#medicalize

[highlightersim]

Rushes To Medicalize 'Trans' Youth Against Expert Advice

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[greenpeugeot]

Obesity as a disease

In June, the American Medican Association declared that obesity is a disease (NYT article), against the recommendation of the committee set out to study it. When I posted the NYT article on facebook, my friend Casey, a public health student, said "my public health brain is exploding." It's a confusing thing, and there is much debate around it. It raises a lot of questions that we don't often wonder about: what is obesity, actually? And what even is a disease? It seems to me (a non-medical, non-public health person, but someone who thinks about this a lot in the context of my urban planning research on food access), that obesity is a risk factor for many things; diabetes, heart disease, etc, because obesity is, in many cases--but not all cases--a result of other unhealthy choices and behaviours. There are, however, plenty of people who eat right and exercise and and generally healthy even though they are overweight. What classifying obesity as a disease does, in the logic of the AMA, is push doctors to actively treat obese and overweight patients. This LA Times article says that "Studies have found that more than half of obese patients have never been told by a medical professional they need to lose weight — a result not only of some doctors' reluctance to offend but of their unwillingness to open a lengthy consultation for which they might not be reimbursed." So, on the whole, doctors in America have been failing their overweight patients, and so the solution is to reclassify obesity as a disease, to medicalize the shape of people's bodies, in order to get doctors to do their jobs well? Another point in these discussions is that classifying obesity as a disease means things for medical insurances, making it easier to cover obesity drugs and obesity surgery. This seems like a good move in the sense that insurance should cover things that doctors deem necessary and things that are important for people's health, but but when we know that poverty is one of biggest indicators of obesity, ill-health, and food insecurity, it seems like things like reducing or eliminating co-pays so that people are sure to get preventative care, and raising the amount of money for SNAP and WIC so that folks can eat better more affordably are two more effective things to focus on, rather than stomach stapling or pharmaceuticals. As Dr. David Katz points, out, obesity is being declared a disease just as the FDA approves the first anti-obesity pill. "Drugs need diseases; diseases need drugs." And lastly, there is also the question of stigma. Some say that obesity-as-disease reduces the stigma attached to being overweight, just as our deeper, medical understanding of depression reduced the stigma around that. Others say that the stigma will be reduced because it upsets the widespread view that people are only obese because they are lazy overeaters (this idea is put forward in that first NYT article I linked to). I'm more inclined to side with the opposite idea, that medicalizing obesity increases the stigma by categorizing all obese or overweight people as diseased, even when they are healthy. This way of talking about obesity strikes me as misguided, causing us to put emphasis on the wrong things, such as drugs; embarrassing, if declaring obesity to be a disease is proposed as a way to address the problem of bad doctoring; and regressive and conservative: we don't need to medicalize obesity, we need to politicize it.