I have heard and felt the rumblings of discontent with the recent decision by the AMA to label obesity as a disease. I know that many think of obesity as a reflection of poor choices, a lack of personal responsibility and a condition of the lazy, apathetic and unmotivated.
I understand the frustration with this condition that is costing our health care systems billions of dollars. America, after all, is the fattest country in the world, with obesity rates at 36 percent of adults, according to the CDC. My surgeon friends complain that they cannot effectively operate, the internist seems to play an endless game of rotating blood pressure, cholesterol and diabetes medications, while our pediatricians have been forced to join the conversation, screening young children for hypercholesterolemia and early puberty due to excessive weight.
In my busy integrative practice, obesity presents in varying forms and wearing different circumstances. I have learned that obesity, like many other conditions, is an individual story for each patient. Much as cancer care has to be personalized based on genetics and risk factors, obesity also needs to be seen as a disease resulting from a complex interaction of unique factors for each patient.
The advantage of an integrative practice is the gift of time with patients. In hearing my patients' stories, I have learned that obesity is ultimately the consequence of a series of poor choices, but that those choices are rooted in more complex health issues. It is a vicious cycle of not feeling well, trying to find a way to feel better, resorting to food to feel better and then not feeling well again. We know that for every 20 pounds of excessive weight, there is a significant drop in energy, ability to move, and lowered self-esteem, leading to worsening depression and anxiety. Imagine what happens when weight gain approaches 50 or 100 pounds.
I believe the rampant obesity in our country is the result of five primary issues; diets mismatched for genetic types, depression and anxiety, stress and the hormone shifts that stress will create, sedentary lifestyles and environmental toxins. Beating obesity may improve with increased physician awareness and creation of patient education models, but will not improve until each patient is managed individually. The role of the physician should be to identify the main cause of obesity and assist the patient in navigating the transition from knowledge to action.
Labeling obesity as a disease may be a start in at least acknowledging the complexity of this particular condition, but it will not solve the obesity crisis. For the majority of patients that are obese, depression and anxiety are the root of erratic eating patterns and poor choices. It is hard to get someone isolated from family, living alone, or stressed financially to focus on healthy eating and healthy lifestyles. Fast food, easily accessible and cheap, becomes a more realistic option, but furthers nutritional deprivation. Existing nutritional deficiencies aggravate feeling "bad" and the cycle continues. I have seen patients "wake up" from a depressed or anxious state after simply correcting a few key nutritional deficiencies, more motivated to exercise and eat well.
The beauty of our country is the mix and melting pot of different ethnicities. This melting pot, however, makes health care challenging. Many patients are placed on "diets" that are not good fits given their genetic backgrounds and hormonal patterns. Emphasizing whole grains in the African-American, East Indian and Hispanic population is a recipe for further frustration with obesity. These cultures were not originally grain-based, so the standard American diet is a very poor fit.
The American lifestyle -- television, video games, and limited opportunity to walk and move -- is a factor as well. Again, it is hard to get anyone to change these behaviors until they mentally feel ready to do so. Environmental toxins are a similar story. They are rampant in our food, water and air, yet very difficult for the average consumer to control.
Solving the obesity crisis requires a team, focused on the individual patient, finding the triggers for a-motivation and creating a plan for success. The physician should be at the center of that team, assessing and understanding the inner workings of each patient. The emphasis on movement, food, and environmental toxins should continue, but in a way that is ultimately stream lined for each patient. We do need the food industry to shape up, physical education back in our schools and government programs that incentivize weight loss. The most critical piece of this American health challenge will be the physician, leading the patient on a journey towards optimal health, and guiding the patient towards realistic programs that support the physician patient goals.
Obesity as a disease is a tentative first step, but much work remains in revamping the medical approach to these patients and creating a culture to support weight loss. Obesity is an American health challenge; lets not make it an American story.
Dr. Taz, the living healthy doctor, is an integrative health expert, medical director for the Atlanta Center for Holistic and Integrative Medicine, and Prevention magazine columnist and contributing editor. She is author of What Doctors Eat, and focuses on preventive health, women's health and pediatric wellness.
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