Medicalizing Obesity; Part 1

June 18, 2013

A Medical Weight Management Program with a Mission;

Optimal Performance

Introduction

To solve Obesity, we must first define the problem;

Why the Body Mass Index causes failure in weight loss programs

If we define Obesity as a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on a person’s health, leading to reduced life expectancy and/or increased health problems, then Obesity, without question, is a global epidemic. At about 35% of the total population, people with a normal body weight are a minority in the US.

The Body Mass Index, or the BMI, is the most commonly used reference tool for determining if a person is obese; BMI= Body Weight in Kilograms/Height in Meters2 or (weight in pounds x 703) divided by height in inches then divided again by height in inches. So, a person that is 68” tall and weighs 190 pounds= (190 x 703)/ 682 = a BMI of 28.8. The reference ranges for BMI are as follows:

  • <20 is underweight
  • 21-24.9 is normal body weight
  • 25-29.9 is overweight
  • >30 is obese

Before 1980, doctors generally used weight-for-height tables — one for men and one for women — that included ranges of body weights for each inch of height. These tables were based on weight alone, rather than body composition and were of limited usefulness. BMI became an international standard for obesity measurement in the 1980s.

The public learned about the BMI in the late 1990s, when the World Health Organization (WHO) launched an initiative to encourage healthy eating and exercise. While it is true that a person’s baseline BMI correlates with their risk of developing co-morbid health conditions and premature death, which makes it a useful tool for helping insurance companies decide how much to charge a person for a term life policy. However, it is totally misleading if used in deciding how much weight a person needs to lose to dramatically improve their health and wellbeing. For instance, consider the following scenario of two men, both 72 inches tall. One man weighs 270 pounds and has a BMI of 37, and the other man weighs 330 pounds and has a BMI of 45. Over the next year the 330 lb person loses 33 lbs, 10% of his body weight, while the 267 lb person gains 33 lbs, +12% of his body weight, so they both weigh 300 pounds and have an identical BMI of 41. Both men are well above the obesity BMI of 30; however, their health and mortality risks are quite different, and this difference underscores how educating the public about BMI misfired and actually caused a setback in the public battle against obesity. In fact, the man who lost nearly 10% of his original bodyweight in the above example, now has reduced his health and mortality risks to be more in line with a person that has normal body mass index. The man who gained more than 10% of his body weight, however, now has an extremely high risk of developing co-morbid disorders and of premature mortality. Furthermore, consider this; If the entire US population was one very large person, and this person lost a mere 7% of his collective body weight, cases of Type 2 Diabetes in the US would go down by 58%!* Researches trying to learn about people’s expectations from a medically supervised weight loss program asked participants, at entry, what percentage of body weight they would need to lose to be:

a)      disappointed with the results of the program?

b)      satisfied with the results of the program?

c)      extremely satisfied with the results of the program?

One hundred percent of the participants answered that they would be disappointed with the results of the program if they lost 10% or less of their initial body weight; and 100% also answered that they would be extremely satisfied only if they lost 20% or more of their initial body weight. In the second phase of this study, those participants who achieved a 10% weight reduction since entering the program, again completed level of satisfaction and wellbeing questionnaires; 100% of this subgroup expressed a high level of satisfaction and a significant improvement in their wellbeing since their entry into the weight loss program.* As this study on people’s expectations from weight management programs eloquently demonstrates, weight loss goals that focus primarily on the BMI, or on reaching one’s ideal body weight, are misleading at best, and are likely to have a detrimental effect on participants’ outcomes. The fact is that fewer than half of people on a diet achieve a 10% weight loss, 90% of whom regain this weight, often more, within two years. Obese people who lose as little as 5% of their body weight, improve their general health, wellbeing and longevity, regardless of their BMI.

Thus the primary contributor to the near universal failure of weight management programs is  participants failure to ever really define the problem of obesity or to make realistic, achievable and clinically meaningful weight loss goals. Consequently, they fail to recognize success even when they actually achieve it. Two entities share most of the blame for this public education debacle; our Healthcare System for their failure to effectively medicalize obesity and weight management, and seizing this educational void as an opportunity to perpetuate their campaign of myths and misinformation is the Commercial Weight Loss Industry.

End Post

Still to come in future posts:

  • The Rational approach to Nutrition and Physical Activity in Medical Weight Management
  • The Rational Use of Medication in Medical Weight Management
  • The Rational Use of Surgery in Medical Weight Management
  • Conclusion and the Future of Medical Weight Management

Mitchell R. Weisberg, MD, MP

Internist-Psychopharmacologist

Founder-CEO and Personal Physician at:

Optimal Performance MD

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4 Responses to “Medicalizing Obesity; Part 1”

  1. Howard felix said

    This country puts a huge tax on cigarettes, tobacco and refuses to legalize marijuana. Yet the commercials are full of romanticizing foods and bragging about how cheap some of this poison is. As an investor I own alcohol and tobacco stocks. I also have no problem owning food stocks that I would never eat.

    Mitch, perhaps a faster way to solve the problem is thru pharmacological compounds now being worked on. This is probably years away from mainstream medicine. Until then I will bet against the masses and invest accordingly.

    Your in shape patient, H

    • Hello Howard:

      The good news is that medications for the rational, safe and effective management of obesity already exist in the marketplace; and they have been in existence for decades. The bad news is that most of these medications are not approved by the FDA for treating obesity. Thus, the main obstacle to progress in medicalizing obesity, as preposterous as it seems, is the nearly universal, archaic perspective of the larger medical establishment with regards to whether or not obesity is truly a medical problem. The evidence for this systemic prejudicial thinking about obesity is overwhelming, but the recent removal from the market of Meridia (Sibutramine) in October of 2010 serves as an excellent case in point; Meridia was withdrawn because in some patients it caused an elevation of blood pressure and in some patients who had pre-existing coronary artery disease, Meridia did cause heart attacks that in some cases were fatal. While, of course, I do not view a fatal heart attack as just a minor nuisance or as an acceptable side effect of a medication, it certainly is a manageable side effect for any competent physician. In fact, Sudafed, an over the counter (requires no medical supervision) decongestant, has a similar risk of exacerbating coronary artery disease as Meridia. Furthermore, the group of people prescribed Meridia are the exact same group of people that are at the highest risk for developing coronary artery disease, and any physician worth their weight in salt will fully assess their patients for coronary disease prior to, as well as frequently monitor their patients’ blood pressure after prescribing Meridia for their patients. When prescribed in accordance with the standard of care, obese patients taking Meridia will actually enjoy a reduction in their risk for having a heart attack and in their blood pressure. To add insult to injury, if a person legitimately needs an over the counter decongestant, they need to show the pharmacist their drivers license as a deterrent for them using Sudafed for making crack in their home labs. Just one more example of the systemic bastardization of obesity by the medical establishment before concluding, aspirin, invented by Bayer Corporation in 1905 and the myriad of other non-steroidal anti-inflammatory drugs, or NSAIDS, that have proliferated in the marketplace since, predictably cause over 8,000 deaths every year in the US from gastrointestinal hemorrhage, the majority of which occur without any prior warning symptoms. Where is the uprising calling for the immediate withdrawal of aspirin or Ibuprofen from the market place? It is nowhere to be found because these medications are perceived asessential for the treatment of “legitimate” and pervasive public health problems commonly known as pain and fever. However, if you have pain and fever and just happen to also be obese, our medical establishment will tell you to take two aspirins and be a contestant on The Biggest Loser because it can’t help you.
      Finally, my next post, which is coming within 48 hours is, The Rational Use of Medications in Medicalizing Obesity; so once again, Howard, your insights are right on the money!

      I thank you for reading my blog, and I thank you even more for your uncanny ability to always get my message.

      Sincerely,
      Mitch Weisberg

  2. Mary said

    http://gma.yahoo.com/ama-declares-obesity-disease-202655051–abc-news-topstories.html
    AMA Declares Obesity a Disease at convention today (6/19/2013)
    Dr. Weisberg the pioneer is obviously right!

    • Hi Mary:

      Thank you so much for sharing this timely news with me and the compliment you paid me in the process. I had no idea that the AMA was even debating the issue of whether or not to call Obesity a disease. My response to this news is mixed; on the one hand, I have a sense of vindication for my views on the subject; I originally conceived Medicalizing Obesity in 2003 and I cannot recall a time in my medical career that I had even the slightest doubt that Obesity is a genuine disease. On the other hand, I am thinking to myself, if it took the AMA until 2013 to determine that Obesity is a bonafide disease, who the heck cares what the AMA thinks? The AMA is the largest representative of physicians in the United States. For them it is obvious that Diabetes, High Cholesterol, High Blood Pressure, Coronary Artery Disease, Cerebrovascular Disease, Peripheral Vascular Disease, Osteoarthritis, gastro-esophageal reflux disease (GERD), Obstructive Sleep Apnea and Gout are all, without question, bonafide diseases and have been diseases before there was ever an AMA; but it takes until 2013 to recognize Obesity, which is the single risk factor common to every one of these aforementioned diseases, as a disease itself? Most medicines that doctors prescribe in this country every day, are to treat ailments that were the direct result of Obesity, but they never considered until this day in history of actually treating Obesity? Frankly, I am more embarrassed by the AMA’s statement than impressed. This is very similar to the incredulousness I felt when the Mental Health Parity Act was enacted into federal legislation in the early days of the first Obama Administration. The World Health Organization declared, decades ago, that mental illness is the leading cause of human disabilty on the globe, but it takes an act of congress to force the medical community to acknowledge this elephant in the room.

      Obviously, that the AMA officially is calling Obesity a disease is good news; the bad news is that by the time the AMA acknowledges that the emperor isn’t wearing clothes, he’s going to be dead from hypothermia.

      Thank you for sharing Mary and my apologies for the rant, but I feel much better now.

      Mitch Weisberg

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