Monday, March 27, 2006

The Obesity "Epidemic": A Cause for Celebration!

I am alternately amused and irritated by the hullabaloo surrounding the supposed obesity epidemic. First of all, people are not dropping like flies from obesity. Anyone who spends a fair amount of time in hospitals can attest to that. There are many people in the hospital because they smoke or they drink, but there are very few people in the hospital solely because they are overweight.

That’s not to say that obesity hasn’t increased. Of course it has. However, rather than being a dire calamity, it is a milestone in the history of medicine. Imagine, if you will, all the healers and practitioners down through the ages trying to conceive of a time when smallpox, diphtheria and yellow fever were not scourges. Could they ever have expected that a time would come when the most serious result of childhood illnesses would be lost school days instead of lost lives? It would have been beyond their wildest dreams to envision a society in which people had enough to eat, let alone more than enough.

The obesity “epidemic” is a direct result of the success of modern medicine (not to mention modern farming, and probably capitalism, too). As physicians, we are privileged to live in a time and place where obesity could possibly be a concern. Instead of wringing our hands, we should be thrilled that we have managed to make this possible.

Sure, we should be counseling patients about healthy eating and healthy weight, but we should recognize this for the important milestone that it is: so many childhood diseases have been vanquished, so many epidemics have been prevented or treated, and perennial food shortages have been relegated to the past. These achievements have allowed us to reach a time when eating too much is a health problem.

4 Comments:

Blogger Flea said...

Amy,

I discuss weight as a "consequence of our prosperity" all the time with my families.

That don't make it less of a problem.

The problem is not that hospitals aren't full (yet) with obese people, it's the health risks that obtain to overweight and obese people that will negatively impact their health.

See Framingham Heart Study.

best,

Flea

5:20 AM  
Blogger marcus said...

Dear Amy,

Flea makes a good point. I'm sure you don't judge all health problems by their admission to the hospital.

7:17 AM  
Blogger Amy Tuteur, MD said...

I'm not saying that obesity isn't a problem. I'm saying that it is a problem we should be thrilled to have.

Furthermore, the importance of the problem is vastly overstated. People are not dying of being overweight; they simply are not. It is also far from clear that maintaining a supposed "ideal" weight will turn out to have any health benefit.

"you don't judge all health problems by their admission to the hospital"

I wouldn't judge any health problem by a single factor. However, hospital admissions are a fairly good proxy for severity of illness, since you can no longer be admitted to the hospital unless you are really ill.

I suspect that the debate about health and lifestyle has a lot to do with the philosophical pro-occupations at the beginning of the 21st century. We are a society obsessed with the notion of control, and it is very difficult to accept that we may not have very much control over our own health. Diets, excercise regimens and supplements are a form of denial.

Furthermore, Americans are brought up to believe that they can engineer their own success and are responsible for their own failure. There are a variety of political issues that are being debated against this backdrop: taxation, welfare, health care financing. It is very American to believe that those who are healthy worked for it and those who are sick deserve it.

9:49 AM  
Anonymous med student said...

Amy, I just found your blog, and I really enjoyed reading this post and many others. I especially appreciate your comment about the concept of "control" over illness. It seems so strange to me that when people get sick there is always a comment about how either "they deserved it" or "how shocking! they had such a healthy lifestyle!" ... we have far less control over whether we get sick or whether we stay healthy than we would like to believe.

7:53 PM  

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