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Walter M. Bortz II, M.D. Headshot

Dare to Be 100: Obesity Is Not a Disease

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Thirty years ago I was a member of the House of Delegates of the AMA. I am certain, in retrospect, that we passed some resolutions that were wrong. But nothing like the one that they passed in June. All newspapers headlined, "AMA declares obesity a disease." Translated, that means about 100 million Americans are officially diseased.

Just plain awful! -- was my reaction. Are nail biting, compulsive gambling, and homosexuality next on their list of "pathologies"?

The stampede has already begun. Wagons full of gleeful surgeons and appetite drug hucksters are heading towards the bonanza that this resolution has created.

A friend recently sent me an article from Time magazine April 20, 1934. The column title was "Fat and Drugs." It read, "no weight-reducing compounds in any form should be used unless the patient is under strict observation by a thoroughly-qualified physician."

The author was Dr. Edward Bortz of Philadelphia, my dad. The article specifically referred to the drug dinitrophenol, which was the "in" fat drug of the day. Quickly, the toxicity of this poisonous compound was discovered, only to be followed in quick order by a whole series of "beat your appetite" pharmaceuticals. The phen-fen debacle of a few years ago was only an echo of Father's remarks on fat and drugs.

What about surgery? To me, bariatric surgery is malpractice. In my view, reorganizing a fat person's intestines is akin to amputating the fingers of a smoker to help him or her stop smoking. It is tantamount to transplanting a new liver or two into the belly of alcoholics so that they will be better able to sop up their booze.

I confess to a personal prejudice on this issue, as I had a relative die after intestinal bypass. The real issue of course is that these addictions are rooted in behavior. Applying a surgical or drug remedy is an inappropriate effort to cure lifestyle and behavior.

How are we going to train millions of gut surgeons to cure this "disease"? How many chemical drug factories will need to be converted to accommodate to the next wonder weight loss drug?

The National Weight Loss Registry is a robust testimonial to the fact that obesity is best confronted without knives or pills. It can be managed by informed adjustment of lifestyle, plus supportive societal action. Enhanced physical education in school comes directly to mind. And remember that there were no fat people in concentration camps. And there's never been a single case of failure to lose weight when under tightly observation.

In 1968 I wrote an article called "Predictability of Weight Loss" in the JAMA. It reported my experience with dozens of overweight persons whom we studied in the metabolic ward of the Lankenau Hospital in Philadelphia supported by a major NIH grant, "The effect of diet on the metabolism of fat in man." The inevitable result of these dozens of studies confirmed that the First Law of Thermodynamics, energy in/energy out, is a sacred law, no exceptions allowed. Billions of dollars have been spent in the search for an exception.

If obesity is a disease that means that we must try to cure it vigorously. "It's not your fault. Let us take care of your waistline," (and wallet).

You can't change human nature, true, but you can change human nurture, which is where the real issue resides. Medical science is grossly uncommitted to pursuit of the actual causes of death: heart, stroke, cancer, diabetes don't kill. The antecedent behavior does. (McGinnis, Foege, Schroeder and many others) (1) But Zimmerman's Law insists, "Nobody notices when things go right." Medicine embraces its repair function, but far undervalues its prevention mission.

Don't medicalize behavior.

Don't try so hard to cure obesity. Prevent it!

1) McGinnis, Foege. Actual Causes of Death. JAMA.193;270:2207-2212.

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