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The American Medical Association decided recently to classify obesity as a disease. Their decision has drawn controversy: Supporters say the label could spur health insurers and the government to fund anti-obesity services. But opponents say obesity is a risk factor, and calling it a “disease” further stigmatizes overweight people. We discuss the controversy.

Show Highlights

Guests:
Dr. Kristine Madsen, pediatrician at UCSF and assistant professor at UC Berkeley School of Public Health
Elissa Epel, professor at UCSF Department of Psychiatry and director of the UCSF Center for Obesity Assessment, Study and Treatment (COAST)
Virgie Tovar, editor of "Hot and Heavy: Fierce Fat Girls on Life, Love and Fashion"

  • Beth Grant DeRoos

    Having been morbidly obese I hired a fitness coach, got help with choosing better food choices and smaller servings and lost the weight.

    Bothers me that something that is pretty much a lifestyle issue for the majority of obese people, is being called a disease. Cancer, type one diabetes, polio are real diseases not lifestyle choice issues.

    Patients already demands a pill to fix a problem so the pharmaceutical industry is laughing all the way to the bank. Isn’t their motto create/invent a need and fill it?

    • thucy

      You overcame a tough challenge, Beth. That’s truly impressive.
      I’m skeptical about UCSF’s motivations. Particularly in light of the fact that their new Chancellor is the former President of Product Development at Genentech. Overweight and Obesity-related illness is a huge money-maker for UCSF. And for the AMA. And for the CNA. You don’t have to be clinically obese to generate revenue for UCSF – you can be just ten pounds overweight, and you’re in a higher risk group.

      If the State of California had any real interest in getting people to lose weight, they could:

      1) impose a higher tax on gas in areas that have existing public transport, thereby encouraging walking and cycling
      2) bring back the PE teachers in low-income schools where parents can’t afford after-school sports fees
      3) issue limitations on the types of food purchasable through SNAP, and increase the SNAP dollar amount with an add’l subsidy.

      This would cost money, but would be cheaper than the tens of billions we blow every year on treatment of overweight and obesity-related illness.

  • Recuerdos

    I’m often amazed at what people eat, and how much.
    People who are happy being very fat often seem to flaunt their bad choices in public, in the way that happy smokers sometimes flaunt theirs. Workers at restaurants encourage this, either because they are told to or because they have adopted a Schadenfreude approach to dealing with fat customers. But if you sit down at a restaurant or coffeehouse and watch what people buy, you will be amazed. Often the workers themselves will have amazed looks on their faces, if they are new.

    BTW to the Forum producer, I want to ask, why wasn’t Robert Lustig brought on as a guest? He owns the obesity topic 🙂

  • James Ivey

    Why is BMI used? It seems ridiculous to me. According to BMI, body builders or anyone who strength-trains is obese despite having very low body fat.

    • thucy

      Untrue. I strength-train and swim, run, cycle, hike, etc. and I’m well within my BMI.
      And don’t hold up body-builders as somehow paragons of health. Put any one of them on a playing field and they’ll fall apart. They’re trash-bodies, built for nothing but narcissism and steroid manufacturers.

      • Recuerdos

        It differs between individuals, and without forced blood tests, we’ll never know for sure what percentage use ‘roids. Surely self-reporting won’t tell us. I don’t see it as a major wrong. I’d be more concerned about tech workers using Ritalin and Adderall than about relatively harmless gym rats using ‘roids.

        • thucy

          I agree with you about the Ritalin, but more with over-Rx to kids. Anyway, we can agree to disagree on body-builders. I’m just relieved that “look” is on its way out. It’s not healthy, and people so bulked up with muscle simply aren’t being scrutinized by the medical community as are “fat” people. They’re under the radar, so to speak.

          • Recuerdos

            The big muscles are unnecessary. I started going to the gym 6 days a week (no roids) and even with my tiny muscles, I am getting good responses. I have no intention to ever bench lift over 150 🙂

          • thucy

            Someday you might even take your playtime out of the looking-glass of the gym and into NorCal’s beautiful open spaces, where you might actually become… a Californian.

          • Recuerdos

            Ha ha. The machines at the gym let me make quick work of the workout itself. But yes, I need to do more hiking etc. I hear wind-surfing is fun…

          • thucy

            The machines in the gym – in fact, the gym in and of itself – are a massive waste of electricity. And time. Not to mention the stale recycled air.
            Those “machines” aren’t making your workout more efficient. You could get a more efficient workout in your driveway with a jumprope. Or join a runner’s club, where you’d actually engage with your neighbors.
            Windsurfing IS fun, but if your interest is efficiency? Not so much.

  • Kate

    Why does something have to be a disease to have conversations start. People who are obese know it and their dr knows it (also what about the dr that is overweight). WHile a few have genetic issues, the majority need to get up and move away from the food and make better food choices. Also, you can cook healthy and it does not need to be expensive. We just have to stop looking for a quick fix. It is not a diet, it is a lifestyle

    • Vicki

      Because when it’s considered a “disease,” your doctor can talk to you, bill for it and get reimbursed by the insurance company.

  • James Ivey

    Obesity is not a lifestyle. It’s not a choice, not really. Everybody eats when they’re hungry and stops when they’re full. Only some accumulate large amounts of body fat. Only those have to work hard to maintain lean bodies. Whether you have a propensity for obesity is not a choice. Only what you do if you have such a propensity is a choice.

    I’m really surprised you guys don’t have Gary Taubes on this show. He’s done extensive research on this.

    • Recuerdos

      If you eat fructose without fiber, you will not know when you are full.

  • Mike

    I applaud the AMA listing obesity as a disease. I think this paves the way for legal action – If someone lives next to a toxic waste dump, certainly they can sue the polluter if the community has increased cancer rates. Now if I live in an environment where my only access the food is high calorie, toxic food that causes obesity, perhaps this paves the way for a class-action lawsuit against fast food companies and other socially irresponsible food vendors.

    • Recuerdos

      The AMA is coming down on the side of big business, are they not? Calling it a disease identifies the origin of obesity as biological instead of business selling fructose-laden junk and calling it food. I can see the doctors licking their lips at the prospect of doing more gastric bypasses.

      • thucy

        Why should that stop you from suing if the disease is aggravated by the toxic environment?

        • Recuerdos

          By that logic, we should all sue SFPUC for putting ammonia in the water supply, which leads to 1000 times more carcinogens than when chlorine alone is added. Oh wait, that’s a good idea.

          • thucy

            Exactly.

    • Vicki

      So you don’t feel you need to take personal responsibility for yourself?

      • Mike

        Of course, Vicki. I would bet that since you are using a computer, you probably have a decent job and live above the poverty line. I would also bet that you live near markets that sell fresh fruit and vegetables and fortunately you have access and the luxury to make these choices. A good portion of America’s poor can pick between the corner store with high fructose garbage and a fast food restaurant because these are the options for people that need to eat on a dollar. Maybe this is why zip code predicts BMI. Easy to claim it is all “free will” but the data say otherwise.

  • $18685506

    Let’s hear from your guests about 2 facts that fly in the face of conventional wisdom about obesity:

    ONE There is a lot of talk about low-fat foods being healthier. However, millions have watched the video where Robert Lustig, a pediatric endocrinologist at UCSF, explains that we’re going at it all wrong. Low-fat foods are harmful because when fat is taken out, carbs are put in. Sugar is as addictive as cocaine. As another commenter said, get Gary Taubes in on this discussion.

    Surprise! The body cannot burn stored body fat if there is insulin in the blood. For the last hundred years, with less physical exertion in our jobs, nearly every meal we eat has huge amounts of carbs that our body can’t burn and so those calories are turned into body fat right away.

    TWO The other aspect no one talks about: 3 toxic halogens block the cell’s access to the one good halogen, iodine. It makes sense that the 3 bad halogens — fluoride, bromine, and chlorine, which are now so prevalent in our lives due to fluoridated water and flame retardants in furniture — could be a hidden cause of obesity because iodine is crucial for good endocrine function (and 80% of us don’t get enough iodine).

    • Heather

      Thank you for this excellent comment.

  • Chemist150

    Obesity is not a disease. Perhaps it’s psychological in nature but nature evolved humans with a lower calorie diet. Evolution has not caught up with lifestyle. I agree with those that say health is more important that weight. I’ve seen some healthy cyclist that are overweight but they definitely have healthy hearts and metabolisms.

    Evolution will probably lead humans to have shorter intestines or larger bodies to accommodate the wealth of calories and there will always be some genetic variations that retain past traits. It’s unfortunate that some will be selected against due to some physical traits but with intelligence, everyone has a choice to eat less or to exercise more.

  • Chris OConnell

    I agree with the angry fitness trainer, but he does deserve an “oh God” and a chuckle. And then he just repeated what he said after demanding to be listened to.

  • Fay Nissenbaum

    What about Samoans, who tend to be larger? Is there any consideration of ethnic differences? It doesn’t sound like it at all. Two people can eat the same diet with different results due to metabolism. A calorie is not a calorie!

    • thucy

      Were the Samoans ever thus? Or did their phenotype change when they were intro’d to US diets in Samoa?
      But I agree completely that there are individual responses.

  • Recuerdos

    I’m generally opposed to privatization, but with gym classes being canceled I would say that if 24 hour fitness were to open a branch inside the local high school and sell memberships to kids, it would be a shrewd move.

    • thucy

      Why should we pay for gyms in schools when the outdoors are free and the terrain and weather are so optimal in NorCal? You don’t need more than a rope and a plank and a hill to run a good circuit.

      What our kids need are coaches, not gyms they’ll become unnecessarily dependent on for their workout.

      • Recuerdos

        If there is no budget
        for a gym teacher, sending kids outdoors without direction won’t help
        much.

        • thucy

          If there’s “no” budget for gum teachers, a 24-hour Nautilus inside the school won’t help.
          Coaches are cheap. Privatization of the schools (e.g. Sbarro’s in the cafeteria) NEVER works.

        • Vicki

          Just the fact that the kids are outdoors are a step in the right direction. As thucy pointed out up there (^^), you don’t need much in order to get a workout.

  • Dan

    I’m curious as to whether or not the pharmaceutical industry has an interest in this classification issue. Calling obesity a disease might move us toward yet another pill for children to take.

    • Recuerdos

    • Bex Vargas

      And god knows the pharma industry is excited at the prospect of selling billions of dollars worth of anti-obesity drugs (that, like most drugs, do more harm than good.

  • Wanda White

    We use to send our children out to play. Put physical education back into schools!!! Also the food industry bombards us with poor food choices. I grew up in Oakland and so many food chains have left our communities. Not everyone can shop at a Traders Joe or Whole Foods. Communities are left with miles and miles of convenience stores and fast food chains and billboards promoting alcohol consumption and cigarettes with no fresh fruits and veggies. Come on. Weight is not a matter of willpower. It’s about what’s available to consumers.

  • JackFry

    Every time a talk show takes up the notion of obesity I find
    myself consumed by frustration, anger, a reminder of what little real knowledge is out there by supposed “experts” (present company excluded), and a desire to throw my radio out the window. Neither does having to hear the rants of people claiming that obese people are weak, lazy, bad, and lack willpower help anyone seeking to find a solution to this malady. From my perspective obesity was the result of an addiction -addiction with a capital ‘A’. I was morbidly obese most of my life (some 50 + years) and, up until seven years ago, weighed in at 410 pounds (and this was not my largest weight). In June of 2006 I found my way into a 12 Step program –one that worked, by the way, and one that I was ready for. In following the suggestions of this program I gave up and maintained a loss of 210 pounds. I still do not fit the “charts” referred to, but I am at a weight that has been confirmed by medical professionals as being right for me. What’s more, my story is not unique.

    In many ways this disease parallels alcoholism, whereby
    once certain foods are consumed they create cravings that one is powerless over. Although an obese person might win trophies galore in manifesting willpower (far from being “weak”), it is nearly impossible to maintain long enough for the desired effect. What’s more, cravings do not dissipate in time, as some medical ‘experts’ have suggested, and giving up certain foods for awhile will not keep a re-activation of occurring once the bite is once again taken up. Can you imagine telling someone who has quit cigarettes that once he’s abstained for a few months, he’ll be able to go back to smoking?

    This addiction also has something similar to the alcoholic ‘high’ of a drunken state and other behaviors associated with the alcoholic: one is numbed by food, experiencing a euphoric high while turning off emotions and pain that occur when confronted with life; as the disease of this addiction progresses the manifestation of lethargy and an inability to focus occur and accelerate; black outs, whereby one might find oneself in front of the fridge chewing and grazing on something without remembering how he got there; secretly stopping by outside-the-neighborhood fast food restaurants and 7-11s to ‘fill-em-up,’ making it look as though your purchasing things for a party or ‘someone else; and behaviors of various kinds that veer away from any notion of authenticity. It would be interesting to view the life of Orson Welles or Marlon Brando from the point of view of a food addiction, noting their frustrations and reactions to projects that were never finished or haphazard and mediocre (symptoms associated with addiction).

    No matter how much I wanted to be liked and loved, and no
    matter how much I wanted to change the way people viewed me, it came from the perspective that I was unable to do anything about my own condition. Also, I truly believe that the tobacco industry has nothing on the research developed by food manufacturers (something I fear will never see the light of day). My recovery is not due to willpower (although people ignorant of this condition still want to suggest otherwise), but having to work a program on a daily basis that involves the help and support of others. It is weakness, not strength, that keeps me in recovery.

    • thucy

      “My recovery is not due to willpower (although people ignorant of this condition still want to suggest otherwise), but having to work a program on a daily basis that involves the help and support of others.”

      I am just blown away by what you achieved. Really tough challenge, and you met it.

      • JackFry

        Thank you, Thucy, for your kind words. My revelation was in realizing and finding a means to surrender my problem rather than fighting it. Telling others about my recovery is one way that I maintain it -and that must be done on a daily basis. Again, thank you for your note.

  • rogeor

    Rather than discussing the question, please consider that classifying it as disease allows us doctors to bill patients and make income from a new disease.

    • Heather

      I am appalled that you are willing to bill for, and presumably, treat a “disease” without considering whether it truly is a disease. How irresponsible. Your comment sounds terribly selfish. All you care about is making money?

      • thucy

        Heather,
        I think you missed his point, which is questioning the motivation behind the classification.

        • rogeor

          That is correct. This Is another way to boost income to an enormous industrial medical complex. Many obstacles have been built to make it hard to provide affordable medical care to our population.

  • Chemist150

    If we should not treat obese people like skinny people, we should not treat skinny people like fat people. She just came off as a food Nazi.

    Don’t take away my choices because others cannot control themselves. It’s an absurd argument that because two people have slightly different genetics leading to different body types makes it OK to be Obese. With intelligence, their is a choice between consuming less or more calories if your body type differs. There is a choice in exercise. Don’t blame others for someones obesity, you only enable them not to improve.

  • Heather

    Obesity is a descriptive characteristic; sometimes it can be a symptom, but it is not a disease itself. How absurd would it be to declare excessive height as a disease? Classifying a symptom or characteristic as a disease is imprudent. Correlation is not causation, and that we disregard that so often is a shame.

  • Renée Voltaggio

    I believe that our food supply is key. My children developed adverse reactions to a lot of packaged foods and even foods that have been treated with hormones and chemicals. Poorer neighborhoods don’t have access to truly nutritious foods and their bodies are reacting in ways that are detrimental to their health.

    • thucy

      And if you’re growing up in an unsafe neighborhood, your parents (or single parent, as is often the case) can’t let you go out to play after school while they are at work. “Good” kids with well-intentioned parents are often most at risk for obesity.

  • David Moren

    As someone who works in schools, it’s remarkable to see how we set kids health up to fail by the types of food we provide – i.e. processed, containing high fructose corn syrup, additives, etc. More importantly though, we tie the hands of our schools to have to choose between this more “affordable” food – which society then pays for later – versus healthier foods like the ones provided by incredible companies like Revolution Foods, who see the vital importance of giving kids fresh, healthy meals that in turn educate, motivate and shift the paradigm of how we eat as a country.

    While I acknowledge the complexity of this new decision by the AMA, I’m all for whatever it takes to get our priorities shifted around so that we can support healthier eating, and at the youngest age possible. For most low-income students, school is likely the only place they’re going to get access to the right kinds of food.

    David Moren
    Experience Corps Bay Area

  • Bex Vargas

    The lady who compared obesity to smoking and applauded the *potential* stigmatization of obesity in the same way that smoking has become stigmatized is completely delusional. If stigmatization of smoking worked, there would be no smokers at all, ever! And fat people have been stigmatized since the beginning of time and yet there are still many fat people on this earth. Believe it or not, harassing and making fun of fat people and making them feel like they are less because they weigh more doesn’t inspire anything other than hurt feelings- it does NOT inspire motivation to lose weight and it is NOT helpful in any way. I don’t believe Obesity is a disease. I think there are many factors that determine whether a person will be big or small: genetics, metabolic conditions, hormonal conditions, consumption of toxic food from a polluted food supply, etc, etc- but we should address the issues we can fix so the entire population can get the benefit, because guess what, skinny people suffer the same “highly correlated with obesity” diseases: heart disease, strokes, diabetes, PCOS, etc. There aren’t ONLY fat people in the hospital even though the media, the weight loss industry, and the “experts” make it seem that way. We live in a toxic time, both physically and spiritually, and we desperately need to heal our society, but pinning it all on fat people is not the right way to go. And furthermore, I love it when people talk about how obesity is such a drain on the taxpayers. Listen, old people qualify for free medicare and all children qualify for free medicaid– those two programs alone are a huge drain on the taxpayer. And lets not even talk about all the money we have spent on the war. Also, people of all ages, races, and BMIs engage in casual sex, drugs, alcohol, tobacco, jaywalking, drunk driving, etc and when they get sick and don’t have insurance, they too become drains on the taxpayer. But we don’t talk about any of that- instead we blame it all on the ‘obesity crisis.’ I have a right to tell you to lose weight because I’m a taxpayer, right? Wrong! I would love to tell people to stop having kids they can’t afford because that is a drain on me, the taxpayer, but, really, who the hell am I to tell them that? Same thing with obesity and any other issue that people hide behind in order to harass people.

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