender, and age. Proponents of both sides of the [disease/not] argument agree that the BMI is an archaic and inaccurate tool with little to no contemporary application. There is a great deal of support for rewriting the standards for obesity, often with the proviso that any such classification should be based on adiposity, rather than gravitational force. The idea that any such classification is arbitrary, however, seems to have escaped most people.
Obesity is a co-morbid condition of many afflictions, and a risk factor of variable, but imprecise significance for others. The endocrine system works through cyclical biofeedback loops, not linear causality chains. The most often cited link to disease is that obesity [sometimes] increases the risk of insulin resistance, which can lead to Type II Diabetes. There is a rarely mentioned, but equally relevant counterpoint that insulin resistance can lead to Type II Diabetes, which predisposes one towards obesity. No one is ever concerned with the second scenario, probably because Diabetes is a disease, and obesity is a product of collective imagination.
The premise for labeling this state of being as a disease is based upon:
1. The false attribution of causality in circumstances of coincidence
2. The baseless emphasis given to one observation over all others
3. The equation of visibility with significance
4. The deliberate negligence of American medical schools
1. There is much media attention given to diseases which the obese seem to suffer at a much higher rate than the rest of the population. Adipose tissue is always the culprit. Heart attack? Your fat needed too much blood. Cancer? Your fat secretes pro-inflammatory cytokines! It never occurs to anyone that there is an underlying problem; the blame always rests with the fat, regardless of where its production came about in the biofeedback cycle. Very high stress environment, skyrocketing cortisol levels, insomnia, etc. may have contributed to both a person's adiposity and their infarction. Fuck investigation, though; he was fat, and that was the cause of everything that ever went wrong in his life. Case closed.
2. Single condition correlation statistics are less than useless; they're counterproductive, and their abuse is borderline criminal. The problem with scientifically relevant data and responsible research is that they rarely yield sensational values. If you're 60 times more likely to have a heart attack with a BMI over 38, it makes for good television. If you add in all those other pesky variables, like age, activity level, diet, stress, sleep patterns, geography, medical history, pre-existing conditions, genetic disposition, et cetera, you may discover that he's no more or less likely to have a heart attack than someone with a BMI of 25. Fuck that, change the channel. Be aware that breathing air and drinking water are habits often observed in people diagnosed with cancer. Better cut that shit out.
3. The importance of spectacle. The fundamental piece of social knowledge familiar to every Italian. Fat man on an operating table can only be there because he's fat. Just look at him! Magic Johnson has AIDS. Nah, he looks fine. We entrust our medical professionals to discover and treat our ailments. We trust that countless years of school and residency have imparted in them the ability to see what may not be readily discernible to the rest of us. It's awfully presumptive of me to make the claim that fat people don't go to the doctor to be told to lose weight, but I stand by it. "Losing weight" implies that weight loss will treat/cure/attenuate whatever ails the patient. This is wrong. Just like "obesity" is not a disease, "lean" is not an indicator of health.
4. Taken alone, weight loss/gain has very little to do with health. It's the means by which we achieve the ends that matters. Every sort of benefit and reduction of risk factors is attributed to "weight loss", while the diet and exercise employed in pursuit of weight loss is the actual mechanism by which hormones become regulated, and quality of life is improved. There is no incentive to teach basic nutrition and exercise science in medical schools, because these institutions function as little more than shill factories for the pharmaceutical industry. The physicians are not to blame; we should not hold someone accountable for knowing what was deliberately withheld from them. If medical schools taught nutrition, our current system of government-subsidized industrial agriculture might be called into question. Cut into the profits of Monsanto AND Pfizer AND McDonald's? Sounds like treason to me. Whose side are you on?
Despite my reputation for being an uncompromising tyrant with impossible expectations, I must declare that the obesity epidemic and subsequent controversy is not meditated by personal responsibility. I encourage everyone to learn and grow and live to their fullest potential, but I do not expect that all, or even most people will follow my advice. To be clear, I am a trainer, not a politician; my policies apply specifically to dedicated volunteers, not to the population at large. I can expect my trainees to learn the fundamentals of nutrition and fitness, because this knowledge is vital to the achievement of their goals. The American education system, however, doesn't place much emphasis on health. The media, even worse, obscures and manipulates the reality of health, and uses the allure of "fitness" to pair empty minds with empty wallets. We have no idea of what comprises the garbage we call "food", and no impetus to search for actual food, which is comparatively expensive, bland, and time consuming. No one blames a lab mouse for pressing the food lever and becoming obese. We've deluded ourselves into believing that social pressure can somehow replace our animal mechanisms of survival; that biology can be subordinated at will to our whimsical fabrications. Hubris indeed.
The title of "disease" removes the trainer and dietitian from the picture, removes the incentive to improve oneself through natural means, and encourages a mentality of victimization and helplessness. Not to fear, however, as your government sanctioned drug dealer will come to your rescue with a magic pill. It won't be magic, however... there will be side effects, recalls, and profiteering. At least you can rest easy that the official autopsy will blame obesity for your demise.
