The Science of Obesity vs. the Social Disgrace

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When we think about someone who has a disease or condition caused by genetics, environment or biology, we don’t normally discredit them because of their disease.

For instance, if someone you know has Parkinson’s disease, the condition doesn’t detract from his character. Or if a neighbor is being treated for kidney disease, she isn’t shamed as a result of the diagnosis. These diseases don’t become the distinguishing mark of social disgrace. So why all the judgement with obesity?

Obesity As A Disease

What defines a disease? Most health-care experts agree on some common themes: 1) impairment of normal function of some aspect of the body, 2) characteristic signs of symptoms and 3) resultant harm or morbidity. Scientists working in the field of obesity have evidence to support obesity as a disease. The science behind this disease state is complicated. The obese person has no control over most of it.

Behaviors play a role in obesity, but just as important are biology, genetics and environment. Let’s look at the causes individually.

Environment 

Industrialization has provided great conveniences in our modern world — and less activity. We no longer hunt for food but can drive up to a restaurant window for a cheeseburger. It’s also a fairly inexpensive way to feed a family of five. We have Dairy Marts, quick-food stops and restaurants on every street corner. Ah, yes, unfettered access to calories.

Unfortunately, we have less access to fresh, healthy produce and organic, chemical-free protein. It’s also a fairly expensive way to feed a family of five.

Diet has changed. We have hundreds of choices of foods, but many contain chemicals such as sweeteners, trans fats and preservatives. Our super-sweet and calorie-dense foods can last weeks without spoiling, but those chemicals that make food taste so good and last so long have wrecked havoc on the mechanisms involved in our metabolism.

Biology

If you’re a regular reader of the Health News Hub,  then you have seen Dr. Pavlos Papasavas‘s discussion on set point. (Read it here.)  For anyone who has tried to lose 30 pounds but regained the weight, it’s a set-point thing — you’re fighting your biology. The body will aggressively defend its stores of fat, or set point (that abnormal Body Mass Index).

Metabolism slows down, hunger hormones increase and you eventually regain the excess weight you just lost. Some people prevail, but most gain back the weight. And dieting is difficult. A study in NeuroImage (Feb 2013) revealed “calorie deprivation increases responsivity of attention and reward brain regions to intake, anticipated intake and images of palatable foods.” The results explain why calorie deprivation diets don’t typically produce lasting weight loss. Weight regulation is not controlled by a uniform tally of “calories in vs. calories out.”

It’s an unfair fight.

Genetics

A predisposition to adiposity (the state of being obese) lies in our genes but not exactly how you’d think. Some obese people have obese parents, but the genetic component relates to the variation in how individual’s weight responds to the same environment. There is much more research being done looking at the genetics of obesity: Identifying obesity-predisposing genes that interact with the environment. Why do some people gain weight when others don’t after consuming similar diets? Why do some people run on fewer calories?

Many experts feel molecular genetics is central to obesity research.

Back to the original question: Why the stigma with obesity? If we don’t engage in unfair judgement and bias with respect to other diseases, then why is it still so prevalent with the disease of obesity? Obesity=disease. It is not purely volitional. Stigma and discrimination are major barriers to effectively addressing the epidemic of obesity. (According to the Centers for Disease Control and Prevention, more than 36 percent of adults and 17 percent of children and adolescents are obese.)

Many reasons for obesity are uncontrollable. But common beliefs are that obese people are to blame for their weight. (“The condition of obesity is under their control.”) Moral judgements about an obese person provide no help in combating the disease. Weight stigma is ineffective and not based on fact.

How can we change our approach? What do we all need to do differently? Obesity should be treated like any other disease, with science-based interventions, community education and compassion. Just as you would care for your friend with Parkinson’s or neighbor with kidney disease, you should care for those who have the disease of obesity.

Sara Thompson is a nurse practitioner with Hartford HealthCare’s Bariatric and Metabolic Services, part of the Surgical & Medical Weight Loss Center.


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