Should obe­sity be clas­si­fied A dis­ease?

Lesotho Times - - Opinion & Analysis - Ut­loang Ka­jeno

A DIS­EASE is a dis­or­der of struc­ture or func­tion in a hu­man, an­i­mal or plant es­pe­cially one that pro­duces spe­cific symp­toms or that ef­fects a spe­cific part, ac­cord­ing to the def­i­ni­tion by the Con­cise Ox­ford English Dic­tio­nary. For its part the Wikipedia, free en­cy­clo­pe­dia, de­fines obe­sity as a med­i­cal con­di­tion on which ex­cess body fat has ac­cu­mu­lated to the ex­tent that it may have a neg­a­tive ef­fect on health.

Peo­ple are gen­er­ally con­sid­ered obese when body mass in­dex (BMI), a mea­sure­ment t ob­tained by di­vid­ing a per­son’s weight by the square of the per­son’s height, is over 30kg/m2, with the range 25-30kg/m2 de­fined as over­weight.

Obe­sity is most com­monly caused by a com­bi­na­tion of ex­ces­sive food in­take, lack of phys­i­cal ac­tiv­ity and ge­netic sus­cep­ti­bil­ity. A few cases are caused by genes, en­docrine dis­or­ders, med­i­ca­tions or men­tal ill­ness. In 2014, more than 1, 9 bil­lion adults 18 years and older, were over­weight, of th­ese 600 mil­lion were obese. The world­wide preva­lence of obe­sity more than dou­bled be­tween 1980 and 2014.

In 2013 the Amer­i­can Med­i­cal As­so­ci­a­tion clas­si­fied obe­sity as a dis­ease. In the United King­dom the 2007 re­port by Sir Derek Wan­less for the king’s fund warned that un­less fur­ther ac­tion was taken, obe­sity had the ca­pac­ity to crip­ple the Na­tional Health Ser­vice fi­nan­cially. The way obe­sity is clas­si­fied in dif­fer­ent cul­tures dif­fers. For in­stance, in most of the in­dus­tri­al­ized first world it is clas­si­fied a dis­ease be­cause of the crip­pling ef­fects it has on the health ser­vices in fi­nan­cial and hu­man terms.

How­ever, in the so called Third World, which Le­sotho is a part of, obe­sity de­pend­ing on the fi­nan­cial and so­cial stand­ing of the in­di­vid­ual is viewed ei­ther as a form of wealth and well-be­ing or if the in­di­vid­ual is from a poor des­ti­tute fam­ily, it in­vari­ably leads to stigma­ti­za­tion and rightly treated as a dis­ease. Obe­sity, ir­re­spec­tive of the back­ground from which the in­di­vid­ual comes from, has far-reach­ing con­se­quences on the health of the in­di­vid­ual, the fi­nances of the health ser­vices and how so­ci­ety treats him. In re­gard to the lat­ter con­se­quence, it leads to stigma­ti­za­tion.

How­ever, ir­re­spec­tive of the wealth or cul­ture of a given so­ci­ety obe­sity by be­ing ac­corded the sta­tus of a dis­ease, be­hoves on the health care au­thor­i­ties of the state to al­lo­cate re­sources to the re­duc­tion or man­age­ment of this med­i­cal con­di­tion thus get­ting the at­ten­tion that it ac­tu­ally de­serves. This in ef­fect al­lows obe­sity to be el­e­vated to the sim­i­lar level as other dis­eases. How­ever, this in no way trans­lates that obese peo­ple should be stig­ma­tized but only that re­sources be al­lo­cated to erad­i­cat­ing or man­ag­ing it.

Obe­sity is as­so­ci­ated with many dis­eases such as car­dio­vas­cu­lar dis­eases, di­a­betes mel­li­tus type 2, ob­struc­tive sleep ap­nea, cer­tain types of can­ner and asthma. It there­fore re­duces life ex­pectancy and there­fore a dis­ease.

Obe­sity is also a no­table causes of mor­tal­ity world­wide. On av­er­age stud­ies found that obe­sity re­duces life ex­pectancy by six to seven years, a BMI of 30-35kg/m2 re­duces life ex­pectancy by two to four years while se­vere obe­sity re­duces life ex­pectancy by ten years.

Obe­sity also in­creases the risk of mor­bid­ity in many phys­i­cal and men­tal con­di­tions. Th­ese co­mor­bidi­ties are most com­monly ev­i­dent in meta­bolic syn­drome, a com­bi­na­tion

of med­i­cal dis­or­ders which in­cludes: di­a­betes mel­li­tus type 2, high blood pres­sure, high blood choles­terol and high triglyc­eride lev­els. Com­pli­ca­tions are also di­rectly caused by obe­sity or in­di­rectly re­lated through mech­a­nisms shar­ing a com­mon cause such as a poor diet or a seden­tary life­style. Health con­se­quences fall into two broad cat­e­gories: a) those at­trib­ut­able to the ef­fects of in­creased fat mass such as ob­struc­tive sleep ap­nea and so­cial stigma­ti­za­tion and b) those due to the in­creased num­ber of fat cells such as di­a­betes, can­cer, car­dio­vas­cu­lar dis­eases and non-al­co­holic fatty liver dis­eases.

In­creases in body fast al­ters the body’s re­sponse to in­sulin, po­ten­tially lead­ing to in­sulin re­sis­tance.

Obe­sity is caused by a com­bi­na­tion of many fac­tors such as ex­ces­sive food in­take and lack of phys­i­cal ac­tiv­ity. The other causes though not lim­ited to are due pri­mar­ily to ge­net­ics, med­i­cal rea­sons or psy­chi­atric ill­ness. Fur­ther, obe­sity rates are in­creased at a so­cial level due to an eas­ily ac­ces­si­ble and palat­able diet, com­monly called junk (fast) foods, or foods with lit­tle nu­tri­tional value.

Th­ese sort of foods are speed­ily pre­pared at lit­tle cost and very cheap. Obe­sity is also caused by in­creased re­liance on cars and mech­a­nized man­u­fac­tur­ing both of which re­quire min­i­mal phys­i­cal ex­er­cise.

Stud­ies have also iden­ti­fied ten (10) other pos­si­ble con­trib­u­tors to in­creas­ing lev­els of obe­sity: 1) in­suf­fi­cient sleep, 2) en­docrine dis­rup­tors such as en­vi­ron­men­tal pol­lu­tants that in­ter­fere with lipid me­tab­o­lism, 3) de­creased vari­abil­ity in am­bi­ent tem­per­a­ture, 4) de­creased rates of smok­ing sup­presses ap­petite, 5) in­creased use of med­i­ca­tions that can cause weight gain, 6) pro­por­tional in­creases in eth­nic and age groups that tend to be heav­ier, 7) preg­nancy at a later stage which may cause sus­cep­ti­bil­ity to obe­sity in chil­dren), 8) epi­ge­netic risk fac­tors passed on gen­er­a­tionally, 9) nat­u­ral se- lec­tion from higher BMI and 10) as­sor­ta­tive mat­ing lead­ing to in­creased con­cen­tra­tion of obe­sity risk fac­tors. While there is sub­stan­tial ev­i­dence sup­port­ing the in­flu­ence of th­ese mech­a­nisms on the in­creased preva­lence of obe­sity, the ev­i­dence is still in­con­clu­sive, as op­posed to the ones dis­cussed in the pre­vi­ous para­graph.

Healthy eat­ing or diet is also a con­trib­u­tory fac­tor to obe­sity. As so­ci­eties be­come in­creas­ingly re­liant on en­ergy-dense, big­por­tions, and fast-food meals, the re­la­tions be­tween fast-food con­sump­tion and obe­sity be­comes more con­cern­ing. Obese peo­ple tend to con­sis­tently un­der-re­port their food con­sump­tion as com­pared to peo­ple of nor­mal weight.

An­other sig­nif­i­cant con­tribut­ing fac­tor to obe­sity is seden­tary life­style. Stud­ies have re­vealed that world­wide there has been a large shift to­wards less phys­i­cally de­mand­ing work. Cur­rently at least 30 per­cent of the world’s pop­u­la­tion gets in­suf­fi­cient ex­er­cise. This is pri­mar­ily due to in­creas­ing use of mech­a­nized trans­porta­tion and a greater preva­lence of la­bor-sav­ing tech­nol­ogy in the home. In chil­dren there ap­pears to be de­clines in lev­els of phys­i­cal ac­tiv­ity due to less walk­ing and phys­i­cal education. In both chil­dren and adults, there is an as­so­ci­a­tion be­tween tele­vi­sion view­ing time and the risk of obe­sity.

An­other sig­nif­i­cant con­trib­u­tor to obe­sity are cer­tain phys­i­cal and men­tal ill­ness and the phar­ma­ceu­ti­cal sub­stances used to treat them can in­crease risk of obe­sity. Med­i­cal ill­nesses that in­crease obe­sity risk in­clude but not lim­ited to sev­eral ge­netic syn­dromes as well as some con­gen­i­tal or ac­quired con­di­tions, growth hor­mone de­fi­ciency and eat­ing dis­or­ders, binge eat­ing dis­or­der and right eat­ing syn­drome.

The risk of obe­sity and over­weight is higher in pa­tients with psy­chi­atric dis­or­ders. In­deed cer­tain med­i­ca­tions may cause weight gain such as in­sulin, steroids, some forms of hor­monal con­tra­cep­tion and oth­ers.

Hav­ing con­sid­ered above the most sig­nif­i­cant con­trib­u­tors to obe­sity it is now pru- dent to con­sider what are the main treat­ments obe­sity of which in­clude di­et­ing and phys­i­cal ex­er­cise. Diet pro­grams may pro­duce weight loss over the short term but main­tain­ing this weight loss is fre­quently dif­fi­cult and of­ten re­quires mak­ing ex­er­cise a lower food en­ergy diet a per­ma­nent part of a per­son’s life style. All type of low car­bo­hy­drate and low fat di­ets ap­pear equally ben­e­fi­cial.

The other ef­fec­tive treat­ment of obe­sity is bariatric surgery. Surgery for se­vere obe­sity is as­so­ci­ated with long-term weight loss, im­prove­ment in obe­sity re­lated con­di­tions and de­creased over­all mor­tal­ity. De­pend­ing on the type of sur­gi­cal pro­ce­dure un­der­taken weight losses dif­fer and in­deed com­pli­ca­tions do oc­cur thus lead­ing to re­searches search­ing for less in­va­sive treat­ment in­clud­ing de­vises that oc­cupy space in the stom­ach.

Le­sotho like the rest of the world, ex­pe­ri­ences health im­pacts in ad­di­tion to many prob­lems in­clud­ing dis­ad­van­tages in em­ploy­ment and busi­ness costs that are at­trib­ut­able to obe­sity. This ef­fects are felt by all lev­els of so­ci­ety from in­di­vid­u­als, to cor­po­ra­tions and gov­ern­ments. Obe­sity can also lead to stigma­ti­za­tion when com­pared to their nor­mal weight coun­ter­parts. Obese work­ers on av­er­age have higher rates of ab­sen­teeism from work and take more dis­abil­i­ties leave, thus in­creas­ing costs for em­ploy­ers and de­creas­ing pro­duc­tiv­ity.

Ex­pe­ri­ence has shown that by of­fi­cially clas­si­fy­ing obe­sity as a dis­ease and el­e­vat­ing it to the at­ten­tion of health care au­thor­i­ties at the high­est level, in a man­ner sim­i­lar to HIV/AIDS and other dis­eases (through this med­i­cal con­di­tion is not ad­mit­tedly as pan­demic as obe­sity), then all and sundry, pri­mar­ily the govern­ment, we can treat and ar­rest this con­di­tion na­tion­ally with the de­sired re­sults, can be chan­neled to­wards treat­ing this con­di­tions. If govern­ment takes the lead ex­pe­ri­ence has demon­strated the na­tion will fol­low suit. How­ever, this is in way should be per­ceived as be­ing alarmist on my part.

Obe­sity is a no­table cause of mor­tal­i­ties world­wide.

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