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One of my first posts noted that Obesity can Kill (March 2015). I have noted some intriguing theories, including one that focuses on transplanting human waste. See Stool Transplant (October 2019). And, in the broad aspect of workers' compensation, we know that issues related to obesity are often seen as inhibition to care and treatment for various work injuries, a "comorbidity" issue. See Comorbidity of Obesity (October 2021).
Of course, one easy solution to being "overweight" or "obese" is simply to change the definitions. That is the course the Canadians elected. What's in a Name? (August 2020). That is a broad effort, but the idea of changing labels made the news. It is, after all, really that simple. Just identify as being thin and dare the weakened and weary world to disagree with you. If they do, sue them in Brazil, see Flying, Disappoitnment, and a Lawsuit (December 2022). Just be "plus" or "big-boned." If only we had some modern-day philosophers like the Rolling Stones to help us through our challenges.
Obesity is big in America. The good folks at Harvard say that "Roughly two out of three U.S. adults are overweight or obese (69 percent) and one out of three are obese (36 percent)." That is amazing in the numerical sense, and perhaps less so when you get out and walk around our world. There are about 330 million Americans, and so about 227 million are "overweight or obese?" Great to be in the majority? As a famous comedian once noted regarding similar statistics "we're the normal ones now."
The good news is it is not our fault. Being obese is not about how many calories one ingests. The American Academy of Pediatrics encourages us to view "obesity more as a biological disease rather than a lifestyle problem," according to a recent story from the British Broadcasting Corporation (BBC). The pediatricians espouse this conclusion because "research has shown that genetics and hormones can have an impact on weight." Not "do" have an impact, but they "can." Since it is possible that such factors "can" "impact" (not "cause," "impact"), then obesity writ large should be viewed as a disease. Post hoc ergo propter hoc? Reductio ad absurdum?
Based upon this interesting logic path, the Academy has issued a new "Guidance" regarding "childhood obesity." It encourages physicians to engage patients through "behavioral and lifestyle changes" as a "first-line approach" in battling obesity. This might involve consuming fewer calories (dieting), or increasing activity (exercise). The old saw may actually ring true - if you burn more calories than you consume you will lose body mass (weight), and the inverse is also true.
I am no scientist, but I think this is a law somewhere regardless of your genetics or hormones. If you consume less calories than you burn, will hormones or genetics make you gain weight anyway? I would love to hear from you if I am missing something and how either genetics or hormones change the physics of calories consumed versus calories burned.
So far, so good. Spot an obesity issue, adjust calorie intake and activity, change the equation, and improve the outcome. This seems like math, not calculus. Having recently gone through a weight loss transformation of my own, I can relate. In two pounds of carrots, there are only 372 calories. Try eating ten pounds of carrots a day (2000 calories per day recommended). I found I could barely eat a pound before being full. Brocolli, even harder. cauliflower, only 113 calories in a pound. Try eating 17 pounds of cauliflower in a day. I'm not saying you should, but if you must snack I am a big proponent of these vegetables.
But, the pediatricians are also advocating more serious intervention if this mathematical approach, this behavior approach, fails. The Academy is "suggesting" that weight loss "medication can be offered for kids as young as 12, and that weight loss surgery can be offered for those as young as 13." The medical community is not specifically endorsing this it seems, this is a "can" not a "should." But, the suggestion seems to be that drugs and surgery are destined to increasingly become a go-to for young patients who find themselves afflicted with weight gain. The idea of getting kids started on drugs early is interesting.
Oh, here come the Stones again. In 1966, they recorded Mother's Little Helper (Decca). They noted that "Kids are different today," in the context of our grown-up lives being a challenge (see, "these kids today" has been a thing since there were kids). And, they celebrated the pharmaceutical solution of diazepam (Valium):
"And though she's not really ill, there's a little yellow pillShe goes running for the shelter of her mother's little helperAnd it helps her on her way, gets her through her busy day"
Pharmaceuticals, you see, are the answer. We know the Stones were not alone. Jefferson Airplane in 1967 (White Rabbit, RCA) advocated instead for Lysergic acid diethylamide (LSD), noting :
"One pill makes you larger, And one pill makes you small
And the ones that mother gives you, Don't do anything at all"
Pills, the experts from the 1960s proclaimed, were the solution to societal ills and challenges. Today, perhaps it is seen in the pot store on every corner, and the myriad of television advertisements for various solutions. Perhaps there should be more ads directed at kids about the panacea of drugs and surgery for body weight? Or, maybe we could all take a lesson or two from those who won't be body-shamed?
Back in the day, when dinosaurs roamed the earth and I was in high school, it was humorous to say "you got a problem, take a pill." Many did. We evolved into the 1990s and the great opium fallacy was foisted upon us by drug pushers and the physicians to whom they marketed. And, the pills flowed like water. How many believed that the harmless and miracle opioids would save the world? How many believed that they were merely a means to an end?
In the 1990s, some chemists decided to mix a weight loss drrug from the 1970s with a second concoction, and
Fenfluramine/phentermine was born. It was nick-named "phen-fen" or "fen-Phen," I can never remember. It was a miracle, a weight loss miracle. Then there were side effects, deaths, litigation, and surprisingly enough this concoction is not widely available anymore. How many prescriptions were written? Many. It was so popular, the National Institute of Health noted that many non-obese people took the drug. That revelation always amazed me.
In this century, we happened upon the challenge of children that were ill-behaved and lacked focus. That was never a problem in the twentieth century. Back then, children were angels. Well, you know, these kids today (sarcasm). Problem? Well, take a pill. In came the age of Attention Deficit Disorder (ADHD), and with it a solution. You guessed it, pills. In a 2021 piece in the Journal of the American Medical Association (JAMA), the authors "found convincing evidence of ADHD overdiagnosis and overtreatment in children and adolescents." Wait, you mean people children were given drugs they did not need?
Like it or not, there are more examples of the rush to diagnoses and delivery of care. Space and time limit my criticisms discussion here.
Despite our track record with pharmaceutical miracles, the Academy is advocating ("guiding") kids as young as 12 to weight loss drugs. What could go wrong? They say the health risks of obesity are so pervasive that these measures are the best alternative. One expert is quoted that "Waiting doesn't work." As a curiosity, from a non-expert, what is the impact on body image, self-esteem, and well-being when you tell a 12 year old she/he/ze needs to take pills to lose weight? Is there any potential for emotional impact from telling a 13-year-old that gastric bypass or similar is appropriate?
There is risk from any surgery. People have died from having their tushy lifted. And, the folks who do bariatric surgery are proud that only one in 1,000 patients die within 30 days of bariatric surgery. Others say it is more like one in 300 to 500 that die of such surgery (perhaps more die outside that intriguing 30-day window cited above?). Are parents to be guided to pharmaceuticals and surgery despite the potential for risk, complication, side effects, and worse?
Admittedly, there are many obese Americans. Rates are trending upward globally according to the BBC. It is interesting that we have reached the point where little pills and surgery for children is "an" acceptable plan (I am not exaggerating or suggesting that the Academy is making these "the" plan). I acknowledge the problem, I see the obesity health risks and understand the angst. But, seriously, what would Mick Jagger say? ("though she's not really ill, there's a little yellow pill").
Are pills and surgery the answer to all of our ills?
By Judge David Langham
Courtesy of Florida Workers' Comp
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About The Author
About The Author
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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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