Rethinking Weight
Hey, maybe it's not a weakness. Just maybe. . .it's a disease
The reason governments, insurance companies, and others still take such positions, says Pi-Sunyer, is that "they are worried they will have to reimburse doctors and patients for treatment. And now, you have such a huge number of people needing treatment." On any given day, about 29 percent of men and 44 percent of women are trying to lose weight, and presumably a large percentage of those would love to be offered medically supervised treatment if it were covered in their health insurance plan.
Instead, they pay out of pocket for a $33 billion commercial diet industry--and keep getting fatter. The number of people who are severely obese--that is, those with a body mass index of 40 or above or who are more than 100 pounds overweight--is growing two times as fast as is obesity generally. From 1986 to 2000, the prevalence of Americans reporting a BMI of 40 or above quadrupled, from about 1 in 200 adults to 1 in 50. People who are severely obese generally have more weight-related illnesses and require more expensive treatments than do those who are merely "too fat."
Fat's high price. A new study by RTI International and the Centers for Disease Control and Prevention, published this month in the journal Obesity Research, shows that the nation is spending about $75 billion a year on weight-related disease. Type II diabetes, heart disease, hypertension, high cholesterol, gallbladder disease, osteoarthritis merely top the list. Almost 80 percent of obese adults have one of these conditions, and nearly 40 percent have two or more.
Healthcare costs for illnesses resulting from obesity now exceed those related to both smoking and problem drinking. About 325,000 deaths a year are attributed to obesity. The trend lines are only expected to get worse, since childhood obesity is also increasing rapidly (Page 56).
Researchers are encouraged by the stance taken by the WHO and NIH, as well as the American Medical Association, the National Academy of Sciences, and the CDC. Says Yale psychologist Kelly Brownell: "The ramifications could be enormous--for opening up better treatments, and to some extent for social attitudes toward people with this problem. When alcoholism was declared a disease, it changed attitudes and reduced the stigma of blame."
And to be sure, there is no shortage of stigma and blame when it comes to obesity. Weight discrimination dates back to the early Christian church, which included "gluttony" as one of the seven deadly sins. Obesity was viewed as the outward manifestation of the "sin" of overindulgence. Most overweight adults have suffered ridicule, self-consciousness, or depression, particularly if they were obese as children or adolescents. Severely obese patients frequently report workplace discrimination. One woman told researchers: "They put my desk in the back office where no one could see me."
Prejudice against the obese stems from the widely held belief that getting fat--and certainly staying fat--results from a failure of willpower, a condition that could be remedied if obese people simply made a personal choice to eat less. But to most obesity experts this notion of personal choice is downright nutty. "Who would choose to be obese?" asks Rudolph Leibel, a Columbia University geneticist and a noted obesity researcher. "Telling someone they've decided to become obese is like saying, `You've decided to give yourself a brain tumor.' "
advertisement
