Saturday, January 23, 2010

Obesity Is Not A Disease

Obesity is much in the news, yesterday because surgeons are complaining that the NHS isn't making provision for many more thousands of gastric-banding operations annually.
Without question obesity is epidemic. Without question obesity shortens life, reduces the quality of life, and inflicts huge costs on our health services.
So what might be a physician's response? The only realistic advice is depressingly ineffective.


Never let yourself get into this condition.


The hard fact is that established obesity is very difficult to reverse. Most obesity we see has developed over many years. The daily habits which have caused the obesity are difficult to change, and any change has to be determined and permanent. Almost all obese patients find this impossible, not least because weight loss is always painfully slow. And the change in habits has to include family and friends - which would be remarkable if it could be achieved.
As I was taught, in language too plain for today:
Look at the family of a fat patient and you will find a fat spouse, fat children, and a fat dog.


Why is dieting so slow to reduce weight? I think the answer lies in energy balances. One gram of fat produces about 9 Calories, so 1 kilogram of fat is 9 kiloCalories, enough energy for 3 days manual labour.
Fat is an insulator, so an obese person needs fewer Calories to maintain body temperature. Obesity causes immobility, consequently the energy demand for activity is also reduced. Many obese people need fewer than 1,500 Calories daily.
So a week of total fasting, water only, might burn off just 1 kilogram of fat.
[And the first few days will see spurious weight loss: fasting causes total body water to be reduced.]


For most people a 1000 Calorie diet is very restricting, but achieves a daily energy deficit of a few hundred Calories at best. Some severely obese people may still be in positive energy balance even at this level of dieting. 
No wonder people get disheartened and miserable, give up, eat for comfort.


In the past we sometimes admitted obese people for very strict dieting under supervision. In a warm ward, in bed or sitting most of the time, surrounded by kindly other patients with chocolates, admission was doomed management. If some reduction was achieved, then it was common to find the weight regained at the first follow-up.


'Weight-watchers', or similar group therapy, has the best chance of success, if people are sufficiently motivated. The same applies to alcoholism: 'Alcoholics Anonymous' does great work in its equally difficult specialty.


There is a genetic element in obesity, in that some people become obese especially easily. Surveys have shown that the obese often eat less than matched, lean people. Even so, the obese are taking more than they can use. There's no justice in nature.
Women are at increased risk of obesity; so are African, Arab and Asian people living a 'western' lifestyle.
In Britain the prevalence of obesity has an inverse relation to income.


'Maturity Onset' diabetes mellitus is associated with obesity. The diabetes causes obesity, and the obesity makes the diabetes more severe. I suspect anyone will become at least chemically diabetic if weight increases enough.
The converse is true: weight loss reduces the diabetic state, in the earlier stages at least. 
Sulphonylurea drugs may be prescribed when dieting fails to reduce the blood glucose values. These drugs increase insulin secretion. Dieting becomes less important in diabetic control. They improve the blood glucose chart at the expense of making weight loss even more difficult.


Other than this type of diabetes, diseases causing obesity are rare. Food intake in excess of need is by far the most prevalent cause of obesity.
And what is eaten is not so important as total energy intake. Fat and sweet foods are rich sources of energy, and so especially fattening.


There is no magic pill which achieves weight loss without dieting. A safe, effective slimming drug would be hugely profitable to its inventor, but the prize remains untaken, and is likely to remain so. We do now have a number of drugs which may be used in selected cases to increase weight loss by dieting. I have no experience of their use, so I will not comment further.


Surgery has its indications, but it is a policy of despair. Obese patients are poor candidates for anaesthesia and surgery. Complications are more frequent, and some will be severe, even fatal, for the patient. For surgeon and hospital litigation is likely to be more frequent - we heard yesterday of claims increasing after obesity surgery.
Procedures include excision of fat deposits, especially abdominal, and liposuction. Other procedures aim to reduce the capacity of the stomach, or reduce the absorption of food in the small intestine. Gastric banding can be done laparoscopically, and is a favoured operation at present.
Operations to bypass a length of small intestine were popular at one time, but a serious risk of late septicaemia became apparent.
All operations on stomach or intestines seem to work by suppressing appetite. In selected patients results can be good, but surgery is a drastic means of enforcing dieting.


So my advice to an obese person is this. Don't consult me. I can only tell you what you know already, that you are eating too much; your only hope of remedy is in determined dieting and exercise. If you want pills or an operation consult someone much younger and more enthusiastic. Don't go to a private practitioner: the prospect of fees may distort the judgement and advice of a saint.
Homo evolved in a hungry world. Our genes create us with a thrifty metabolism; we are poorly adapted to food abundance. War-time rationing proved to be good for the nation's health.


My generation may be the first never to have known hunger in Britain: compare our stature with our parents', and our childrens' with ours. But epidemic obesity warns against excess and complacency. We are now rich enough to waste food on a grand scale - truly we have grown decadent.


Those whom God wishes to destroy he first makes rich.

34 comments:

Anonymous said...

I am not sure if you are quite right to say that obesity is not a disease. COPD is caused by smoking but it is a disease. Cirrhosis of the liver can be caused by too much alcohol but it is a disease. So why isn't obesity a disease caused by an unnatural supply of extraordinarily palatable food? Couldn't you argue that it is a disease which is the result of our finding ourselves in an environment that we are not adapted to - an environment that demands little physical effort and has cheap ready made food everywhere?

If you want to make rats fat the way to do it is simply to give them a cafeteria diet. Since humans are essentially like rats it is not surprising that many of us given a cafeteria diet will just eat and eat. It is a disease brought on by the environment. Just as acute mountain sickness is brought on by the environment.

Many obese patients have diabetes. Would you say that diabetes is not a disease just because the patients are fat and have eaten themselves into the diabetic state? And you are very negative about modern surgical treatment following which the risks are surprisingly small and the patients live considerably longer. And, if they have the right operation, their diabetes can be cured overnight which shows there is rather more to type 2 diabetes than we thought. What is more even you agree that there is no other treatment that works in the really obese patient. If there was the patient wouldn't be that fat in the first place.

That is not to say that I don't have quite a lot of sympathy for your view. There is no doubt that fat people have fat pets so the faulty response to the plentiful food in our environment does lie between the ears. And there is often complicity within the family. There have been a few TV programmes on bed bound fat people which have puzzled me. How do these people get their dinner if they can't even walk? If you look carefully you will see that there is always somebody misguidedly stuffing them with food. In the real world it is only the surgeons that win with these patients.

Lori said...

I agree that obesity is not a disease. While it may fit textbook definitions of disease I don't lump obesity, alcoholism or drug addiction in with cancer, ALS, rheumatoid arthritis, cystic fibrosis and the like. Alchoholics can just 'stop' drinking despite their compulsion to do so.

Obese persons can eat less and move more despite their compulsions.

I have a friend with ALS. He can't just 'stop' having his disease by eating less, quitting drinking, washing his hair or whatever.

By calling obesity a 'disease' many obese persons will feel even less empowered to do something about their obesity...after all they're so 'ill'!

Funny bit by Ricky Gervais on the subject. There is a couple of F-bombs though, so be warned:
http://video.google.com/videoplay?docid=8114016578250829800&ei=ts9US78_k9qrAv_O9e0C&q=ricky+gervais&hl=en#

Lily said...

Some reports of World Health Organization shows that a large number of products and oils with saturated fats are the cause of many diseases such as obesity, hypertension, cholesterol and even heart disease ... This is already a social problem

Dennis E. Houghton
buy generic viagra

Anonymous said...

Obesity is NOT a disease, it is an effect of choosing to eat more than you move.Diabetes IS a disease often brought on by being obese.Just because you are free to eat all you want, doesn't make it right to do so.This is America, and it's just going to get worse, if you don't force most people they just go with the crowd, a million people, doing the same stupid thing, over and over and over,...

Anonymous said...

http://site.ru - [url=http://site.ru]site[/url] site
site

Anonymous said...

Whеn insistencе iѕ applied to thе
гeflex ρoints on the feet, effective techniques of a Skilled massage therapist, a іntеrvеntion corpoгate with tаntгic massages prοveѕ to be mοrе ѕuccessful, satisfying, and annоyancе-free.
tantric massage is a thеrapy that makes use of phуsical аbnormalitіes are ruled
out, сonstiρation can be subdivided into:а.
Also see my website :: tantric massage

Anonymous said...

pls fwd me the hyperlink of the video clip.

My blog post :: xerox phaser 8560 driver

Anonymous said...

The same is true if you're a employment candidate at the new company, because Hour or so managers go through so many resumes. Often, a person may do not have service, Fast priority these types of partake in for less-than-perfect credit score! To are eligble for Sallie Mae's unsubsidized loan, you should be enrolled on the institution supplying you with the loan! fast same day loans It's often thought that acquiring a job purchase outstanding bills, sudden bills, random emergency, and many others.

Anonymous said...

Just after confirmation of one's details, the quantity credits within your bank account throughout matter of time. The financial reasons commute these of very long the many employers processed need of functions of capital in the unleveraged loan. You can get away from credit card debt if you decide to go with Secured personal loans! click here Normally, gross income is greater than their particular take home shell out!

Anonymous said...

say thanks to's wonderful idea, you are better than samsung's
engineer !!!

Also visit my webpage: appletv.altervista.org

Anonymous said...

The best ways to Download hp laserjet 1020 vehicle driver for windows 7 from web?


my website :: http://www.eatingcultures.com

Anonymous said...

Thanks lots. Works a treat.

Stop by my homepage; xerox phaser 8560 error codes

Anonymous said...

Is 300 dpi the minimum need for all prints?

my webpage :: xerox phaser 8560 ld

Anonymous said...

This is very interesting, You are an excessively professional blogger.
I've joined your feed and sit up for in quest of more of your excellent post. Additionally, I've shared your web site in my social networks

Feel free to surf to my blog xerox 8560 yellow

Anonymous said...

It's a pity you don't hаve a ԁonatе button!
I'd certainly donate to this brilliant blog! I suppose for now i'll ѕettle for book-marking and adding yοur RSS feеd to my Gοоglе асcount.
I loοk forward tο fresh updateѕ аnd will shaгe this blog with my Fасebοoκ group.
Chat soon!

Also visіt my web ρage; developers facebook

Anonymous said...

What regarding printing index cards?
Gary.

Also visit my website - xerox phaser 8560 maintenance kit

Anonymous said...

best of luck! give it a try.

Also visit my website xerox phaser 8560 error codes

Anonymous said...


Good day there Phil,.

Here is my weblog - xerox phaser 8560 maintenance kit

Anonymous said...

How can I download a cost-free variation of hplaserjet 1020?


Here is my site - xerox phaser 8560

Anonymous said...

Hello! This post couldn't be written any better! Reading this post reminds me of my good old room mate! He always kept talking about this. I will forward this write-up to him. Fairly certain he will have a good read. Thanks for sharing!

Feel free to surf to my web site - xerox 8560 mfp

Anonymous said...

Pls for your kindness send me the video idea
of making pcb so effortless. Many thanks.

My page: xerox Phaser 8560 maintenance kit

Anonymous said...

Check out the bottom of one of the notice emails and you can easily pull out at any time.


Also visit my web site ... blogspot.com

Anonymous said...

nice information, follow these easily set up Samsung ML-1210 printer motorist, and
great job.

Review my web page: xerox phaser 8560dn

Anonymous said...

Great deliѵery. Greаt arguments. Keеp uρ the goοd ѕpirit.


Μу webpage ... sign up to google [www.camecocorporation.net]

Anonymous said...

There are a lot of different was to make name badges:
this is just one example. This article may be freely
reprinted or distributed in its entirety in any ezine, newsletter, blog or website.
You might notice some swelling in different parts of
your body.

my web site - cancerous skin tags (olgogogo.com)

Anonymous said...

When you have both skin tags as well as warts on your body, you can use the skin tag removal products that will also help you to remove the skin warts.

Do this method up to four times a day until the skin tag falls
off. 'We usually have two or three people in the room, no-one has time, so we have one person tightening the body and another giving a treatment on the face'.


Also visit my website remove skin tags naturally **

Anonymous said...

Just wish to say your article is as astounding. The clearness in your post is simply cool and i can assume you're an expert on this subject. Fine with your permission allow me to grab your RSS feed to keep up to date with forthcoming post. Thanks a million and please continue the rewarding work.

Feel free to visit my blog post; UK hosting

Anonymous said...

Whoa! This blog looks exactly like my old one!
It's on a entirely different subject but it has pretty much the same page layout and design. Excellent choice of colors!

Feel free to visit my website: xerox 8560n

Anonymous said...

I'm not sure where you are getting your information, but great topic. I needs to spend some time learning more or understanding more. Thanks for magnificent information I was looking for this info for my mission.

Take a look at my webpage :: xerox 8560 cartridges

Anonymous said...

At this time it seems like Expression Engine is the top blogging platform out there right now.
(from what I've read) Is that what you're using on your blog?


Feel free to visit my blog post; xerox 8560 manual

Anonymous said...

Look at all-time low of among the alert emails and you can easily pull out any time.



Check out my web page :: xerox phaser 8560dn **

Anonymous said...

The best ways to Download hp laserjet 1020 driver for windows 7
from web?

Review my blog - xerox phaser 8560mfp []

Lanny said...

"Without question obesity shortens life, reduces the quality of life, and inflicts huge costs on our health services."

Wrong, wrong and wrong.

Show me direct evidence of the actual physiology process of obesity that shortens life. You will be hard pressed to find it. You will find statistical correlation. Correlation does not mean causation. Obesity can be *symptomatic* of a bad diet and sedentary lifestyle. But not always. People of all sizes suffer heart diseases, etc. It's the fundamental public, and sadly, medical misunderstanding, of this simple concept that has lead the the ridiculous 'obesity diseases' silliness. Metabolic health is a far better indicator of the likely hood to suffer the various diseases common associated with obesity.

Obesity does not reduce quality of life, that is pure ignorance. For some people, maybe. But for many obese people living happy, active lifestyles, that's just plain offensive.

No, 'obesity' does not inflict a huge cost on the NHS. Bad diets, smoking, sedentary lifestyle etc, may do though.

There is a lot of research to show that for those who are obese and do suffer with heart diseases, they are more likely to recover faster and actually live, as opposed to their 'slim' counterparts suffering the same diseases.

Frankly, your last sentence is plain awful. I find it frightening someone with such an attitude was a physician responsible for patient care.

Anonymous said...

e cigarette reviews, e cigarette, e cig, buy electronic cigarette, e cigarettes, electronic cigarettes