Disease or Choice?

There is a developing tendency to consider obesity from different perspectives. Body habitus is not new to these pages. See Can I Get a Team Gulp (July 2014), Stool Transplant (October 2019), What's in a Name (August 2020), Comorbidity of Obesity (October 2021), The BMI Conundrum (August 2022), and Obesity Yet Again (January 2023).
There is a fascination in America with body habitus and health. We spend tens of billions each year on workout equipment, gym memberships, diets, drugs, and more. And, there is a growing sentiment, it seems, that fat is inevitable and unassailable through simple diet and exercise. The Yet Again (January 2023) post notes the latest scientific conclusion that drugs and surgery for children is the right path to svelt.
In a recent article, focused on the off-label use of diabetic medication for weight loss, there is a repetition of the word "disease." Repeatedly, I have noted the distinction between science and consensus. and the potentiality for them to become intertwined, intermingled, or even confused. And, in our world, there is an ever-present effort to manipulate and persuade through the careful selection of words.
In that vein, there may be some challenge in the medical community with differentiating a diagnosis (malady, damage, or disease) from symptomatology. For a layperson, this is an easy dichotomy to over gloss. The simple question “what is wrong?“ when directed at a patient, is likely to evoke a list of symptoms ("it hurts when I do this"). When someone asks us what is wrong, it is our habit to tell them our perceptions. In terms of what is actually wrong (causation), it is the scientist's job to name and explain the damage, the dysfunction, or the disease.
Doctors have long distinguished between the two in their discussions of “complaint(s)." This section of the medical record or report is an opportunity for the doctor to delineate those complaints or symptoms voiced by the patient: pain, discomfort, dysfunction, or inability. In an utterly distinct section, there is the conclusion of cause, the “diagnosis.“ This is the scientist's delineation of damage or dysfunction or disease from which the scientist believes the symptoms emanate.
For the sake of clarity, I am neither a scientist nor a patient. I have never played one on TV. It has been a long time since I stayed in a Holiday Inn Express.
The diabetic drug article demonstrates what seems to be a growing tendency toward confusion between the cause (the illness) and the effect (symptom). A doctor is quoted in the article, acknowledging a perception that one demographic "struggle(s) with the disease of obesity." The article also notes that this diabetic medication, may not be the answer for "everyone with obesity . . . As with treating other diseases, different types of therapy may be needed."
That seems to overstate obesity. It is hard to consider body weight itself as a disease. However, as it is defined, this is perhaps accurate. 
Brittanica says that "disease" means
disease, any harmful deviation from the normal structural or functional state of an organism, generally associated with certain signs and symptoms and differing in nature from physical injury.
Websters defines it as
a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms
It is difficult to perceive that symptom is synonymous with disease. However, it appears that at least some consider obesity in this category. And, with the off-label success some are having in using this diabetes drug as a weight loss tool, there is lamentation that some obese people cannot afford this medication. The spirit of the article seems focused on a perceived inequity in access to financial resources. A better focus might be on how increased exercise and decreased caloric intake can result in weight loss. 
The perspectives on this obesity epidemic are intriguing and troubling. As a species, we are apparently losing this war on every continent. CNN reports obesity is growing at such a rate that "more than half of the world’s population will be overweight or obese by 2035." That is roughly 4 billion people reaching that threshold in the next dozen years, an expansion from the 2.6 billion now obese. This is based on a recent report. 
The article acknowledges the recent endorsement of drugs and surgery for children. It laments the predicted doubling of "childhood obesity." The fat wars could cost us 3% of global GDP by 2035. The most significant growth rates are predicted in "low- or middle-income countries in Asia and Africa."
An article from the British Broadcasting Corporation provides an analysis of the causes of this trend of increasing obesity. It lists: 
  1. dietary preferences towards more highly processed foods,
  2. greater levels of sedentary behavior,
  3. weaker policies to control food supply and marketing, and
  4. less well-resourced healthcare services to assist in weight management and health education
These seem to provide some reasonably simple solutions (1-3). They are not treatment foci, as with disease, except perhaps 4. They largely come down to prevention foci on not eating categories of food, getting off the couch, avoidance, and education. Perhaps the marketing aspect of such things as the Food Pyramid and MyPlate are not answering the need for public information? Do people even know what MyPlate is? As a publicity campaign, might the lack of exposure be indicative of its failure?
There are likely those who are predisposed to issues with body habitus. But, in the end, we each can control what we consume and how we spend our time. Caloric intake and activity level are the calculus of this growing epidemic. Characterizing the resulting obesity as a disease, and thus casting it as an effect for which we bear no responsibility, is unfortunate and with most inaccurate. The enemy is processed foods, empty calories, and inactivity. We have seen the enemy, and it is us. That is not encouraging, but with the knowledge comes the power to defeat it. 
By Judge David Langham
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    About The Author

    • Judge David Langham

      David Langham is the Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims at the Division of Administrative Hearings. He has been involved in workers’ compensation for over 25 years as an attorney, an adjudicator, and administrator. He has delivered hundreds of professional lectures, published numerous articles on workers’ compensation in a variety of publications, and is a frequent blogger on Florida Workers’ Compensation Adjudication. David is a founding director of the National Association of Workers’ Compensation Judiciary and the Professional Mediation Institute, and is involved in the Southern Association of Workers’ Compensation Administrators (SAWCA) and the International Association of Industrial Accident Boards and Commissions (IAIABC). He is a vocal advocate of leveraging technology and modernizing the dispute resolution processes of workers’ compensation.

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