Quickies

Skepchick Quickies 6.21

Amanda

Amanda is a science grad student in Boston whose favorite pastimes are having friendly debates and running amok.

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  1. Amanda

    I’m glad that Exodus Ministry has shut down. It really doesn’t help when there’s people out there who insist they’ve gotten rid of their homosexuality, despite the fact that all the data suggests its not a learned behavior. “ex gay” groups like that only spread homophobia and hamper progress.

  2. I dislike labeling anything as a “disease” that doesn’t have a viral, bacteriological, etc., source. “Akin to a disease” works. But I am not dismissing the complexity of an issue (obesity, addiction, etc.), I’m just uncomfortable about the label. Am I missing something?

    1. I don’t think you’re missing anything. I’m quite annoyed by the AMA deciding to do this (especially since it is against the recommendation of their experts). Labeling obesity a disease will have consequences for how providers interact with patients (even though providers already overwhelmingly shame fat people when they visit). This could lead to physicians seeing a fat person and attributing whatever health issue they are having to their size instead of seeking an actual pathology. A person’s size is not necessarily indicative of any health problems–there are plenty of fat people who are healthy and feel great. I don’t think this move will actually help physicians do their job better, and it just hides the sociocultural factors that contribute to obesity that cannot be solved in a doctor’s office.

      1. Agreed. Treating obesity as a disease leads to misdiagnosis in over 70 million Americans — the healthy obese and unhealthy thin people alike.”“Psychologist Deb Burgard examined the costs of overlooking the normal weight people who need treatment and over-treating the obese people who do not. She found that BMI profiling overlooks 16.3 million ‘normal weight’ individuals who are not healthy and identifies 55.4 million overweight and obese people who are not ill as being in need of treatment” (http://www.nutritionj.com/content/10/1/9)

        And it’s already egregiously common for so-called “healthcare practitioners” to prescribe weight loss for everything from strep throat to sprained ankles: http://fathealth.wordpress.com/

      2. Will, against that there is this for instance
        http://obesitywhitebook.nhri.org.tw/whitepaper_doc/%E7%BE%8E%E5%9C%8B/2008%20The%20Obesity%20Sociaty_Obesity%20as%20a%20Disease.pdf

        Proponents suggest that recognition as a disease will reduce stigma and improve reimbursement for treatment. Even opponents recognise that obesity is a risk factor for diabetes, cardiac disease, and so on.

        I am still blown away by Zylla’s apparent refusal to recognise anything other than infectious diseases – what about cancer, FFS? – he might want to clarify that.

        1. “Proponents suggest that recognition as a disease will reduce stigma and improve reimbursement for treatment.”

          I highly doubt it will result in anything other than INCREASED pressure to lose weight and undergo risky procedures and experimental medicine for it. Consumers are hardly the beneficiaries of this policy.

          1. Moniqa, I totally agree with you that BMI is a poor measure of obesity and I share your horror of quack treatments. It would be foolish to assume that therefore obesity is not a risk factor, for instance for metabolic syndrome
            http://www.mayoclinic.com/health/metabolic%20syndrome/DS00522
            There are better measures of body fat such as these
            http://en.wikipedia.org/wiki/Body_composition
            http://en.wikipedia.org/wiki/Hydrostatic_weighing
            http://www.livestrong.com/article/113959-alternatives-bmi/
            Many local gyms can provide this service.

        2. First, to say that labeling something a disease will reduce stigma is absurd because it clearly does not happen that way. For example, see HIV. Or depression. Or alcoholism.

          Second, I did not say that obesity is not a risk factor for health problems. I said that there are plenty of people who are obese that are healthy that will now be labeled unhealthy because the AMA has decided to pathologize fatness.

          Going through this paper, one thing jumps out at me right from the second paragraph:

          “The panel recognized that there is a clear majority view among the general public as well as among authoritative bodies that it is reasonable to call obesity a disease.”

          This is an appeal to popularity and an appeal to authority. This tells me nothing useful. What does tell me something is that the AMA’s House of Delegates ignored the advice of their own experts and took a vote. In other words, this move to pathologize obesity is not based on sound evidence or reasoning, but on the opinions of non-experts.

          I’m also wholly unconvinced by this paper. The authors admit that the question is unanswerable from a scientific perspective due to the lack of a rigorous and agreed-upon definition of “disease.” Then they use a “forensic” approach which is basically an appeal to popularity and is also determined inadequate by the authors. They take a utilitarian framework, which they also say is speculative and subjective. And so this is supposed to be convincing evidence that physicians will magically stop stigmatizing fat patients?

          Anyway, I have my doubts that it will change the way physicians engage with fat patients in a good way. I think it will either stay as it already is or get worse. As any fat person can tell you, physicians already lecture about obesity to patients even when they are there for something completely unrelated. Pathologizing their size gives physicians another reason to keep doing that and ignoring patient needs.

          1. Well, at least you took the trouble to read the paper (unlike certain masturbias!) and good on you for that!

            In passing I would note that the non experts you speak of, the AMA House of Delegates, went against the recommendations of the experts, the Council on Science and Public Health, but went with the recommendations of the American Association of Clinical Endocrinologists and the American College of Cardiology.

            I never thought I would end up defending a bunch of endocrinologists, but there you go!
            You are right that this is in the end an appeal to authority.

            On the other hand the Council on Science and Public Health cited the shortcomings of BMI as the reason for rejecting the proposal. I think that is a poor reason in view of the many possible alternative tests for body fat mass. With relatively modest funding a more accurate replacement for BMI could be found and a comparative study done.

          2. But that’s still arbitrary. Even if there are other ways than BMI, someone draws a line and says “Someone directly below this line does not have a disease, and someone directly above this line does have a disease.” It’s not based on anything but some scale that people invent to test body mass and pathologizing certain numbers on those scales. It’s not based on symptoms of ill health as being fat is not necessarily a symptom of ill health. Taken with other factors, it can be a sign of ill health, but it is not in and of itself a sign of ill health. In fact, in many societies, fatness is seen as a sign of great health (e.g., see this text).

          3. It also kind of ignores the criterion that a disorder or disease should be something that somehow detracts from a patient’s quality of life (either through impairment of normal function or significant distress). The distress caused by societal fat shaming really doesn’t count here. I am trying to decide if there should be a category that does treat obesity that impairs function/distresses the patient as a medical condition, since even that would tend toward abuse.

          4. Well, it will be interesting to see how the grand poo-bahs define the new disease. If it was me I would attempt to be objective about it and tie it to a point where cardiac or diabetic risk began to exponentiate. but you never know! What did Einstein say, “You look like scientists, you talk like scientists, but there is not a single scientist among you!”

            By the way I think you are missing the point that obesity is considered an independent risk factor for cardiac disease in its own right.
            http://www.ncbi.nlm.nih.gov/pubmed/6219830

            Anyway, I’m not too invested in whether obesity is considered a disease or a risk factor. If an individual wants to believe they are in the group of healthy obese people, that’s their business. I include myself in that group!

          5. I’m not missing that point at all though. I’ve explicitly said that obesity can be a risk factor for diseases and ill health. My point is that obesity is not necessarily indicative of ill health. Just because a person is fat does not mean they have cardiac disease. Plenty of people who are thin or muscular or average have cardiac disease. Being gay is a risk factor for HIV/AIDS. This does not mean that being gay is a disease.

        3. Obesity alone is not a risk factor in many diseases for which people assume it is. Fully one-third of obese people are NOT at risk for diabetes and heart disease and one quarter of normal weight people ARE. (source: http://www.webmd.com/diet/news/20080811/benign-obesity-malign-normal-weight) The AMA’s recommendation gives physicians full license to treat people based on appearance rather than existing symptoms, already problematic and poised to become moreso.

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