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Obesity, as a disease?

How many times have you seen the doctor and have been told, you need to lose weight?  How many times have you been told the other problems you are having are related to your weight, and if you lose weight, you can help fix these problems?  How many times has the obesity been treated instead of the co-morbidity?

This is the question many doctors and patients are starting to ask.  With obesity on the rise, even in our children, why aren’t more things being done to treat and prevent it?  Also, why aren’t more insurance companies paying for the diagnosis?  One of the answers I believe is the stigma associated with obesity.  Another reason may be they don’t want to hurt a patient’s feelings.   Obesity like other diseases has a genetic factor, you see families that are obese and are raising obese children.   These same families also have diabetes, hypertension, sleep apnea, and heart disease to name a few comorbidities that most likely “run in the family.”   These comorbidities and others all have medical interventions to treat the disease.  Although we have medical interventions for obesity, they are not covered well by insurance the majority of the time, if they are covered at all.  In our country we consider smoking, drug addiction, and alcohol addiction all diseases that are treatable.  We don’t tell the person, you just need to stop using, and expect them to quit and be treated.  So, why do we expect to do that to the obese?  I know I have raised a lot of questions, probably more that even the experts can answer, but I am going to share my “perfect world” in which lies some, but not all of the answers.

We need to start with our school children, for the first time the current younger generation have a lower life expectancy than their parents.  Adolescents are on blood pressure medication and diagnosed with Type 2 or adult onset diabetes.  To help this we need more fruit and vegetables to be available in student cafeterias.  Less soda pop, high carbohydrate juices, and chips and candy should be available.  We need to teach our children to play outside, and go with them and do it.  I swung on a swing and went off a diving board for the first time in close to 20 years a couple weeks ago, and I had fun, we as adults need to play more.  We need to encourage schools to have gym class, not cut out recess to have gym, but have both.  This need continues into high school as well.  I had great physical education classes in high school (gymnastics, circus stunts, and self defense) and I still broke a sweat but had fun doing it.  I know these things may not have funding, but remember this is my Perfect World.

After high school comes college and the freshman 15, or 20 or 30, depending on lifestyle, of course.  This is when it gets challenging because parents have no control, and this age group is very self conscientious.   By diagnosing overweight and obesity, more can be done to help at this age level.  Also, by learning in younger years the proper way to eat, and by staying active we can decrease or eliminate that extra weight the first years away from home bring on.  It is difficult when you go from a situation where limited foods are available to one where there are many different types of food available in abundance.  This is also a time where gym is no longer a necessity to graduate; and those that were athletes in high school may not be in college.  All these bring on the extra pounds, and to prevent it, it comes again to watching what you eat and increasing activity.

Now on to adulthood, this is where the circle ends and begins.   Many people I run into have very different obesity stories.  Some have been obese all their lives, some became overweight during college and then obese after marriage and children.  Some were normal weight their whole lives and then became obese later in life.  No matter the story the outcome becomes the same, co morbid conditions, difficulty with activity, low self esteem, depression, and this can go on.  It is important for us to understand that nothing can be fixed overnight, no one goes to bed one day normal weight and wakes up the next obese, so it can not come off that quickly either.   Having surgery to fix the obesity is not the end all, be all, it takes dedication to lifestyle change to be successful as well.  I believe this is why it is difficult to diagnose obesity as a disease.  Many other problems we have medication for, but even those you still have to have a lifestyle change to make it last.  A newly diagnosed diabetic may have good control with one oral medication, but eventually it goes to two or three or even to insulin use if the person does not adapt good dietary and exercise habits.  But with obesity, there are not many medications that have long term results, you can not build on them, if they are not working you stop the medication, and any weight the person might have lost comes back on.  To properly lose weight, you need dietary and exercise counseling, but for the majority of people, these are not covered services and most people can not pay out of pocket for them as well.  There is also the downside to diet and exercise counseling, it is normally not successful long term for the morbidly obese population, and surgery for weight loss is the only proven successful long term treatment for morbidly obese.  So to properly use diet and exercise counseling it needs to be done when a pt is overweight, not wait until the patient is morbidly obese and has co morbid conditions.  By treating at a lower weight, there is a higher chance of being successful and thus a lower chance of advancing to obesity or morbid obesity.  By treating obesity in adulthood, even with surgery your goal needs to be to teach the younger generations how to eat properly, how you eat after surgery, not how you ate prior to surgery.  I hear many times how patients make 2 suppers, one for them and one for their family, because their spouses or children just won’t eat what they eat.  By passing on healthy eating information now, you will help prevent complications later.

So, in my perfect world there is less “junk food,” more affordable fruits and vegetables, more activity and family play time, and generalized good health.  Primary care physicians will sit down and have a discussion with patients when they are slightly overweight and not obese with co morbid conditions.  If a patient is obese, doctors will diagnose obesity as a disease and insurance companies will pay for treatment for obesity. Treatment can be diet and exercise counseling alone or combined with surgical or pharmaceutical intervention.   I know these ideas are not perfect, nor complete.  It is just some ideas to get you started.  Remember in the end, it is up to each individual to determine their commitment.  If you choose us or have chosen us to help you, we will commit with you (a spin off of one of Dr Boyce’s favorite sayings.)    Take time out to play each day, it really is as fun as the kids make it look, and you will burn calories while doing it.

Hope everyone is having a great start to the new school year, a new beginning for some, a re-commitment for others.

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