Rethinking Weight
Hey, maybe it's not a weakness. Just maybe. . .it's a disease
Fat or fit? Not all scientists agree that labeling obesity "a disease" will improve the situation for people like Pfisterer or Moore. Stephen Ball, an exercise physiologist at the University of Missouri, says, "If we call obesity a disease, then anything that reduces one's fatness or lowers BMI would be a successful treatment, such as liposuction or a very low-calorie diet, where we know these are not healthy. By the same token, if you don't lose weight with an exercise program but your blood glucose becomes normal, cholesterol improves, then that could be considered a failure, because it didn't reduce weight. Fitness is a more important indicator of health outcomes than fatness."
Indeed, Steven Blair at the Cooper Institute in Dallas has shown that cardiovascular fitness as measured on a treadmill test is a better predictor of mortality and illness than BMI. "I'm convinced . . . that people who are active or fit but in a high BMI group have lower death rates from all causes--cancer, heart disease, diabetes--than the sedentary and unfit in the normal or lean BMI category. Even among women in our study with BMIs of 37, 20 percent did well enough on the treadmill test to be considered fit. We're obsessed with weight, but where has that gotten us?"
Ultimately, if better and more accessible treatments are not offered to obese Americans, the cost not only of obesity but of treatment and health insurance will escalate. The number of people undergoing surgery doubled from 2001 to 2003, in part because people are becoming more obese but also because many want medical help with weight loss and can't find any other treatment health insurers will cover.
Frustrated with her options and limited ability to pay for treatment, about six months ago Maria Pfisterer began to explore the possibility of gastric bypass surgery. She is not 100 pounds overweight, and her BMI is not over 40--generally the criteria physicians use for evaluating candidates who would benefit from surgery. Gastric bypass surgery is an irreversible procedure in which the size of the stomach is reduced and the small intestine is bypassed to produce rapid weight loss in people whose fat is putting their lives in danger. Recovery is long, complication rates are high, side effects are bothersome, and it's major surgery--people die from it. But Pfisterer learned through obesity-help.com, a Web site offering advice to the obese, that her insurer might pay for surgery, given her family history.
"For people like me, who are considered on the low end for surgery, there are other options that might be better," she says. "But I can't take advantage of them unless health insurance starts to pay for them."
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